Clinical Efficacy of Incomplete Cognitive Behavior Therapy for Insomnia

ABSTRACT

BACKGROUND: It is widely accepted that cognitive-behavioral therapy for insomnia (CBT-I) is more effective than pharmacological treatments. However, the lack of trained experts and the duration, intensity, and cost of four individual treatment sessions curtail the widespread use of CBT-I in Korea. The aim of this study was to determine the clinical efficacy in patients who completed four sessions of CBT-I and in those who did not. METHODS: We investigated 81 patients with chronic insomnia (32-82 years old) who participated individual, four-session CBT-I between February 2010 and June 2013. The clinical efficacy was evaluated by estimating of total sleep time (TST), sleep latency (SL), waking after sleep onset (WASO), and sleep efficiency (SE) based on the sleep diaries. RESULTS: Of the 81 patients, 28 (34.6%) completed the four sessions. 22 (27.1%) withdrew after 1st session, 17 (20.9%) dropped after 2nd session, and 8 (9.9%) stopped voluntarily after 3rd session. Six were excluded due to incomplete sleep diaries. Clinical efficacy was measured in patients who completed at least two sessions (n=53, 65.4%); the mean SE improved from 68.8 to 87.6%, and in 40 (75.4%) the SE was normalized (> or =85%). Other parameters (TST, from 321.0 to 351.3 min; SL, from 61.9 to 25.0 min; WASO, from 86.3 to 24.4 min) were all improved after incomplete CBT-I. CONCLUSIONS: Sleep induction and maintenance as well as quality have improved in patients who underwent at least two of the four CBT-I sessions. It needs to develop briefer CBT-I to increase adherence to patients.