Positive Psychology: Testing CBT for Treating Chronic Insomnia

Monday, July 1, 2019

Testing CBT for Treating Chronic Insomnia

Original Contribution
April 11, 2001

Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia

A Randomized Controlled Trial

Jack D. Edinger, PhD; William K. Wohlgemuth, PhD; Rodney A. Radtke, MD; et alGail R. Marsh, PhD; Ruth E. Quillian, PhD

Author Affiliations
JAMA. 2001;285(14):1856-1864. doi:10.1001/jama.285.14.1856

Abstract

Context

Use of non - pharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking.

Objective

To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia.

Design and Setting

Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 to July 1997.

Patients

Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years).

Interventions

Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), or a quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months.

Main Outcome Measures

Objective (polysomnography) and subjective (sleep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep-related self-efficacy, and mood.

Results

Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment.

For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure.

Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%.

Conclusions

Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia.

This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.

JAMA

Link: https://jamanetwork.com/journals/jama/fullarticle/193729

Positive Psychology given credence by Academia:

Positive psychology is the scientific study of the strengths and virtues that enable individuals and communities to thrive.

Commentators on the subject Martin Seligman and Mihaly Csikszentmihalyi, note that:

"The field of positive psychology at the subjective level is about valued subjective experiences: well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present).

At the individual level, it is about positive individual traits: the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom.

At the group level, it is about the civic virtues and the institutions that move individuals toward better citizenship: responsibility, nurturance, altruism, civility, moderation,tolerance, and work ethic."