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VOLUME 37, ISSUE 08

RANDOMIZED TRIAL OF VIDEO-BASED CBT FOR INSOMNIA IN BREAST CANCER
Is a Video-Based Cognitive Behavioral Therapy for Insomnia as Efficacious as a Professionally Administered Treatment in Breast Cancer? Results of a Randomized Controlled Trial

http://dx.doi.org/10.5665/sleep.3918

Josée Savard, PhD1,2,3; Hans Ivers, PhD1,2,3; Marie-Hélène Savard, PhD2,3; Charles M. Morin, PhD1

1School of Psychology, Université Laval, Québec, Canada; 2Centre de recherche sur le cancer, Université Laval, Québec, Canada; 3Centre de recherche du CHU de Québec, Québec, Canada



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Study Objective:

To assess the short-term efficacy of a video-based cognitive behavioral therapy for insomnia (CBT-I) as compared to a professionally administered CBT-I and to a no-treatment group.

Design:

Randomized controlled trial.

Setting:

Radio-oncology department of a public hospital affiliated with Université Laval (CHU de Québec).

Participants:

Two hundred forty-two women with breast cancer who had received radiation therapy in the past 18 mo and who had insomnia symptoms or were using hypnotic medications were randomized to: (1) professionally administered CBT-I (PCBT-I; n = 81); (2) video-based CBT-I (VCBT-I; n = 80); and (3) no treatment (CTL; n = 81).

Interventions:

PCBT-I composed of six weekly, individual sessions of approximately 50 min; VCBT-I composed of a 60-min animated video + six booklets.

Measurement and Results:

Insomnia Severity Index (ISI) total score and sleep parameters derived from a daily sleep diary and actigraphy, collected at pretreatment and posttreatment. PCBT-I and VCBT-I were associated with significantly greater sleep improvements, assessed subjectively, as compared to CTL. However, relative to VCBT-I, PCBT-I was associated with significantly greater improvements of insomnia severity, early morning awakenings, depression, fatigue, and dysfunctional beliefs about sleep. The remission rates of insomnia (ISI < 8) were significantly greater in PCBT-I as compared to VCBT-I (71.3% versus 44.3%, P < 0.005).

Conclusions:

A self-administered cognitive behavioral therapy for insomnia (CBT-I) using a video format appears to be a valuable treatment option, but face-to-face sessions remain the optimal format for administering CBT-I efficaciously in patients with breast cancer. Self-help interventions for insomnia may constitute an appropriate entry level as part of a stepped care model.

Trial Registration:

ClinicalTrials.gov Identifier: NCT00674830.

Citation:

Savard J, Ivers H, Savard MH, Morin CM. Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial. SLEEP 2014;37(8):1305-1314.

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