Group Cognitive Behavioral Therapy and Acupressure for Insomnia

October 23, 2018 updated by: Fiona YY Ho, Chinese University of Hong Kong

The Efficacy of Cognitive Behavioral Therapy (CBT) and Acupressure for Insomnia: A Pilot Randomized Controlled Trial

This study will examine the use of cognitive behavioural therapy (CBT) and acupressure in treating insomnia in Chinese adults. The main components of CBT for insomnia (CBT-I) includes psychoeducation, sleep restriction, stimulus control, cognitive restructuring, and relaxation. CBT-I is widely used in western countries but it fails to address patient preference among Chinese adults with insomnia, as demonstrated in a previous study examining the subjective experience of chronic insomnia in Hong Kong Chinese adults. The study revealed that Chinese adults showed distrust in hypnotics and preferred traditional Chinese medicine (TCM) which was believed to be more natural. In order to maximize the therapeutic effects of psychological interventions for insomnia, integrative medicine with a combination of CBT-I and TCM could be an alternative to address insomnia in the Chinese population. Acupressure, a non-invasive therapy, is commonly used in TCM. It is suggested that acupressure can induce relaxation and improve sleep quality. Some studies have demonstrated the separate efficacy of CBT-I and acupressure in treating insomnia. However, few studies have examined the effect of their combination.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Hong Kong, Hong Kong
        • The Chinese University of Hong Kong
      • Sha Tin, Hong Kong
        • The Chinese University of Hong Kong

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Hong Kong residents who are able to communicate in Cantonese;
  2. Aged ≥ 18 years;
  3. A current clinical DSM-5 diagnosis of insomnia disorder according to the Sleep Condition Indicator (SCI) ≥ 21;
  4. Insomnia Severity Index (ISI) score ≥ 8; and
  5. Willing to give informed consent and comply with the trial protocol.

Exclusion Criteria:

  1. Have suicidal ideation based on Beck Depression inventory (BDI-II) Item 9 score ≥ 2 ;
  2. Receiving psychotherapy, acupuncture, and/or practitioner-delivered acupressure treatment for insomnia in the past 6 months;
  3. Pregnancy; and
  4. Taking herbal remedies, over-the-counter medication, or psychotropic drugs that target insomnia within 2 weeks prior to the baseline assessment.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Wait-list Control Group
Experimental: CBT Group
Cognitive Behavioral Therapy for Insomnia
Cognitive Behavioral Therapy for Insomnia including psychoeducation, sleep restriction, stimulus control, cognitive restructuring, and relaxation.
Experimental: Combined Group
Cognitive Behavioral Therapy for Insomnia plus Acupressure
Cognitive Behavioral Therapy for Insomnia including psychoeducation, sleep restriction, stimulus control, cognitive restructuring, and relaxation.
Acupressure, a non-invasive therapy, is commonly used in Traditional Chinese Medicine

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Insomnia Severity Index
Time Frame: Pre-treatment, 1-week post-treatment and 4-week post treatment
A 7-item scale designed to evaluate perceived insomnia severity. Ratings on the 5-point Likert scale are obtained on the perceived severity of sleep-onset, sleep-maintenance, early morning awakening problems, satisfaction with current sleep pattern, interference with daily functioning, noticeably of impairment attributed to the sleep problem, and level of distress caused by the sleep problem.
Pre-treatment, 1-week post-treatment and 4-week post treatment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in 7-Day Sleep Diary
Time Frame: Pre-treatment, 1-week post-treatment and 4-week post treatment
The standardized sleep diary records sleep-onset latency (SOL; min), wake after sleep onset (WASO; min), total wake time (TWT; min), total sleep time (TST; min), time in bed (TIB; min); sleep efficiency (SE; calculated as TST/TIB * 100%), etc.
Pre-treatment, 1-week post-treatment and 4-week post treatment
Change in Hospital Anxiety and Depression Scale (HADS)
Time Frame: Pre-treatment, 1-week post-treatment and 4-week post treatment
A 14-item self-rating scale that measures anxiety and depression in both hospital and community settings. It is divided into an Anxiety subscale (HADS-A) and a Depression subscale (HADS-D) both containing seven intermingled items. It is for screening purpose and not meant to be a diagnostic tool.
Pre-treatment, 1-week post-treatment and 4-week post treatment
Change in Dysfunctional Beliefs and Attitudes about Sleep Scale - 16-item version (DBAS-16)
Time Frame: Pre-treatment, 1-week post-treatment and 4-week post treatment
A 16-item self-report measure designed to evaluate sleep related cognitions (e.g., faulty beliefs and appraisals, unrealistic expectations, perceptual and attention bias).
Pre-treatment, 1-week post-treatment and 4-week post treatment
Change in Multidimensional Fatigue Inventory (MFI)
Time Frame: Pre-treatment, 1-week post-treatment and 4-week post treatment
A 20-item self-report instrument designed to measure fatigue. Ratings on a 5-point Likert scale are obtained on the dimensions of general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity.
Pre-treatment, 1-week post-treatment and 4-week post treatment
Change in Short Form (Six-Dimension) Health Survey - The Chinese (Hong Kong) Version (SF-6D)
Time Frame: Pre-treatment, 1-week post-treatment and 4-week post treatment
A preference-based single index measure of health. A six-digit number represents each SF-6D health state, each digit denotes the level of one of six SF-6D dimensions: physical functioning, role limitation, social functioning, bodily pain, mental health, and vitality.
Pre-treatment, 1-week post-treatment and 4-week post treatment

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Credibility-Expectancy Questionnaire (CEQ)
Time Frame: Pre-treatment and 1-week post-treatment
The 6-item CEQ yielded ratings of treatment credibility, acceptability/satisfaction, and expectations for success.
Pre-treatment and 1-week post-treatment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 11, 2017

Primary Completion (Actual)

April 30, 2018

Study Completion (Actual)

May 31, 2018

Study Registration Dates

First Submitted

September 15, 2017

First Submitted That Met QC Criteria

September 18, 2017

First Posted (Actual)

September 25, 2017

Study Record Updates

Last Update Posted (Actual)

October 24, 2018

Last Update Submitted That Met QC Criteria

October 23, 2018

Last Verified

October 1, 2018

More Information

Terms related to this study

Other Study ID Numbers

  • PSY001

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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