Who is at risk for dropout from group cognitive-behavior therapy for insomnia?
Open accessAbstract
Objective The aim of the present study was to identify characteristics of patients who are at risk for dropout from a seven-session group cognitive-behavior therapy for insomnia (CBT-I) in a clinical setting using the receiver operating characteristic curve (ROC) approach.Methods Two separate ROC analyses were conducted using predictor variables taken from questionnaire packets and sleep diaries collected at baseline including age, gender, Beck Depression Inventory (BDI), Morningness-Eveningness Questionnaire, Beliefs and Attitudes about Sleep, use of sleep medication, sleep onset latency, wake time after sleep onset, and total sleep time (TST).Results The first ROC analysis was conducted on the entire sample of 528 patients with treatment completion vs. dropout (noncompletion) as the outcome variable. No significant predictor variables were found in this analysis. The second ROC analysis was conducted on the 211 patients who did not complete treatment with early termination (prior to fourth session) vs. late termination (at or after fourth session) as the outcome variable. The results revealed that patients who reported an average baseline TST <3.65 h were at greatest risk for early termination. Sixty percent of patients in this group terminated early compared to 9.3% of patients with TST > or =3.65 h. Among patients with TST > or =3.65 h, 22% of those with BDI scores > or =16 were early dropouts compared to 4.3% of those who reported BDI <16.Conclusion These findings indicate that short sleep duration and elevated symptoms of depression at baseline are associated with increased risk of early termination from CBT-I.
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Variables of insomnia patients that render them unsuitable for CBT-I include the severity of depression, comorbidity, and difficulties in conducting sleep restriction and stimulus control therapy.
“Variables of insomnia patients that render them unsuitable for CBT-I include the severity of depression,3 comorbidity,4 and difficulties in conducting the restriction of sleep and therapy of stimulus control.5”
From Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial (2023) · cites this paper as [3]
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Self-citation
- Authors
- Ong, J. C., Kuo, T. F., & Manber, R.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Ong, Jason C.
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 64
- Issue
- 4
- Pages
- 419-425
- ISSN
- 0022-3999 (ISSN-L)
- PMC
- PMC2435302
- OpenAlex
- W2070584913
- Cited by
- 168
- References
- 41
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 10 · 2023: 26 · 2022: 6 · 2021: 11 · 2020: 12 · 2019: 12 · 2018: 10 · 2017: 11 · 2016: 10 · 2015: 13 · 2014: 7 · 2013: 5 · 2012: 1
- FWCI
- 6.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (MH-19938, T32MH019938)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive behavioral therapy for insomnia, treatment discontinuation, early termination, risk factors, total sleep time, depression, sleep duration, sleep medication use, sleep diary, group therapy
- MeSH terms
- Adult, Aged, Circadian Rhythm, Culture, Depression, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Dropouts, Personality Inventory, Psychotherapy, Group, Risk Factors, ROC Curve, Sleep Deprivation, Cognitive Behavioral Therapy
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