Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: Analyses of outcome data at 12 months posttreatment
Ca. Espie et al., Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: Analyses of outcome data at 12 months posttreatment, J CONS CLIN, 69(1), 2001, pp. 58-66
The clinical efficacy of cognitive behavior therapy (CBT) for chronic insom
nia has been established, yet clinical effectiveness is less clear. This st
udy presents data on 109 patients from general practice during a formal eva
luation of clinical effectiveness. Two thirds achieved normative values of
less than or equal to 30 min for sleep latency and wakefulness during the n
ight after CBT. Furthermore, almost half of the sample reduced sleeplessnes
s by greater than or equal to 50% Logistic regression revealed that initial
severity did not contraindicate, good outcome. Rather, greater sleep distu
rbance was positively associated with large symptom reduction, although low
er endpoint scores were less likely. Similarly, symptoms of anxiety, depres
sion, and thinking errors positively predicted good outcome. Hypnotic using
patients responded equally well to CBT, and demographic factors were of no
significant predictive value. It is concluded that CBT is clinically and d
urably effective for persistent insomnia in routines practice.