Managing Acute Insomnia in Prison: Evaluation of a “One-Shot” Cognitive Behavioral Therapy for Insomnia (CBT-I) Intervention

Abstract

Objectives/Background: Insomnia is a serious condition that affects over 60% of the prison population and has been associated with aggression, anger, impulsivity, suicidality, and increased prison health care use. Nonpharmacological interventions for prison inmates are scarce despite the high prevalence and significant consequences of insomnia among those incarcerated. The aim of the present study was to examine the preliminary efficacy and effectiveness of a one-shot session of cognitive behavioral therapy for insomnia (CBT-I) for prison inmates with acute insomnia in an open trial. Method/Participants: The intervention consisted of one 60-70 min session of CBT-I and a self-management pamphlet. A consecutive series of 30 adult male offenders with acute insomnia from a UK prison completed measures of prospective sleep (daily sleep diary), insomnia symptoms severity (Insomnia Severity Index), and mood symptoms (Patient Health Questionnaire and General Anxiety Disorder) one week before and four weeks after receiving the intervention. Results: Pairwise t-tests revealed that a single shot of CBT-I was effective in reducing the severity of insomnia in adult male offenders (t = [29], 12.65, p < 0.001). Further, the results demonstrated moderate to large effect sizes for reductions in depressive (d RM = 0.77) and anxious (d RM = 0.83) symptoms, as well as insomnia severity (d RM = 2.35). Conclusions: A single-shot session of CBT-I is effective in managing acute insomnia and mood (depression, anxiety) symptoms in adult male prison inmates. Future research should focus on testing if the single-shot CBT-I intervention can be implemented and disseminated in other settings and populations (e.g., female and juvenile or youth offenders). An estimated 11-81% of prison inmates report insomnia symptoms (Dewa, Kyle, Hassan, Shaw, & Senior, 2015). The wide variation among studies may be due to different criteria used to define insomnia as well as different measures used to assess insomnia symptoms. For example, requests for hypnotics were used as an indicator of insomnia in one study (10.9%; Kjelsberg & Hartvig, 2005), whereas other studies, with much higher prevalence rates, used clinical screening instruments or general health questionnaires with one or two sleep-related items embedded within (e.g., 74%, Singleton, Meltzer, & Gatward, 1998; 71. 6%, O'Brien, 2001). The only study to date that has used an insomnia-specific measure, the Sleep Condition Indicator (Espie et al., 2014), suggests an overall prevalence rate for Insomnia Disorder of 61.6%, with women significantly more likely to report insomnia, in prison, compared to men (Dewa, Hassan, Shaw, & Senior, 2017). The consequences of insomnia in prison inmates include aggression, anger, impulsivity, and increased prison health care use (

Dealing with sleep problems during home confinement due to the COVID‐19 outbreak: Practical recommendations from a task force of the European CBT‐I Academy

“…The European Academy for Cognitive-Behavioral Treatment of Insomnia (The European CBT-I Academy) was founded to improve accessibility to the most effective treatment for insomnia, cognitive behavioural therapy Morin, 2016;Morin et al, 2009;Riemann et al, 2017). Classically aimed at treating longterm sleep problems called chronic insomnia, recent evidence shows that cognitive behavioural therapy can also serve to treat suddenonset (acute) insomnia due to rapid stress-causing situation changes (Boullin, Ellwood, & Ellis, 2016;Randall, Nowakowski, & Ellis, 2019).…”

“…The European Academy for Cognitive‐Behavioral Treatment of Insomnia (The European CBT‐I Academy) was founded to improve accessibility to the most effective treatment for insomnia, cognitive behavioural therapy (Baglioni et al., 2020; Morin, 2016; Morin et al., 2009; Riemann et al., 2017). Classically aimed at treating long‐term sleep problems called chronic insomnia, recent evidence shows that cognitive behavioural therapy can also serve to treat sudden‐onset (acute) insomnia due to rapid stress‐causing situation changes (Boullin, Ellwood, & Ellis, 2016; Randall, Nowakowski, & Ellis, 2019). Many elements of this treatment can be applied to the current situation, and may be adapted to treat and prevent sleep problems that result from confinement, increased levels of stress, and changes in daytime and night‐time activities and routines.…”

Efficacy of simplified-cognitive behavioral therapy for insomnia(S-CBTI) among female COVID-19 patients with insomnia symptom in Wuhan mobile cabin hospital

“…CBTI is widely accepted as a first-line treatment for chronic insomnia, but there are few studies on non-drug therapy for acute insomnia. Charlotte Randall and colleagues developed a "one-shot" CBT-I intervention which was effective in managing acute insomnia and mood (depression, anxiety) symptoms in adult men who were prison inmates [20]. In the current study, SCBTI was more effective in patients with acute insomnia than in patients with chronic insomnia.…”

“…Previous studies have produced concise versions of CBTI, which have been shown to be effective for insomnia sufferers [16][17][18]. Recent evidence suggests that CBTI can also be used to treat acute insomnia due to stress [19,20]. Traditionally, group or individual CBTI is implemented by trained psychiatrists or psychotherapists.…”

Effectiveness of App-Based Yoga of Immortals (YOI) Intervention for Insomnia in Asian Population during Pandemic Restrictions

“…Insomnia is associated with several adverse health outcomes, such as poor physical health, poor mental health, including symptoms of anxiety and depression, and decreased quality of life [ 6 , 7 ]. Cognitive behavioral therapy for insomnia (CBT-I), traditionally used to treat chronic insomnia, has recently been used to treat acute insomnia secondary to the situational changes from acute stress [ 8 , 9 ]. Although CBT-I is traditionally delivered in face-to-face individuals or group settings, remote delivery online or by telephone has also been used, albeit with less robust supporting data .…”