Mediators of cognitive-behavioral therapy for insomnia: A review of randomized controlled trials and secondary analysis studies
The examination of treatment mechanisms in randomized controlled trials (RCTs) has considerable implications for research and clinical practice. Insomnia is a highly prevalent and distressing disorder, associated with many adverse outcomes. Although extensive work has focused on the cognitive-behavi...
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Published in | Clinical psychology review Vol. 32; no. 7; pp. 664 - 675 |
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Main Authors | , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Ltd
01.11.2012
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Subjects | |
Online Access | Get full text |
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Summary: | The examination of treatment mechanisms in randomized controlled trials (RCTs) has considerable implications for research and clinical practice. Insomnia is a highly prevalent and distressing disorder, associated with many adverse outcomes. Although extensive work has focused on the cognitive-behavioral treatment of insomnia (CBT-I), few studies have directly examined the mechanisms of this intervention. CBT-I is a short-term, multi-component treatment that has demonstrated strong efficacy in treating insomnia. The purpose of the present study is: (a) to investigate if CBT-I works in accordance with its proposed mechanisms, and (b) to evaluate how the field is progressing in its understanding of these processes. This study comprehensively reviewed CBT-I RCTs for their inclusion of mediator variables. Secondary analysis studies were also surveyed for relevant mediator variables. Results demonstrated that 21 RCTs (39% of the total RCTs) and 11 secondary analysis studies examined at least one of the proposed mediators. Results of this review highlight that, although CBT-I appears to be targeting the hypothesized sleep processes, more research is needed to better understand whether CBT-I works in accordance with its theorized mechanisms. Inclusion of mediational analyses in future RCTs and secondary analysis studies would allow for further refinement of CBT-I and improved treatment outcomes.
► This study reviewed mediators of cognitive-behavioral therapy for insomnia. ► Randomized controlled trials and secondary analysis studies were investigated. ► 21 RCTs (39% of total) and 11 secondary analysis studies included mediator variables. ► Cognitive-behavioral therapy of insomnia appears to target proposed sleep processes. ► Future mediational analyses would allow for further refinement of treatment. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
ISSN: | 0272-7358 1873-7811 |
DOI: | 10.1016/j.cpr.2012.06.006 |