Effectiveness of a CBT Intervention for Persistent Insomnia and Hypnotic Dependency in an Outpatient Psychiatry Clinic

• Published in: Journal of clinical psychology Vol. 71; no. 7; pp. 666 - 683
• Main Authors: Taylor, Hannah Lund, Rybarczyk, Bruce D., Nay, William, Leszczyszyn, David
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2015; Wiley Periodicals Inc
• Subjects: Adult; Behavior modification; CBT for insomnia; Cognitive therapy; Cognitive Therapy - methods; comorbid insomnia; Comorbidity; Effectiveness; Female; Hospitals, Psychiatric; Humans; Hypnosis; hypnotic dependency; Hypnotics and Sedatives - administration & dosage; Insomnia; Male; Mental Disorders - epidemiology; Mental Disorders - therapy; Middle Aged; Outcome Assessment (Health Care); Outpatient care facilities; Outpatients; psychiatric comorbidity; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - therapy; Substance-Related Disorders - epidemiology; Substance-Related Disorders - therapy; comorbid insomnia; CBT for insomnia; hypnotic dependency; insomnia; psychiatric comorbidity
• ISSN: 0021-9762; 1097-4679
• DOI: 10.1002/jclp.22186

Objective To test cognitive‐behavioral therapy for insomnia (CBT‐I) in patients who not only receive psychiatric treatment in a outpatient psychiatry clinic but also continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. CBT‐I included an optional module for discontinuing hypnotic medications. Method Patients were randomized to 5 sessions of individual CBT‐I (n = 13) or treatment as usual (n = 10). Sleep parameters were assessed using sleep diaries at pre‐ and posttreatment. Questionnaires measuring depression, anxiety, and health‐related quality of life were also administered. Results CBT‐I was associated with significant improvement in sleep, with 46% obtaining normal global sleep ratings after treatment. However, no changes in secondary outcomes (depression, anxiety, quality of life) were obtained and no patients elected to discontinue their hypnotic medications. Conclusions Patients with complex, chronic psychiatric conditions can obtain sleep improvements with CBT‐I beyond those obtained with pharmacotherapy alone; however, sleep interventions alone may not have the same effect on mental health outcomes in samples with more severe and chronic psychiatric symptoms and dependency on hypnotic medications.