A Pilot Randomized Controlled Trial (RCT) of Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Chronic Insomnia

ABSTRACT

Objective

To compare the effectiveness of protocols for acceptance and commitment therapy for insomnia (ACT-I) and cognitive behavioral therapy for insomnia (CBT-I) in adults.

Method

Participants were 37 adults (74.3% women; M = 43.7 years, SD = 10.7) with chronic insomnia who were randomized to 6 weekly group sessions consisting of ACT-I (n = 19) or CBT-I (n = 18). The primary outcome measures were based on the Insomnia Severity Index (ISI) total score, a measure of insomnia complaints, and included the proportions of treatment responders (defined as a change in score of 8 points or more) and remitters (defined as a final score below 8).

Results

Both treatment modalities significantly reduced insomnia severity. Post-treatment, the proportion of treatment responders was higher in the CBT-I than the ACT-I (64.7% vs. 50.0%, respectively) group and six months later, ACT-I made further improvements whereas CBT-I had a reduced treatment response (58.8% vs. 55.6%, respectively). CBT-I was associated with a higher proportion of insomnia remission at post treatment.

Conclusions

Both CBT-I and ACT-I are effective, with a higher proportion of insomnia remitters in CBT-I post-treatment. The different change trajectories for the two therapy groups provide insights into behavioral change via a cognitive versus contextual approach.

Acknowledgments

We would like to thank all participants; L. Castro, for her statistical advising; Prof. F. Lotufo Neto and D. Suzuki Borges, for their contribution.

Declarations

All authors have seen and approved the manuscript.

Disclosure statement

CCM receives research support from Idorsia and Canopy Health; has participated in the advisory boards for Merck, Eisai, Pear Therapeutics, Sunovion.

Additional information

Funding

RER-F receives research support from the São Paulo State Research Support Foundation (FAPESP) [case number Fundação de Amparo a Pesquisa do Estado de São Paulo 2018/19506-5 and 2019/25537-3].