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Sleep Med Rev. 2019 Nov 9;49:101230. doi: 10.1016/j.smrv.2019.101230. [Epub ahead of print]

Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis.

Author information

1
College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; University of Washington School of Nursing, Seattle, WA, USA. Electronic address: manu.thakral@umb.edu.
2
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
3
University of Washington School of Nursing, Seattle, WA, USA.
4
School of Psychology, Université Laval, Quebec City, Quebec, Canada.
5
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.

Abstract

Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.

KEYWORDS:

CBT-I; Cognitive behavioral therapy; DBAS; Dysfunctional beliefs about sleep; Insomnia; Sleep-related cognitions

PMID:
31816582
DOI:
10.1016/j.smrv.2019.101230

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