Group cognitive–behavioral therapy in insomnia: a cross-sectional case-controlled study

Figures & data

Table 1 Scale scores of the PHQ-9, PHQ-15, DBAS-16, and PSQI questionnaires from the GCBT (n=26), zolpidem (n=27), and healthy control (n=31) groups before intervention

Scale	GCBT	Zolpidem	Healthy controls
PHQ-9	7.31±5.88a	6.41±5.54a	1.03±1.56
PHQ-15	5.73±4.40a	4.78±3.00a	1.48±2.29
DBAS-16
Consequence of insomnia	18.42±3.38a	16.74±2.75a	14.58±4.96
Worrying about sleep	22.46±4.38a	21.44±3.40a	15.32±5.75
Sleep expectations	7.42±1.79	6.67±1.94	4.48±2.28
Medication attribution	8.65±1.96	8.00±1.44	7.84±2.84
PSQI
Subjective sleep quality	1.77±0.82a	1.67±0.83a	0.39±0.50
Sleep latency	1.88±1.11a	2.07±0.92a	0.71±0.74
Sleep duration	1.38±1.17a	1.41±1.22a	0.29±0.53
Habitual sleep efficiency	1.62±1.36a	1.67±1.24a	0.13±0.43
Sleep disturbances	1.81±0.75a	1.63±0.49a	0.94±0.44
Use of sleeping medication	2.50±1.03a	2.41±1.18a	0.13±0.34
Daytime dysfunction	1.12±0.82a	0.81±0.79	0.45±0.62

Notes:

a p<0.05 vs healthy control group. Data presented as mean ± SD.

Abbreviations: DBAS-16, Dysfunctional Beliefs and Attitudes about Sleep-16; GCBT, group cognitive–behavioral therapy; PHQ-9, Patient Health Questionnaire-9; PHQ-15, Patient Health Questionnaire-15; PSQI, Pittsburgh Sleep Quality Index.

Table 2 Mean scale scores (mean ± SD) after 16 weeks (in parentheses) and their changes (baseline minus conditioned, immediately after parentheses) in the PHQ-9, PHQ-15, DBAS-16, and PSQI questionnaires from the GCBT (n=26), zolpidem (n=27), and healthy control (n=31) groups

Scale	GCBT	Zolpidem	Healthy controls
PHQ-9	(4.58±4.69) 2.73±4.95a	(3.93±3.56) 2.48±5.87a	(0.94±1.53) 0.10±0.54
PHQ-15	(3.88±3.74) 1.85±3.41a	(4.07±4.04) 0.70±3.36	(1.42±2.17) 0.06±0.25
DBAS-16
Consequence of insomnia	(14.81±4.23) 3.62±4.46a,b	(15.96±3.13) 0.78±1.87	(14.62±3.74) −0.06±0.57
Worrying about sleep	(17.62±4.56) 4.85±5.56a,b	(19.22±3.38) 2.22±3.53a	(15.37±5.45) −0.06±0.63
Sleep expectations	(6.01±2.08) 1.81±2.37a,b	(6.57±2.13) 0.04±1.32	(4.22±2.78) 0.23±1.67
Medication attribution	(7.65±1.81) 1.00±2.17a,b	(8.56±1.67) −0.56±1.87	(7.68±3.54) 0.19±0.70
PSQI
Subjective sleep quality	(1.04±0.72) 0.73±0.92a	(1.22±0.58) 0.45±0.89a	(0.39±0.50) 0.00±0.00
Sleep latency	(1.46±0.95) 0.42±0.90a	(1.89±0.85) 0.19±0.68	(0.71±0.74) 0.00±0.00
Sleep duration	(1.15±1.01) 0.23±0.99	(1.33±1.07) 0.07±1.00	(0.29±0.53) 0.00±0.26
Habitual sleep efficiency	(0.69±1.05) 0.92±1.29a,b	(1.37±1.21) 0.30±1.20	(0.13±0.43) 0.00±0.00
Sleep disturbances	(1.31±0.55) 0.50±0.81a,b	(1.48±0.58) 0.15±0.60	(0.94±0.44) 0.00±0.00
Sleeping medication use	(1.73±1.43) 0.77±1.42a,b	(2.48±1.12) −0.07±1.04	(0.13±0.34) 0.00±0.00
Daytime dysfunction	(0.85±0.83) 0.27±1.04	(0.48±0.89) 0.33±1.00	(0.42±0.62) 0.03±0.18

Notes:

a p<0.05 vs healthy control group.

b p<0.05 vs zolpidem group. Data presented as mean ± SD.

Abbreviations: DBAS-16, Dysfunctional Beliefs and Attitudes about Sleep-16; GCBT, group cognitive–behavioral therapy; PHQ-9, Patient Health Questionnaire-9; PHQ-15, Patient Health Questionnaire-15; PSQI, Pittsburgh Sleep Quality Index.

Table S1 Summary of the manual of group cognitive–behavioral therapy

Course and theme	Therapist’s role	Patient’s role
1. Insomnia self-management (I)	T1.1. Demonstrate the role of self-management and the power of teamwork T1.2. Guide patients to establish a team contract	P1.1. Introduce self P1.2. Join a team by a contract P1.3. Set goals for the following 2 weeks
2. Insomnia self-management (II)	T2.1. Demonstrate the role and the meaning of positive action T2.2. Deliver techniques and skills of sleep self-monitoring and time management	P2.1. Feedback what has been accomplished according to goals set during the last course P2.2. Set goals for the following 2 weeks
3. Misunderstanding of insomnia	T3.1. Evaluate the therapy effect of the previous 4 weeks T3.2. Deliver the knowledge of sleep hygiene and sleep energy T3.3. Demonstrate the effects of medication/drugs and alcohol on sleep	P3.1. Feedback what has been accomplished according to goals set during the last course P3.2. Brainstorm for realizing some misunderstandings of insomnia P3.3. Set goals for the following 2 weeks
4. Positive behavior training	T4.1. Demonstrate roles of aerobic exercise and positive interpersonal communication and interests on sleep	P4.1. Feedback what has been accomplished according to goals set during last course P4.2. Set goals for the following 2 weeks
5. Relaxation therapy	T5.1. Demonstrate the role of relaxation T5.2. Guide patients doing relaxation training	P5.1. Feedback what has been accomplished according to goals set during the last course P5.2. Do some relaxation training, eg, abdominal respiration, progressive muscle relaxation, and guided imagination P5.3. Set goals for the following 2 weeks
6. Cognitive restructuring	T6.1. Deliver techniques of distinguishing thought traps T6.2. Deliver techniques of how to operate programmed theoretical knowledge	P6.1. Feedback what has been accomplished according to goals set during the last course P6.2. Discuss techniques to minimize negative thoughts P6.3. Set goals for the following 2 weeks
7. Physical treatment	T7.1. Feedback through electroencephalogram T7.2. Feedback with visible music	P7.1. Feedback what has been accomplished according to goals set during the last course P7.2. Set goals for the following 2 weeks
8. Sleep self-efficiency improvement	T8.1. Emphasize the importance of the repeated therapy T8.2. Deliver techniques to prevent insomnia relapse	P8.1. Feedback what has been accomplished according to goals set during the last course P8.2. Get in touch with team members in the future

Notes: Each session lasted for 2 weeks; sleep hygiene practices included diet, exercise, and environmental preparations.