Brief cognitive behavioral therapy for insomnia delivered to depressed veterans receiving primary care services: A pilot study

Pigeon, Wilfred R.; Funderburk, Jennifer S.; Bishop, Todd M.; Crean, Hugh F.

doi:10.1016/j.jad.2017.04.003

Cited by 44 publications

(29 citation statements)

References 31 publications

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“…In primary care settings, brief behavioral treatment for insomnia (BBTI), group CBT-I, and classroom settings have been investigated as a way to deliver the treatment to more patients using fewer resources. [77][78][79] A BBTI protocol with two in-person sessions and two telephone sessions has demonstrated efficacy compared to control groups in veteran populations 80,81 and is currently being directly compared to CBT-I. 82 Overall, there are a number of promising alternatives to standard CBT-I that have demonstrated efficacy; it is now time to move along the continuum toward effectiveness and implementation trials.…”

Section: Developing and Testing Alternative Delivery Formats For Cbt-imentioning

confidence: 99%

Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review

2018

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The American College of Physicians (ACP) recently identified cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia. Although CBT-I improves sleep outcomes and reduces the risks associated with reliance on hypnotics, patients are rarely referred to this treatment, especially in primary care where most insomnia treatment is provided. We reviewed the evidence about barriers to CBT-I referrals and efforts to increase the use of CBT-I services. PubMed, PsycINFO, and Embase were searched on January 11, 2018; additional titles were added based on a review of bibliographies and expert opinion and 51 articles were included in the results of this narrative review. Implementation research testing specific interventions to increase routine and sustained use of CBT-I was lacking. Most research focused on pre-implementation work that revealed the complexity of delivering CBT-I in routine healthcare settings due to three distinct categories of barriers. First, system barriers result in limited access to CBT-I and behavioral sleep medicine (BSM) providers. Second, primary care providers are not adequately screening for sleep issues and referring appropriately due to a lack of knowledge, treatment beliefs, and a lack of motivation to assess and treat insomnia. Finally, patient barriers, including a lack of knowledge, treatment beliefs, and limited access, prevent patients from engaging in CBT-I. These findings are organized using a conceptual model to represent the many challenges inherent in providing guideline-concordant insomnia care. We conclude with an agenda for future implementation research to systematically address these challenges.

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Section: Developing and Testing Alternative Delivery Formats For Cbt-imentioning

confidence: 99%

Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review

2018

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“…Researchers have continuously called for greater empirical focus on the investigation of insomnia-treatment effects on mitigating suicide risk. 33 , 64 , 79 – 83 Although studies examining the efficacy of insomnia treatments on reducing suicide risk have been conducted, 84 there is a significant need for more research (ie, randomized controlled trials). Cognitive behavioral therapy for insomnia (CBT-I) is one insomnia treatment that appears promising for mitigating suicide risk in insomnia patients.…”

Section: Insomnia Symptomsmentioning

confidence: 99%

“…CBT-I is currently recommended as the initial treatment for chronic insomnia in adults, 85 and is associated with significant reductions in suicide-related thoughts from pre- to posttreatment. 18 , 84 , 86 Researchers have continuously called for greater empirical focus on investigating the effects of insomnia treatment on mitigating suicide risk. 33 , 64 , 79 – 83 We also argue that such research is needed, especially since there has not been enough research to establish adequate efficacy and because prescription sleep medications (eg, sedative–hypnotics) have been associated with suicide ideation 34 and suicide, 57 , 87 and were a stronger predictor of past-year suicide ideation and nonfatal suicide attempts than insomnia symptoms in a general US population sample.…”

Section: Insomnia Symptomsmentioning

confidence: 99%

Suicidality in sleep disorders: prevalence, impact, and management strategies

Drapeau¹,

Nadorff²

2017

NSS

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Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep–suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep–suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders.

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“…Recent studies revealed that PCPs commonly treat insomnia with sleep hygiene alone, pharmacotherapy alone, or both (Bjorvatn, Meland, Flo, & Mildestvedt, 2017; Conroy & Ebben, 2015; Everitt et al., 2014; Sivertsen et al., 2010). Sleep hygiene is often the first treatment (Bjorvatn, Fiske, & Pallesen, 2011; Everitt et al., 2014; Sivertsen et al., 2010), although it is less effective than CBT‐I (Pigeon, Funderburk, Bishop, & Crean, 2017). When patients do not respond to sleep hygiene measures, many PCPs prescribe medication (Everitt et al., 2014), most commonly benzodiazepines, antidepressants (Bjorvatn et al., 2017; Everitt et al., 2014; Maire et al., 2020; Marschall et al, 2017; Sivertsen et al., 2010), and phytopharmaceuticals (Everitt et al., 2014; Lai, Tan, & Lai, 2011; Sanchez‐Ortuno, Belanger, Ivers, LeBlanc, & Morin, 2009).…”

Section: Introductionmentioning

confidence: 99%

Treating insomnia in Swiss primary care practices: A survey study based on case vignettes

Linder

Duss

Dvořák

et al. 2020

Journal of Sleep Research

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Guidelines recommend cognitive behavioural therapy for insomnia (CBT‐I) as first‐line treatment for chronic insomnia, but it is not clear how many primary care physicians (PCPs) in Switzerland prescribe this treatment. We created a survey that asked PCPs how they would treat chronic insomnia and how much they knew about CBT‐I. The survey included two case vignettes that described patients with chronic insomnia, one with and one without comorbid depression. PCPs also answered general questions about treating chronic insomnia and about CBT‐I and CBT‐I providers. Of the 820 Swiss PCPs we invited, 395 (48%) completed the survey (mean age 54 years; 70% male); 87% of PCPs prescribed sleep hygiene and 65% phytopharmaceuticals for the patient who had only chronic insomnia; 95% prescribed antidepressants for the patient who had comorbid depression. In each case, 20% of PCPs prescribed benzodiazepines or benzodiazepine receptor agonists, 8% prescribed CBT‐I, 68% said they knew little about CBT‐I, and 78% did not know a CBT‐I provider. In the clinical case vignettes, most PCPs treated chronic insomnia with phytopharmaceuticals and sleep hygiene despite their lack of efficacy, but PCPs rarely prescribed CBT‐I, felt they knew little about it, and usually knew no CBT‐I providers. PCPs need more information about the benefits of CBT‐I and local CBT‐I providers and dedicated initiatives to implement CBT‐I in order to reduce the number of patients who are prescribed ineffective or potentially harmful medications.

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Brief cognitive behavioral therapy for insomnia delivered to depressed veterans receiving primary care services: A pilot study

Cited by 44 publications

References 31 publications

Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review

Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review

Suicidality in sleep disorders: prevalence, impact, and management strategies

Treating insomnia in Swiss primary care practices: A survey study based on case vignettes

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