Cognitive behavioural group therapy for insomnia (CBGT-I) in patients undergoing haemodialysis: a randomized clinical trial

Abstract

Background: Given the many complications of drug therapy, it seems reasonable to use non-pharmacological therapies that can improve mental and physical disorders in haemodialysis patients. Aims: This study aims to determine the effectiveness of cognitive behavioural group therapy for insomnia (CBGT-I) in sleep quality, depression, anxiety and general psychological health of haemodialysis patients. Method: This randomized clinical trial was conducted on 116 haemodialysis patients who were randomly assigned to experimental (n=58) and control (n=58) groups. In the experimental group, CBGT-I was provided during nine weekly sessions. Data collection tools included Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDIII), Beck Anxiety Inventory (BAI), General Health Questionnaire (GHQ-28), Clinical Global Improvement Scale (CGI), Client Satisfaction Questionnaire (CSQ) and Working Alliance Inventory-Short Form (WAI-S). Data were analysed by SPSS-25 and p<.05 was considered significant. Results: The findings demonstrated that CBGT-I compared with control group was effective in improving sleep quality (p<.001, η2=.790), depression (p<.001, η2=.616), anxiety (p<.001, η2=.682) and general psychological health (p<.001, η2=.871). Participants of CBGT-I showed notable improvements as a result of the treatment, were satisfied with treatment, and had a good therapeutic relationship. Conclusions: CBGT-I is effective in reducing depression and anxiety in addition to improving sleep quality and general psychological health in haemodialysis patients. Therefore, it is recommended to be used as a complementary treatment for these patients.

Effectiveness of psychoeducational interventions on psychological distress and health-related quality of life among patients with maintenance hemodialysis: a systematic review and meta-analysis

“…This review included 14 RCTs, among which four studies [ 37 , 39 , 42 , 44 ] were conducted in China, three [ 36 , 41 , 45 ] in Iran, two [ 38 , 43 ] in America, and one study in Singapore [18] , Turkey [46] , Australia [47] , Mexico [48] , and Jordan [40] , respectively. These studies were published between 2005 and 2022.…”

“…All included studies applied education together with psychotherapeutic techniques. ESRD-related information including treatments [ 36 , 40 , 42 ], medication and diet management [ 18 , 37 , 40 , 47 ], dialysis care [ 18 , 36 , 37 ], monitoring blood pressure and blood sugar [18] , dealing with problematic symptoms [39] , exercise and sleep management [ 45 , 47 ] using booklets [18] , online platforms [47] , face-to-face [ 18 , 36 , 37 , 39 , 40 , 42 , 45 , 47 ] education.…”

“…In addition, the educational content of the other seven studies involved the education of psychological knowledge, including what is stress [ 41 , 48 ], anxiety and depression [ 38 , 43 , 45 ], and the introduction of ways to improve these problems and spiritual sustenance [46] .…”

“…In terms of psychotherapeutic techniques, emotion regulation [ 18 , 37 , 39 – 43 , 45 – 48 ], coping strategies [ 18 , 36 – 41 , 46 , 48 ], relaxation techniques [ 18 , 36 , 37 , 39 , 40 , 44 – 46 , 48 ], problem-solving [ 18 , 36 , 38 – 40 , 42 , 46 , 47 ], goal-setting [ 18 , 37 – 39 , 42 , 48 ], behavioral modification [ 43 , 44 , 48 ] were used in included studies. Emotion regulation, the use of cognitive resources to alter emotional responses [49] , was the most commonly used technique in the included studies to help MHD patients maintain good and stable emotions.…”

“…All interventions were carried out in hospitals or dialysis centers. Regarding intervention delivery forms, group [ 36 – 38 , 41 , 45 , 48 ], individual [ 18 , 40 , 42 – 44 , 46 , 47 ], and combined group and individual [39] interventions were used in included studies. A large variety of methods were used to conduct interventions, including lectures, group discussions, questions and answers, and/or role-playing.…”