Psychiatry research · 2026
Predictors of cognitive-behavioral therapy for insomnia (CBT-I) outcomes in individuals with psychiatric disorders: A retrospective observational cohort study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Stern Emilie, Dahan Louise, Maruani Julia, Palagini Laura, Dufayet Geoffrey, Lengereau Ariane, Lejoyeux Michel, Bungener Catherine, Geoffroy Pierre A
Аннотация
OBJECTIVE: Insomnia disorder is highly prevalent in patients with psychiatric disorders, and cognitive-behavioral therapy for insomnia (CBT-I) remains the first-line treatment. However, remission is achieved in only 40 %, particularly among those with comorbid mood disorders. Identifying factors moderating CBT-I effectiveness is crucial to developing more personalized approaches that optimize outcomes.
METHOD: 56 patients with insomnia disorder comorbid with psychiatric disorders from a referent sleep psychiatric center participated in a four sessions CBT-I group therapy and completed a series of questionnaires.
RESULTS: The most notable effects were observed at 3-months follow-up, suggesting that the full benefits emerge over time. The intervention led to significant improvements in insomnia severity, with a mean ISI score reduction of 3.9 and a large effect size of r = 0811 (ΔISI: μbaseline = 17.0 to μfollow-up =13.1; W = 421, p<,001) with notable remission rates (18,75 %) and improvements of sleep quality (PSQI) and hyperarousal symptoms (HAS). Several baseline factors predicted treatment outcomes, including hyperarousal and anxiety symptoms, PTSD-related intrusion symptoms, temporal perspective, and emotional regulation. The therapeutic alliance emerged as the strongest predictor of remission, explaining as much as 35,5 % of the variance. Its objective dimension on its own explained 38,4 %, likely due to its more direct relevance to the underlying mechanisms. The effect of CBT-I on hyperarousal symptoms and subjective sleep quality accounted for 41,9 % of the difference in insomnia symptoms, while the most comprehensive model (initial anxiety and CBT-I effects on hyperarousal and sleep quality) explained 48,1 %.
CONCLUSIONS: The findings underscore the substantial significance of a strong therapeutic alliance, individual characteristics, and the role of hyperarousal in insomnia, supporting a personalized and relationally grounded approach to insomnia treatment.
METHOD: 56 patients with insomnia disorder comorbid with psychiatric disorders from a referent sleep psychiatric center participated in a four sessions CBT-I group therapy and completed a series of questionnaires.
RESULTS: The most notable effects were observed at 3-months follow-up, suggesting that the full benefits emerge over time. The intervention led to significant improvements in insomnia severity, with a mean ISI score reduction of 3.9 and a large effect size of r = 0811 (ΔISI: μbaseline = 17.0 to μfollow-up =13.1; W = 421, p<,001) with notable remission rates (18,75 %) and improvements of sleep quality (PSQI) and hyperarousal symptoms (HAS). Several baseline factors predicted treatment outcomes, including hyperarousal and anxiety symptoms, PTSD-related intrusion symptoms, temporal perspective, and emotional regulation. The therapeutic alliance emerged as the strongest predictor of remission, explaining as much as 35,5 % of the variance. Its objective dimension on its own explained 38,4 %, likely due to its more direct relevance to the underlying mechanisms. The effect of CBT-I on hyperarousal symptoms and subjective sleep quality accounted for 41,9 % of the difference in insomnia symptoms, while the most comprehensive model (initial anxiety and CBT-I effects on hyperarousal and sleep quality) explained 48,1 %.
CONCLUSIONS: The findings underscore the substantial significance of a strong therapeutic alliance, individual characteristics, and the role of hyperarousal in insomnia, supporting a personalized and relationally grounded approach to insomnia treatment.