Long-Term Effects of Two Formats of Cognitive Behavioral Therapy for Insomnia Comorbid with Breast Cancer

Abstract

Study Objectives

The goal of this randomized controlled trial, conducted in breast cancer patients, was to assess the long-term efficacy of a video-based cognitive behavioral therapy for insomnia (VCBT-I), as compared to a professionally administered intervention (PCBT-I) and to a no-treatment group (CTL). An earlier report revealed that, at posttreatment, VCBT-I patients showed significantly greater sleep improvements than CTL, but that PCBT-I produced superior effects than VCBT-I on some sleep and secondary outcomes. In this report, long-term effects are compared.

Methods

Two hundred forty-two women with breast cancer and with insomnia symptoms or using hypnotic medications participated to this three-arm randomized controlled trial: (1) PCBT-I (n = 81); (2) VCBT-I (n = 80); or (3) no treatment (CTL; n = 81) group. PCBT-I was composed of six weekly, individual sessions of approximately 50 min, whereas VCBT-I comprised a 60-min animated video and six booklets.

Results

Study measures (sleep and secondary variables) were administered at pretreatment and posttreatment, and at a 3-, 6-, and 12-mo follow-up. Treatment gains were well sustained at follow-up in both PCBT-I and VCBT-I. As at posttreatment, the remission rate of insomnia at follow-up was greater in PCBT-I than in VCBT-I, which was greater than in CTL.

Conclusions

Although face-to-face therapy remains the optimal format to efficaciously administer CBT for insomnia in cancer patients, a minimal intervention, such as the video-based intervention tested in this study, produces significant and sustainable treatment effects.

Clinical Trial Registration

ClinicalTrials.gov identifier NCT00674830.

Significance

Self-administered forms of cognitive behavioral therapy for insomnia (CBT-I) are increasingly recommended to increase patients' accessibility to this treatment. However, it is important to compare their long-term efficacy to that of a professionally-administered CBT-I (PCBT-I), which constitutes the standard delivery format. This study suggests that a video-based CBT-I (VCBT-I) provides a most valuable alternative. It could be used as a stand-alone treatment in settings where resources for administering CBT-I are lacking. However, given that many VCBT-I patients were still symptomatic following treatment, minimal interventions should ideally be used as part of a stepped care model in which low-intensity interventions are followed by more intensive forms of treatment (e.g., group or individual sessions) when needed. Clinical trials are needed to assess the utility of a stepped care approach to administer CBT-I.

cognitive behavioral therapy, insomnia, long-term effects, minimal intervention, self-help