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11-08-2013 | Sleep medicine | Article

Age and self-efficacy guide suitability of CBT for insomnia


Free abstract

medwireNews: Group-administered cognitive behavior therapy for insomnia (CBT-I) in older adults is most beneficial for those who are relatively younger and are confident in their own ability to sleep, study findings show.

“Our hope is that the results from our study will provide clinicians with a useful guide when considering the use of a brief and inexpensive group-based CBT-I treatment program for older patients,” say Nicole Lovato (Flinders University, Adelaide, South Australia) and team.

A total of 86 adults (mean age 64 years) with sleep maintenance problems or early morning awakening insomnia participated in weekly 60-minute sessions of CBT-I, held in groups of four or five individuals, for 4 weeks. This led to an average 17% increase in sleep efficacy – calculated as a percentage of the amount of time spent asleep at night while in bed – as documented in sleep diaries.

The researchers note that the proportion of individuals with sleep efficiencies of 85% or greater, which indicates good sleep, increased from 1% before treatment to 53% afterwards. Sleep efficiencies were still within this range for 32% of participants 3 months after treatment had stopped.

Factors found to be associated with an improved outcome after treatment and 3 months later were age, insomnia severity, self-reported sleep disturbance, and sleep self-efficacy.

However, after pretreatment sleep efficiency had been taken into account, only younger age predicted improved sleep efficiency post-treatment and only a higher score on the Sleep Self-Efficacy Scale predicted improved sleep efficiency at 3 months of follow up.

Lovato and team comment in Sleep Medicine that as sleep self-efficacy before treatment predicts improvement in sleep efficacy following treatment, “adapting the content of CBT-I to include some motivational enhancement techniques may be beneficial in maximizing a favorable response to treatment.”

They also caution that the predictive factors identified in their study explained only about 4–12% of the variance in sleep efficiency improvement, which indicates that there are other factors not assessed in their study that are likely to influence treatment response.

Nevertheless, they conclude that the findings “suggest that relatively younger insomniacs in the older age category and with higher sleep self-efficacy can benefit from brief, small, group-administered CBT-I treatment programs.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter