Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans

• Published in: Behavior therapy Vol. 51; no. 4; pp. 535 - 547
• Main Authors: Bramoweth, Adam D., Lederer, Lisa G., Youk, Ada O., Germain, Anne, Chinman, Matthew J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2020
• Subjects: Behavior Therapy; behavioral therapy; Cognitive Behavioral Therapy; Humans; insomnia; noninferiority; Sleep Initiation and Maintenance Disorders - therapy; Time Factors; Treatment Outcome; Veterans; cognitive behavioral therapy; veterans; noninferiority; behavioral therapy; insomnia
• ISSN: 0005-7894; 1878-1888
• DOI: 10.1016/j.beth.2020.02.002

The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (<30–45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be noninferior to CBTI. The Reliable Change Index was used to establish a noninferiority margin (NIM) of 3.43, representing the maximum allowable difference between groups on the pre-post Insomnia Severity Index change (ΔISI). Sixty-three veterans with chronic insomnia were randomized to either BBTI or CBTI and veterans in both groups had significant reductions of their insomnia severity per the ISI and improved their sleep onset latency, total wake time, sleep efficiency, and sleep quality per sleep diaries. While CBTI had a larger pre-post ΔISI, this was not significantly different than ΔISI BBTI and was less than the NIM. However, the 95% confidence interval of the between group pre-post ΔISI extended beyond the NIM, and thus BBTI was inconclusively noninferior to CBTI. Limitations, such as small sample size and high rate of dropout, indicate further study is needed to compare brief, alternative yet complementary behavioral insomnia interventions to CBTI. Still, evidence-based brief and flexible treatment options will help to further enhance access to care for veterans with chronic insomnia, especially in non-mental-health settings like primary care. •Both BBTI and CBTI resulted in significant reductions of insomnia symptoms.•There were no significant differences between BBTI and CBTI on any outcome measure.•Non-inferiority of BBTI vs. CBTI was inconclusive.•BBTI may be an appropriate intervention for broader implementation in the VA.