Long-Term Effects of Two Formats of Cognitive Behavioral Therapy for Insomnia Comorbid with Breast Cancer

Abstract

Study objectives: The goal of this randomized controlled trial, conducted in breast cancer patients, was to assess the long-term efficacy of a video-based cognitive behavioral therapy for insomnia (VCBT-I), as compared to a professionally administered intervention (PCBT-I) and to a no-treatment group (CTL). An earlier report revealed that, at posttreatment, VCBT-I patients showed significantly greater sleep improvements than CTL, but that PCBT-I produced superior effects than VCBT-I on some sleep and secondary outcomes. In this report, long-term effects are compared.

Methods: Two hundred forty-two women with breast cancer and with insomnia symptoms or using hypnotic medications participated to this three-arm randomized controlled trial: (1) PCBT-I (n = 81); (2) VCBT-I (n = 80); or (3) no treatment (CTL; n = 81) group. PCBT-I was composed of six weekly, individual sessions of approximately 50 min, whereas VCBT-I comprised a 60-min animated video and six booklets.

Results: Study measures (sleep and secondary variables) were administered at pretreatment and posttreatment, and at a 3-, 6-, and 12-mo follow-up. Treatment gains were well sustained at follow-up in both PCBT-I and VCBT-I. As at posttreatment, the remission rate of insomnia at follow-up was greater in PCBT-I than in VCBT-I, which was greater than in CTL.

Conclusions: Although face-to-face therapy remains the optimal format to efficaciously administer CBT for insomnia in cancer patients, a minimal intervention, such as the video-based intervention tested in this study, produces significant and sustainable treatment effects.

Clinical trial registration: ClinicalTrials.gov identifier NCT00674830.

Keywords: cognitive behavioral therapy; insomnia; long-term effects; minimal intervention; self-help.

© 2016 Associated Professional Sleep Societies, LLC.

Figures

Figure 1

Participants' flow chart. CBT-I, cognitive behavioral therapy for insomnia; ISI, Insomnia Severity Index; RCT, randomized controlled trial; Rx, hypnotic medication.

Figure 2

Between-groups differences at each time point. ISI, Insomnia Severity Index; Pre, pretreatment; Post, posttreatment; FU3, 3-mo follow-up; FU6, 6-mo follow-up; FU12, 12-mo follow-up; PCBT-I, professionally administered cognitive behavioral therapy for insomnia; VCBT-I, video-based cognitive behavioral therapy for insomnia; CTL, control group; TWT, total wake time; SE, sleep efficiency; IIS, Insomnia Interview Schedule.