Study On The Application Of Formal Feedback In Brief Behavioral Therapy For Insomnia

Objective:Brief Behavioral Therapy for Insomnia(BBTI)is a simplified version of Cognitive Behavioral Treatment for Insomnia(CBTI),which focuses on behavioral interventions of treatment,with fewer and shorter sessions.It is the first-line treatment for chronic insomnia.However,the existing studies on BBTI have been mostly conducted with elderly insomniacs and still have the limitation of high attrition rate among subjects.Previous studies have shown that the application of formal feedback in clinical psychotherapy can reduce the attrition rate,increase the rate of symptom relief,and bring better treatment results.Therefore,in this study,we proposed to use the brief behavioral treatment for insomnia to treat chronic insomnia patients aged 18-80 years old and randomly assigned them into either BBTI treatment group or formal feedback BBTI(feedback-BBTI,f-BBTI)group to investigate the efficacy of BBTI in adult chronic insomnia patients and the effect of the application of formal feedback on the efficacy of BBTI.In addition,the f-BBTI group was further divided into a daily feedback group and an on-demand feedback group according to the intensity of feedback guidance given by the therapist to further investigate the effect of therapist feedback intensity on the efficacy of BBTI.Methods:The subjects included 96 patients who met the diagnostic criteria for chronic insomnia,50 in the BBTI group and 46 in the f-BBTI group.Among them,the number of dropped-out person is 9 in the BBTI group and 6 in the f-BBTI group.The subjects in both groups were required to fill out a one-week sleep diary before treatment,after four weeks of treatment,and at the three-month follow-up after treatment(the main indexes included:Time in bed-TIB,Total sleep time-TST,Sleep onset latency-SOL,Number of awakening-NOA,Wake time after sleep onset-WASO,Sleep efficiency-SE),Insomnia severity index(ISI),Pittsburgh sleep quality index(PSQI),Epworth sleepiness scale(ESS),Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),Dysfunctional beliefs and attitudes about sleep(DBAS-16),Body perception questionnaire(BPQ)and Multidimensional assessment of interoceptive awareness(MAIA).Repeated measures ANOVA was performed on TIB,TST,SOL,NOA,WASO,SE,ISI,PSQI,ESS,SDS,SAS,DBAS-16,BPQ and MAIA between the groups of subjects at the point in time before treatment,after 4 weeks of treatment and at three months after the end of treatment.Results:1.Subjects in the BBTI and f-BBTI groups both showed significant improvements in TIB,SOL,NOA,WASO,SE,ISI,PSQI,SDS,SAS,DBAS,and BPQ from baseline to 4-week posttreatment(p<0.001),no significant changes was found in TST(p=0.369),ESS(p=0.301),MAIA(p=0.399).There was a significant between-group effect in ESS(p<0.037).A time×group interaction effect was found in TIB(p<0.005),and post hoc analysis showed that TIB was significantly smaller in the f-BBTI group than in the BBTI group at 4-week posttreatment level(F=11.640,p=0.001,partialη~2=0.128).2.At the time of 3-month follow-up after the end of treatment,compared with baseline,subjects in the BBTI group and f-BBTI group both showed significant improvements in TIB,TST,SOL,NOA,WASO,SE,ISI,PSQI,SDS,SAS,DBAS,and BPQ(p<0.05),no significant changes was found in ESS(p=0.663)and MAIA(p=0.678).There was a significant between-group effect in ESS(p=0.043).No significant time×group interaction effect for all variables(p>0.05).3.Subgroup analysis of f-BBTI showed that there were significant improvements in TIB,SOL,NOA,WASO,SE,ISI,PSQI,SDS,SAS,DBAS,and BPQ both in the daily feedback group and the on-demand feedback group from baseline to 4 weeks posttreatment(p<0.05),no significant changes was found in TST(p=0.062),ESS(p=0.846),and MAIA(p=0.863).There was a significant time×group interaction effect in SOL(p=0.050)and post hoc analysis showed that in the daily feedback group,the SOL at 4-week posttreatment(19.11±11.90)was significantly smaller than baseline(35.49±23.37),F=5.347,p=0.026,partialη~2=0.123;in the on-demand feedback group,the SOL at 4-week posttreatment(20.27±7.36)was significantly smaller than baseline(55.99±37.92),F=31.036,p<0.001,partialη~2=0.450.Conclusions:1.4 weeks of BBTI can significantly reduce the severity of subjective insomnia in adults with chronic insomnia,reduce non-adaptive lying-in-bed behaviour,sleep latency,number of midnight awakenings and midnight waking time,improve sleep efficiency and sleep quality,alleviate anxiety and depression,adjust patients’adverse sleep-related beliefs and reduce patients’body perception sensitivity.At 3 months follow-up,these effects still persist and significant improvements in total sleep duration can be found.All of these prove the early-term and long-term benefits of BBTI.2.The application of formal feedback can induce patients to reduce their harmful bedtime more quickly and improve their propensity to fall asleep during the day than traditional BBTI treatment.3.The intensity of the therapist’s feedback doesn’t affect the efficacy of the BBTI.