Single session therapy for insomnia

Single session therapy for insomnia

In other articles we have reported the evidence on how Single Session Therapy can be applied to  different areas of intervention  and used with  different therapeutic approaches  (eg CBT, hypnosis, Ericksonian psychotherapy, psychoanalysis, psychodynamic therapies, strategic therapy , systemic and family therapies, EMDR, etc.).

Here, we will show how TSS can be concretely integrated with a specific therapeutic approach,  Cognitive-Behavioral Therapy (CBT), in the specific  treatment of insomnia, highlighting  the results .

What is the goal?

Our goal in this case will not be to demonstrate whether cognitive-behavioral therapy is an effective treatment for insomnia, but in the words of Dr. D. Hwang, MD, director of the sleep medicine department at  Kaiser Permanente Medical Center , California, reported in the journal   Medscape Medical News :

” The challenge is to demonstrate how CBT can be delivered in a  cost-effective way, so that it is not only effective for an individual, but that it can represent an  effective method for a population “.

 

Why is this goal important?

This is important because  chronic insomnia  is a very common condition affecting  up to 30% of the population  and traditional programs that are run individually or in small groups require multiple visits and limit the volume of patients that can be treated (Hwang, 2013 ).

Therefore we report a study carried out by researchers at the Kaiser Permanente Medical Center, on groups of 20 people suffering from chronic insomnia, to whom  a single session of cognitive-behavioral therapy  for insomnia (CBTI) was applied with  effective results .

 

What is the innovation of the intervention?

The program proposed by Kaiser Permanente is presented to large groups, in  a single face to face session , followed by telephone follow-up calls.

The center offers  2 weekly sessions , each lasting  2.5 hours  with up to  20 people with chronic insomnia .

The program, taught by a medical assistant, deals with:

  •  sleep hygiene
  • beliefs about sleep
  • relaxation techniques
  • sleep restriction
  • optimal sleeping position .

Within Kaiser Permanente, other CBTI programs are taught by nursing educators in multiple sessions, but the  Center is the only one  that uses the  Single Session format .

It is also the only one who uses  a medical assistant  within the sleep medicine department who offers  comprehensive insomnia management including  medication and treatment of secondary  causes  of insomnia , such as  depression ,  leg syndrome. restless  and sleep apnea .

 

What are the benefits obtained by patients?

The results of the program were presented at the Associated Professional Sleep Societies’ 27th annual meeting in 2013 and demonstrated that based on  subjective feedback :

  • 321 (88%)  of  363  adults with insomnia who completed the CBTI program reported an  improvement in their insomnia ;
  • overall sleep   time  improved by   an average of  1.5 hours , from  5.0  to  6.5 hours , and  time  to  fall asleep decreased  from  51 to 22 minutes ;
  • 134 patients taking   sleep   medications  decreased their  use  from  about 6 to 4 nights  per week, and  41 patients (30%) stopped  using sleep aids altogether; 
  • the improvements were  similar  for  men  and  women ,  shift workers , those with  obstructive  sleep apnea,  fibromyalgia  , or  restless  legs syndrome,  and those taking  antidepressant drugs .

 

Other studies based on  objective measures , comparing  doctor visits  and  pharmacy refills , 1 year before and 1 year after the program, found:

  • the  decrease  in primary care visits (average decrease of approximately 1 visit) after attending the insomnia program;
  • the  gradual increase in the  use of medications before the program and the  gradual decrease  in the use of drugs the year after the program, particularly those for sleep and antidepressant drugs.

 

Conclusions

This study therefore strongly indicates  the effectiveness of a single session of CBT  integrated in  a group format , demonstrating the impact of the program on the  functioning  of primary care, allowing to make a broader evaluation of this combination and the opportunity that could create in the healthcare sector in terms of efficiency of the service provided.

 

 

Angelica Giannetti
Psychologist, Psychotherapist
Team of the Italian Center
for Single Session Therapy

 

Bibliography

Hoyt, MF & Talmon, M. (2014) . Capturing the Moment: Single Session Therapy and Walk-In Services. Crown House Pub.

Hoyt, MF (2009) . Brief pychotherapies: Principles and practices. Phoenix, AZ: Zeig, Tucker & Theisen (Tr. It. Brief psychotherapies. Principles and practices. Rome: CISU).

Hwang, D. (2013) . A single session of cognitivebehavioral therapy for insomnia (CBTI) delivered in groups. Medscape, June 05 . (online)

 

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