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.
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.
Team of the Italian Center
for Single Session Therapy
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)