Variables associated with the success of group cognitive behavioral therapy for insomnia: preliminary results

Abstract

Introduction. Insomnia Disorder (ID) is defined as the predominant dissatisfaction with the quantity or quality of sleep associated with difficulty in initiating or maintaining sleep or early-morning awakenings with the inability to go back to sleep. Cognitive Behavioral Therapy (CBT) has proven its effectiveness for ID, being established as a frontline treatment.

Objective. To identify the variables associated with the success of CBT for insomnia.

Method. The sample consisted of 28 patients who attended the HCUV Sleep Unit and met ID diagnostic criteria. All patients underwent a CBT program in group format. Several sociodemographic and clinical characteristics (general psychopathology, anxiety, depression, anger, emotional regulation, and personality) were evaluated in order to determine which discriminated between patients who improve and those who do not improve after CBT, using the Index Insomnia Severity (ISI) as a criterion variable. Results: After the program, almost 60% of the sample improved. Significant differences were found in the level of severity of insomnia after CBT according to sex (p = 0.027), with women improving more. Likewise, lower levels of psychopathology were related to a better response to the intervention (p = 0.007). Moreover, two personality dimensions were significant: low Harm avoidance (p = 0.006) and high Self-directedness (p = 0.026), appearing associated with improvement.

Conclusions. The CBT-I group program was globally effective in improving insomnia, detecting that certain clinical and personality profiles benefit the most. More research is needed to determine if they could be patients with different subtypes of insomnia. The temperament dimensions seem to play a relevant role in determining subtypes of insomnia and perhaps we could offer more personalized treatments.