Savard, J., Villa, J., Simard, S., Ivers, H., & Morin, C. M. (2011). Feasibility of a self-help treatment for insomnia comorbid with cancer. Psycho-Oncology, 20, 1013–1019.doi: 10.1002/pon.1818
To determine feasibility and assess patient satisfaction with a self-administered format of cognitive-behavioral therapy (CBT) for insomnia comorbid with cancer.
To provide initial information on the effect of self-administered CBT on subjective measures of sleep and other symptoms.
Patients were given a battery of self-report scales to complete for baseline evaluation and were then contacted by an interviewer. They underwent a 75-minute interview followed by instructions to complete a sleep diary for two weeks. Then, patients were given the self-help CBT module for insomnia. It was comprised of six modules, each with a video segment and booklet covering the following topics on sleep and insomnia: (1) insomnia facts, (2) stimulus control therapy and sleep restriction strategies, (3) cognitive restructuring strategies, (4) revision of maladaptive sleep cognitions, (5) sleep hygiene, and (6) relapse prevention strategies. They were instructed to read one module per week for six weeks. At posttreatment and follow-up, they completed the same battery of self-report scales and sleep diaries.
Patients were undergoing the transition phase after initial treatment.
The study used a single-group, nonrandomized pre-/post design.
All patients adhered to the treatment, and all found the format to be excellent and interesting. All patients reported subjective improvement in their sleep quality and motivation to continue the strategies in the future. Sleep measures showed effect sizes of large magnitude in total ISI score, wake after sleep onset, sleep onset latency, sleep efficiency, and total DBAS score. There were moderate effect sizes of HADS–Depression (HADS-D) and QOL scores, with small effect sizes for total sleep time, hypnotics usage, HADS–Anxiety (HADS-A), and MFI scores. These results were sustained at three months.
A self-help CBT strategy for insomnia in patients with breast cancer is feasible. It appears to improve sleep outcomes and dysfunctional beliefs and may improve QOL and depression.
Self-administered CBT for insomnia may be a good first line strategy to treat insomnia in patients with cancer. It allows for treatment at a time that is convenient to the patient and for improved access to care because it can be performed without a sleep expert present.