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28-07-2013 | Sleep medicine | Article

Primary care CBT helps insomnia patients


Free abstract

medwireNews: Cognitive behavioral therapy (CBT) administered by nurses appears an effective means of treating chronic insomnia in primary care patients, research shows.

Almost half of patients assigned to such treatment either improved or recovered following treatment, the study investigators, led by Kristoffer Bothelius (Uppsala University, Sweden), report.

CBT consisted of five biweekly group sessions lasting 60–90 minutes and was delivered by four primary healthcare nurses and one social worker who had been trained on how to use a guidance manual accompanying the therapy.

No formal training in sleep medicine was given, the researchers note, but the nurses and social worker all had relatively solid training in CBT.

Following 9 weeks of treatment, insomnia was significantly less severe in the 32 patients who were randomly assigned to receive CBT compared with 34 patients who were assigned to a wait-list “treatment-as-usual” group.

Scores on the Insomnia Severity Index (ISI) fell by an average of 29% among CBT patients, from 19.0 at baseline to 13.4 post-treatment. This compared with a post-treatment score of 17.1 for the waiting-list group.

Similarly, sleep onset latency (SOL) and wake time after sleep onset (WASO), measured using sleep diaries, decreased significantly by an average of 13.4% and 31.6%, respectively, following CBT.

The researchers report in the Journal of Sleep Research that the effect size for ISI scores was high, while for SOL and WASO it was medium.

The team also carried out additional analyses to determine the number of patients who significantly improved or recovered as a result of treatment. They found that 12 patients receiving CBT recovered, based on having an ISI score below 11.5 or SOL or WASO lasting for less than 30 minutes. And a further two patients showed significant improvement, achieving a 50% reduction in SOL and WASO compared with baseline.

Bothelius et al therefore estimate that, in a group session of five patients, CBT would be effective for at least two.

They note, however, that by the 18-month follow up, sleep measures had started to deteriorate again, and that this method of delivering CBT, although effective in primary care, may not be “as powerful or stable over time as more traditional methods.”

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

By Lucy Piper, Senior medwireNews Reporter