Between 50-80 percent of patients in psychiatry have insomnia-type sleep problems. In addition to reduced quality of life and impaired function, sleep problems can aggravate other psychiatric problems and increase the risk of relapse into, for example, depression. According to international guidelines, cognitive behavioral therapy for insomnia (CBT-i) should be used as the first choice for treatment of insomnia. In practice, however, it is very uncommon for psychiatric patients to be offered CBT-i, instead most are treated with sleep medications. There is also a lack of research studies evaluating CBT-i in regular clinical practice. This pilot study investigated the feasibility of a group treatment with CBT-i at a psychiatric outpatient clinic in Stockholm for patients with depression, bipolar disorder II, anxiety syndrome and PTSD. Changes in symptoms of insomnia, depression, and anxiety after treatment were also investigated. Patients with self-perceived sleep problems were offered a six-session group treatment based on CBT-i. The primary outcome was clinical feasibility, defined as: the influx of patients sufficient to start at least one group per semester (at least 8 patients); at least half of included patients participate in the first session; patients participate in at least half of the sessions; less than half of the patients drop out of treatment; group leaders find the treatment manual credible, easy to use and want to continue working with it after the study is completed. Secondary outcomes were changes in insomnia symptoms, and changes in symptoms of depression and anxiety.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
Behavioral intervention based on Cognitive Behavioral Therapy for insomnia, adjusted for psychiatric patients with anxiety disorders, affective disorders and trauma
Program for Anxiety and Affective disorders, Stockholm Southwest Psychiatry
Stockholm, Sweden
Number of participants registering to participate in the treatment
Influx of patients should be sufficient to start at least one group per semester (at least 8 patients)
Time frame: Screening
Number of included participants attending the first treatment session
At least half of included patients should attend the first treatment session
Time frame: First session (1 week)
Number sessions attended by the participants
Average number of sessions attended should be no less than 3
Time frame: Post-treatment (6 weeks)
Number of participants dropping out of treatment
Less than half of the patients should drop out of treatment
Time frame: Post-treatment (6 weeks)
Qualitative measure of group leaders' perception of the manual
Group leaders should find the treatment manual credible and easy to use, and be willing to continue using the treatment manual after the study is completed
Time frame: Post-treatment (6 weeks)
Insomnia Severity Index
7-item self-reported measure of insomnia severity, 0-28 points, lower is better.
Time frame: Post-treatment (6 weeks), Three-month follow-up (21 weeks)
Patient health questionnaire (PHQ-9)
9-item depression inventory, 0-27 points, lower is better
Time frame: Post-treatment (6 weeks), Three-month follow-up (21 weeks)
Generalized Anxiety Disorder Assessment (GAD-7)
7-item anxiety inventory, 0-21 points, lower is better
Time frame: Post-treatment (6 weeks), Three-month follow-up (21 weeks)
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