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Adherence to cognitive behavioral therapy for insomnia: A systematic review
Open accessAbstract
Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence. This review describes a comprehensive literature search of adherence to CBTI. The search revealed 15 studies that evaluated adherence to CBTI in adults using valid and reliable measures of sleep, and measure of adherence other than study withdrawals. The primary purposes of this review were to 1) synthesize current study characteristics, methodology, adherence rates, contributing factors, and impact on outcomes, 2) discuss measurement issues, and 3) identify future practice and research directions that may lead to improved outcomes. Strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the role of adherence as a factor and outcome of CBTI success. The importance of standardized adherence and outcome measures is discussed. In light of the importance of adherence to behavior change, this systematic review may better inform future intervention efforts.
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“the intervention involves multiple components, each requiring significant commitment from the patient (115).”
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“Controlled studies suggest white noise or relaxing soundscapes may improve sleep continuity in some individuals [57,58].”
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Lahousse, A., Roose, E. C. S., Leysen, L., Yılmaz, S. T., Mostaqim, K., dos Reis, F. J. J., Rheel, E., Beckwée, D., & Nijs, J. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm11010195 · Cited by 49
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“However, CBT-I is limited by adherence issues and high costs, whereas benzodiazepines and hypnotics may cause tolerance, dependence, and addiction (Matthews et al., 2013; Morin et al., 2015).”
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“patient compliance were barriers to continuing one study [9].”
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Can a tDCS treatment enhance subjective and objective sleep among student-athletes?
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“The lack of standardization of CBT-I may be one major contributor to the deficiency in adherence of this treatment.(36) Additionally, a single tDCS session improves mood, leading to believe that adherence could be optimized, and attrition could hypothetically be decreased.”
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Apport de la pleine conscience dans les thérapies cognitives et comportementales de l’insomnie
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“The accessibility and availability of CBT are limited by the number of trained practitioners and the cost of time [26, 27].”
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“Currently, the American Academy of Sleep Medicine guideline recommends cognitive behaviour therapy as a treatment for insomnia, but it is not easily or widely available [9].”
BackgroundEmerging applications of objective sleep assessments towards the improved management of insomnia
Scott, H., Lechat, B., Manners, J., Lovato, N., Vakulin, A., CATCHESIDE, P. G., Eckert, D. J., & Reynolds, A. C. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.10.030 · Cited by 17
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“…its therapeutic potential, and negatively affect the individual's acceptance of integrating SCT. Adherence to the various SCT recommendations is considered difficult (Chambers, 1992; Vincent et al., 2008), and is estimated to be between 40% and 85% (Agnew et al., 2021; Matthews et al., 2013).”
BackgroundMapping the insomnia patient journey in Europe and Canada
O'Regan, D. J., Garcı́a-Borreguero, D., Gloggner, F., Wild, I., Leontiou, C., & Ferini‐Strambi, L. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1233201 · Cited by 19
Cognitive Behavior Therapies for Insomnia I
Morin, C. M., Davidson, J. R., & Beaulieu‐Bonneau, S. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00085-4 · Cited by 18
Use of the Consumer-Based Meditation App Calm for Sleep Disturbances: Cross-Sectional Survey Study
Huberty, J., Puzia, M., Larkey, L., Irwin, M. R., & Vranceanu, A. (2020) · JMIR Formative Research · doi:10.2196/19508 · Cited by 17
“Research on adherence to sleep interventions indicates that participants who perceive the intervention to be relevant or necessary are more consistently engaged in their prescribed treatment [24,25].”
BackgroundGodzik, C. M., Crawford, S., & Ryan, E. (2020) · Geriatric Nursing · doi:10.1016/j.gerinurse.2020.12.006 · Cited by 17
Adherence to sleep restriction therapy – An evaluation of existing measures
Steinmetz, L., Simon, L., Feige, B., Riemann, D. W., Akram, U., Crawford, M., Johann, A. F., & Spiegelhalder, K. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13975 · Cited by 15
“To date, three systematic reviews have examined adherence to CBT-I (Agnew et al., 2021; Matthews et al., 2013; Mellor et al., 2022).”
BackgroundSadler, P., McLaren, S., Klein, B., Jenkins, M., & Harvey, J. T. (2015) · Trials · doi:10.1186/s13063-015-1066-6 · Cited by 17
“The information gained from a mixed methods design will provide an opportunity to gather rich, personal data through older adults that can either confirm or disconfirm the questionnaire outcome measures [13, 33].”
BackgroundIntensive Sleep Re-Training: From Bench to Bedside
Lack, L. C., Scott, H., Micic, G., & Lovato, N. (2017) · Brain Sciences · doi:10.3390/brainsci7040033 · Cited by 15
“Compliance is necessary for successful treatment but is often suboptimal [21], very likely arising from the difficulty in changing lifestyle habits at home and the sleep loss over several weeks of the treatment.”
BackgroundResultAcute Cancer Cognitive Therapy
Levin, T. T., & Applebaum, A. J. (2014) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2014.03.003 · Cited by 14
Daridorexant: A New Dual Orexin Receptor Antagonist for Insomnia
Onge, E. S., Phillips, B., & Rowe, C. (2022) · Journal of Pharmacy Technology · doi:10.1177/87551225221112546 · Cited by 14
Niu, S., Lin, C., Chen, P., Fan, Y., Huang, H., & Chiu, H. (2021) · Research in Nursing & Health · doi:10.1002/nur.22126 · Cited by 14
Cho, H. J., Kremer, S., & Young, J. (2021) · Current Sleep Medicine Reports · doi:10.1007/s40675-021-00220-3 · Cited by 15
Sandlund, C., Kane, K., Ekstedt, M., & Westman, J. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0798-2 · Cited by 18
Hyperarousal and Insomnia in Survivors of Cancer
Riley, K. E., Garland, S. N., Mao, J. J. J., Applebaum, A. J., Li, Q. S., Gehrman, P., DuHamel, K. N., & Verrico, Z. (2021) · International Journal of Behavioral Medicine · doi:10.1007/s12529-021-09962-4 · Cited by 14
“, education, socioeconomic status), varied CBT-I components, and lack of a standardized definition and measurement of adherence [40], indicating that those with lower education and socioeconomic status may benefit from additional treatment adherence; accommodations to systemic barriers that would prevent treatment ini…”
BackgroundZhang, C., Zeng, S., Xu, Y., Liu, S., Du, S., Fang, L., Lv, Z., Zhang, L., & Zhang, B. (2023) · General Psychiatry · doi:10.1136/gpsych-2023-101013 · Cited by 13
Shams, F., Tai, A. M. Y., Kim, J., Boyd, M., Meyer, M., Kazemi, A., & Krausz, R. M. (2023) · Digital Health · doi:10.1177/20552076231203876 · Cited by 18
Actitudes ante el insomnio de los médicos de AP de Mallorca
Torrens, I., Ortuño, M., Guerra, J. I. P., Esteva, M., & Lorente, P. (2015) · Atención Primaria · doi:10.1016/j.aprim.2015.06.012 · Cited by 13
Song, Y., Papazyan, A., Lee, D., Mitchell, M. N., McCurry, S. M., Irwin, M. R., Teng, E., Alessi, C., & Martin, J. L. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18720 · Cited by 12
“31,32 Overall adherence to a sleep schedule in our study participants was slightly lower than that in other studies of PLWD 29 or older adults 33 although different definitions of adherence have been used.”
ResultLudwin, B. M., Bamonti, P. M., & Mulligan, E. A. (2017) · Clinical Gerontologist · doi:10.1080/07317115.2017.1399190 · Cited by 12
“In order to answer these questions, clinicians and researchers will need to develop and utilize multiple measurement methods for adherence, particularly for the cognitive and other behavioral components (e.g., relaxation and behavioral activation) (Matthews et al., 2013).”
BackgroundSánchez-Ortuño, M. M., Pécune, F., Coelho, J., Micoulaud‐Franchi, J., Salles, N., Auriacombe, M., Serre, F., Levavasseur, Y., de Sevin, É., Sagaspe, P., et al. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad163 · Cited by 11
Technology-based cognitive behavioral therapy interventions
Newby, J. M., Upton, E., Mason, E., & Black, M. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.02.004 · Cited by 11
Ranteh, O., Tedasen, A., Rahman, M. A., Ibrahim, M. A., & Sama‐ae, I. (2024) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2024.108491 · Cited by 10
Sleep Disorders in the Elderly
Chokroverty, S. (2017) · Springer eBooks · doi:10.1007/978-1-4939-6578-6_51 · Cited by 10
Drake, C. L., Kalmbach, D. A., Cheng, P., Ahmedani, B. K., Peterson, E. L., Joseph, C. L. M., Roth, T. G., Kidwell, K., & Sagong, C. (2022) · Trials · doi:10.1186/s13063-022-06850-4 · Cited by 10
Development and preliminary validation of the treatment adherence rating scale
Gumport, N. B., Dong, L., Lee, J. Y., Zhao, X., & Harvey, A. G. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101832 · Cited by 11
Acupuncture as an Adjunct Treatment to Cognitive-Behavioral Therapy for Insomnia
Kutana, S., Mao, J. J. J., & Garland, S. N. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2022.10.005 · Cited by 9
He, J., Chan, S. H., Chung, R. C. K., & Tsang, H. W. H. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.10.025 · Cited by 9
Groninger, H., Arem, H. E., Ayangma, L., Gong, L., Zhou, E. S., & Greenberg, D. (2024) · JMIR Formative Research · doi:10.2196/64869 · Cited by 10
“Though CBT-I remains the gold standard intervention, adherence can be challenging due to a variety of patient and treatment-related factors as well as multiple changes to bedtime required by the CBT-I component called sleep restriction [25,26].”
Metadata
- Authors
- Matthews, E. E., Arnedt, J. T., McCarthy, M. S., Cuddihy, L. J., & Aloia, M. S.
- Affiliations
- University of Colorado Denver (US)
- University of Michigan (US)
- Pine Rest Christian Mental Health Services (US)
- National Jewish Health (US)
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 17
- Issue
- 6
- Pages
- 453-464
- ISSN
- 1087-0792 (ISSN-L)
- PMC
- PMC3720832
- OpenAlex
- W2018449766
- Cited by
- 199
- References
- 76
- Citations by year
- 2026: 17 · 2025: 11 · 2024: 27 · 2023: 26 · 2022: 22 · 2021: 15 · 2020: 15 · 2019: 13 · 2018: 8 · 2017: 19 · 2016: 4 · 2015: 13 · 2014: 9
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Health
- National Institute of Nursing Research (1K23NR010587, #2010-049)
- American Nurses Foundation
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy for insomnia, medication adherence, chronic insomnia, attrition, adherence measurement, behavior change, sleep outcomes, standardized outcome measures
- MeSH terms
- Adult, Humans, Sleep Initiation and Maintenance Disorders, Patient Compliance, Cognitive Behavioral Therapy
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