Fiorentino, L., McQuaid, J. R., Liu, L., Natarajan, L., He, F., Cornejo, M., . . . Ancoli-Israel, S. (2009). Individual cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover pilot study. Nature and Science of Sleep, 2010, 1–8.

To examine the effects of six individual cognitive-behavioral therapy (CBT) sessions on sleep.

Individual CBT treatment consisted of six, one-hour weekly sessions comprised of education, behavioral components (sleep restriction, stimulus control, adhering to the sleep hygiene rules, and training in progressive muscle relaxation techniques), and cognitive interventions to counteract maladaptive thought. It also included homework assignments (sleep diaries and practicing behavioral and cognitive strategies) followed by six weeks of no-treatment follow-up. Data were collected at baseline and at the end of the first and second six-week components, and daily diary data were recorded during the treatment phase.

• The study enrolled 21 patients, and 14 finished treatment (six in the experimental group and eight in the wait-list control group).
• Mean age was 61 years (standard deviation = 11.6 years; range 45–85 years).
• All patients were female, and 12 were Caucasian.
• All patients were survivors of breast cancer who had completed treatment between 5 months and 24 years prior (mean years since completion = 6; median = 5).
• All patients met the criteria for insomnia as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).

• Single site
• San Diego, California

Patients were undergoing the long-term follow-up phase of care.

This was a randomized, controlled, crossover pilot study.

• Actigraphy (Actillume®)
• Insomnia Severity Index (ISI)
• Pittsburgh Sleep Quality Index (PSQI)
• Sleep diary
• Sleep medications list
   

After six weeks, objective data (actigraphy) showed statistically significant differences in change scores between the treatment condition group and the delayed treatment control condition group on total sleep time, wake after sleep onset, number of awakenings per night, and percent of time asleep. There was a significant decrease in insomnia in the treatment group compared to the control group. Follow-up at six weeks showed continued improvement with a clinically significant decrease in PSQI scores. Cohen’s d effect size estimate for PSQI was large (d = 0.8).

These preliminary results suggest that individual CBT is appropriate for improving sleep in survivors of breast cancer.

• The study had a small sample size.
• There was little racial/ethnic diversity among the patients.

If found to be effective, the intervention is potentially useful in several different settings.