Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2003). Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. Journal of Consulting and Clinical Psychology, 71, 189–200.

DOI Link

Intervention Characteristics/Basic Study Process

The study used a two-phase, multimodal, cognitive-behavioral therapy (CBT) combined strategy:  (a) over 3 to 10 weeks and (b) over eight weeks; eight weekly sessions lasted 90 minutes.

The purposes were to establish treatment objectives, stimulus control, sleep restriction, coping strategies for fatigue, and reframe maladaptive cognitions.

Outcomes were sleep, mood, fatigue, and global and cognitive quality of life (QOL).

Sample Characteristics

  • The sample was comprised of 10 women with nonmetastatic breast cancer (stages I–III).
  • Mean age was 54.3 years.
  • Women completed chemotherapy and/or radiation therapy.
  • All had a diagnosis of chronic insomnia disorder per the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).
  • All had completed high school.

Setting

  • Single site
  • Patients were recruited from the community sleep laboratory and subjects’ homes.
  • Quebec, Canada

Phase of Care and Clinical Applications

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

Study Design

The study used a prospective, nonrandomized, repeated measures, quasiexperimental, single-case design comparing each individual over time.

Measurement Instruments/Methods

  • Insomnia Interview Schedule (ISI) 
  • Sleep diary
  • Self-report scales
  • Polysomnography and breathing parameters

Results

Most women experienced a statistically significant improvement in sleep efficiency and decreased total wake time pre- and posttreatment. Sleep efficiency continued at the six-month follow-up, but total wake time did not. Findings on sleep diaries were corroborated by objective measures.

Limitations

  • The study had a small sample size.
  • The sleep diaries were incomplete.
  • The potential existed for influence factors, such as intragroup alliance and empathy.
  • Sleep improvement may be an effect of time away from cancer therapy.
  • A trained psychologist must administer the tests; in addition, cost is incurred by using a sleep laboratory for polysomnography.