Effectiveness of a cognitive behavioral self-help program for patients with primary insomnia in general practice - a pilot study

Objective: This study was conducted to evaluate the effectiveness of a cognitive behavioral self-help program (SHP) in combination with pharmacotherapy in patients with primary insomnia in general practice.

Participants: Patients were recruited from 31 general practitioners (GPs) in the Hamburg area, who were randomly assigned to the two different study conditions. Eighty patients completed the study. They had suffered from insomnia for several years and showed a high impairment according to the Pittsburgh Sleep Quality Index.

Intervention: According to assignment of their GP the patients either received a progressively reduced 4-week pharmacotherapy or a combination of pharmacotherapy and a SHP consisting of six chapters on progressive muscle relaxation, cognitive relaxation, modified stimulus control, thought stopping, and cognitive restructuring.

Measures and results: After study enrollment patients had short weekly consultations with their GPs during treatment to receive sleep medication and questionnaires. They completed questionnaires measuring general sleep quality and sleep-disruptive beliefs and also sleep diaries before treatment, during treatment, immediately following treatment, and at a 6-week and 6-month follow-up time point. For collection of changes in mood the Beck Depression Inventory was used. The whole sample showed reductions of sleep onset latency and time awake after sleep onset. Total sleep time increased and mood improved. Patients additionally working with the SHP showed significantly more improvements in sleep quality and negative sleep-related cognitions like ruminating and focusing on sleep. Treatment effects were significant at the end of therapy and remained stable at the six-week and six-month follow-up.

Conclusion: This study supports the use of a cognitive-behavioral SHP on primary insomnia in the setting of a general practice and should be investigated in more detail. Also, regular appointments and the utilization of sleep logs seem to have a positive influence on sleep disorders.