Todd Arnedt, PhD, underscore that challenges lie ahead in implementing CBT-I on a large scale. Kathal, MD, and University of Michigan psychologist J. In an editorial accompanying the AIM article, University of Minnesota physician Roger G. For example, studies show that compared with antidepressant medication alone, CBT-I can significantly reduce depressive symptoms and increase remission rates when used in conjunction with medications, as well as reduce suicidal ideation in veterans. What's more, CBT-I can help to address the co-morbid conditions, research finds. As many as 40 percent of patients remit entirely, often after treatment is discontinued, he adds. Acute, in-person treatment of four to eight sessions cuts in half the time it takes people to fall asleep or get back to sleep when they've woken up during the night, and two-year follow-up assessments show those gains last. "While chronic insomnia is a risk factor if not a precursor to a variety of diseases," says Perlis, "the good news is it represents one of the most modifiable risk factors you could imagine."ĬBT-I is equally effective for simple insomnia and insomnia with co-morbidities, says Perlis, who studies a range of behavioral sleep medicine issues. The endorsement is particularly salient because research is finding increasing evidence that sleep disorders can accompany or signal other psychiatric and medical conditions including weight gain, hypertension, diabetes, cardiovascular disease and even Alzheimer's disease, says Michael Perlis, PhD, director of the behavioral sleep medicine program at the University of Pennsylvania. The article was written by a team led by Philadelphia internist Amir Qaseem, MD, PhD, who heads the ACP's evidence-based medicine and clinical practice guidelines program. The recommendation that CBT-I be the first-line treatment for insomnia appeared as a practice guideline in the July 19 Annals of Internal Medicine, ACP's flagship journal. The strongest and most extensive research is on in-person treatment, but CBT-I is also conducted in groups, in briefer formats, via telephone and Skype, by internet programs and with self-help books. While studies are underway to determine if one of the components of CBT-I is more potent than others, experts hold that the behavioral interventions produce the most rapid and largest clinical effects. (For major depression, the ACP recommends selecting between either CBT or second-generation antidepressants, while for mild to moderate depression, the United Kingdom's medical system recommends CBT with behavioral activation and problem-solving as the go-to treatment.)ĬBT-I is a combination of treatments that includes behavioral therapy interventions, such as sleep restriction and stimulus control cognitive interventions, including restructuring dysfunctional beliefs and decastrophizing negative thoughts about sleep and sleep hygiene to address factors that may augment treatment outcomes. It's the first time a psychological treatment has been given the thumbs up as the preferred treatment by a medical organization, at least in the United States. In July, the organization that represents the internal medicine community in the United States - the American College of Physicians, or ACP - officially endorsed what many meta-analyses have found: Cognitive behavioral therapy for insomnia, or CBT-I, is the best treatment for chronic insomnia disorder and should be the first line of treatment for the approximately 24 million adults suffering from the condition.
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