Deconstruct the Paper Assignment

Paper: Improving mental health and daytime function in adult insomnia patients

predict cognitive behavioral therapy for insomnia effectiveness: A case-control study

HMB342 - TUT0202

PODS Group 4: Lydia Ghide, Katya Hortogiannos, Celine Li, Ilhan Yusuf

9 Feb 2024
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HMB342 - Deconstruct the Paper

Lay Summary:

Having trouble sleeping, known as insomnia, can affect daily life and health. This

study aimed to understand what factors affect the success of a therapy designed for insomnia

called cognitive behavioural therapy for insomnia (CBT-I). The researchers expected that

personal traits, sleep quality, and mental health could predict how well people respond to

therapy for insomnia. To test this, they looked at data from 42 adults who completed this

therapy to see if certain traits or habits affected how well the therapy worked for them. Other

factors they checked for were the severity of insomnia, beliefs about sleep, and mental health

issues. As a result, they found that people with severe insomnia and high anxiety responded

the best to CBT-I, regardless of demographic characteristics. So, monitoring mental health

and daytime activities during treatment could make the therapy more effective and help

people with insomnia sleep better.

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Paper Deconstruction:

Objective

The objective of this case-control study was to identify factors influencing the response to

cognitive behavioural therapy for insomnia (CBT-I) and to assess whether these predictors

differed from factors influencing adherence and attendance to the CBT-I program. Through

self-reported questionnaires, the authors aimed to advance our understanding of the complex

relationships between demographics, sleep-related variables, mental health, and CBT-I

treatment response.

Hypothesis

Given that adults with primary insomnia displayed high adherence to the program, the

authors hypothesized that factors such as demographics, sleep-related symptoms, and mental

health status could be effectively utilized as predictors of a significant treatment response to

CBT-I. Additionally, the authors proposed that positive changes in mental health and daytime

functioning would be indicative of a more beneficial response to CBT-I treatment.

Rationale

The study addresses the need to identify critical predictors of treatment response in CBT-I to

improve sleep outcomes. Examining the relationship between predictors and treatment

response may provide greater insights into optimizing treatment strategies for insomnia

patients. Furthermore, determining these predictors is imperative for progressing clinical

outcomes and tailoring interventions to better address the multifaceted nature of insomnia.

Methods

This case-control study included 52 participants meeting the insomnia diagnostic criteria.

Participant exclusion criteria included missed sessions, uncontrolled medical/psychiatric

conditions and specific sleep disorders. Participants underwent four weekly face-to-face

CBT-I sessions and online consultations. Treatments consisted of sleep hygiene education,
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sleep restriction, cognitive therapy, stimulus control and relaxation techniques. Response to

treatment was recorded after 4 weeks of treatment. The predictors analyzed at baseline and

post-treatment to understand the factors that influence treatment response include

demographic information, medical comorbidities, participant’s use of sleep medication,

assessments of depressive mood, anxiety, and sleep-related symptoms using the Korean

versions of PHQ-9, GAD-7, PSQI, ISI, DBAS-16, and GSES.

Results

In a sample of 42 participants receiving CBT-I for insomnia (CBT-I), 59.5% responded

positively. The mean baseline insomnia severity indicated moderate insomnia. Mild to

moderate depression and anxiety were prevalent. Baseline demographics showed no

differences between responders and non-responders to treatment. The predictors of treatment

response included higher anxiety, more severe baseline insomnia, and lesser dysfunctional

sleep beliefs. The severity of insomnia and psychological distress, particularly anxiety, was

necessary for treatment response. Anxiety seemed to influence CBT-I response more than

depression. More severe anxiety and depression correlated with lower treatment completion

rates. Notably, severe insomnia and sleep-related anxiety were strong predictors of CBT-I

response, while less severe beliefs about sleep were associated with better response.

Conclusions

Overall, the authors established a significant association between the efficacy of CBT-I and

improvements in mental health and daytime function within adult insomnia patients. Through

the use of a case-control study design, the study results emphasize the potential use of CBT-I,

with improving mental well-being and strengthening daytime function predicting a more

significant positive response to treatment. These findings underscore the necessity of a

comprehensive and patient-centred approach to treating adult insomnia, aiding in advancing

future analysis of insomnia altogether.

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References

Shin, J.-W., Kim, S., Park, B., Shin, Y. J., & Park, S. (2023). Improving mental health and

daytime function in adult insomnia patients predict cognitive behavioral therapy for

insomnia effectiveness: A case-control study. Sleep Medicine: X, 5, 100071.

https://doi.org/10.1016/j.sleepx.2023.100071