Insomniacs' reported use of CBT components and relationship to long-term clinical outcome

Although there is considerable evidence for the efficacy of non-pharmacolog ical treatment of insomnia, many of the larger trials have delivered CBT in multicomponent format. This makes it impossible to identify critical ingre dients responsible for improvement. Furthermore, compliance with home imple mentation is difficult to ascertain in psychological therapies, and even mo re so when trying to differentiate across a range of elements. In the prese nt report, 90 patients who had completed 12 month follow-up after participa tion in a clinical effectiveness study of CBT in general medical practice, responded to a questionnaire asking them about their use of the ten compone nts of the programme. Reports of home use were then entered as predictors o f clinical response to treatment. Results indicated that reported home use of stimulus control/sleep restriction was the best predictor of clinical im provement in sleep latency and nighttime wakefulness. Cognitive restructuri ng also contributed significantly to reduction in wakefulness. In spite of being the most highly endorsed component (by 79% of respondents) use of rel axation did not predict improvement on any variable. Similarly, sleep hygie ne was unrelated to sleep pattern change and use of imagery training was mo destly predictive of poor response in terms of sleep latency. There are met hodological limitations to this type of post hoc analysis, nevertheless, th ese results being derived from a large patient outcome series raise importa nt issues both for research and clinical practice. (C) 2001 Elsevier Scienc e Ltd. All rights reserved.