This should include discussing the benefits, harms, and costs of medications. If CBT-I alone is unsuccessful, ACP recommends that doctors use a shared-decision making approach with their patients to decide whether drug therapy should be added to treatment. Cognitive behavioral therapy can be conducted through individual or group therapy sessions, telephone or web-based modules, and/or self-help books. Sleep medications can be associated with serious adverse effects.”ĬBT-I consists of a combination of treatments that include cognitive therapy around sleep, behavioral interventions such as sleep restriction and stimulus control, and education such as sleep hygiene (habits for a good night’s sleep). “Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms. “Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting,” said ACP President Wayne J. Philadelphia, - Cognitive behavioral therapy for insomnia (CBT-I) should be the first-line treatment for adults with chronic insomnia, the American College of Physicians (ACP) recommends in a new evidence-based clinical practice guideline published today in Annals of Internal Medicine. Significant within-group differences were found for both groups on depression, anxiety, and posttraumatic stress disorder symptoms, but there was no group by time interaction for these symptoms or for use of hypnotics or alcohol.ĬBTi was an effective treatment for insomnia and comorbid symptoms including daytime fatigue, general mental health, nicotine, and caffeine use.Ĭ Identifier: NCT01549899 "Comparing Internet and In-Person Brief Cognitive Behavioral Therapy of Insomnia".CBT-I combines cognitive therapy around sleep with a variety of behavioral therapies Exploratory analyses also showed CBTi outperformed Control on nicotine (d = -0.22) and caffeine (d = -0.47) use reduction. CBTi also outperformed Control in the combined sample (N = 151) on four of the five subscales of the Multidimensional Fatigue Inventory (d = -0.32 to -0.96) and the mental health subscale on the Veterans RAND 12-Item Health Survey (d = 0.37). ![]() This study replicated Original (n = 66) findings (CBTi outperformed Control) in a follow-on sample (n = 85) on diary-assessed sleep efficiency (d = 1.04), total sleep time (d = 0.38), sleep latency (d = -0.93), number of awakenings (d = -0.56), wake time after sleep onset (d = -0.91), sleep quality (d = 1.00), and the Insomnia Severity Index (d = -1.36) in active duty soldiers. Randomized clinical trial of 151 active duty US Army personnel at Fort Hood, Texas. To compare the efficacy of cognitive behavioral therapy for insomnia (CBTi) disorder and a Control condition on reducing insomnia and comorbid symptoms in a sample of active duty military personnel. 10 Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX.9 Department of Psychological and Brain Sciences, Boston University, Boston, MA.8 Department of Psychiatry, Boston University School of Medicine, Boston, MA.7 Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA.Darnall Army Medical Center, Fort Hood, TX. ![]() 5 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.4 Department of Psychology, University of Texas at San Antonio, San Antonio, TX.3 Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX.2 Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX. ![]()
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