Psychological effects of cognitive behaviour therapy (CBT) for persistent insomnia associated with cancer: randomised controlled trial (RCT)

Introduction: Insomnia can be caused, or exacerbated, by the stress of having cancer, and up to 40% of patients report persistent sleep problems. Whereas CBT is effective for primary insomnia, the treatment literature on insomnia related to cancer is sparse. Moreover, little in known about psychological changes following CBT for insomnia in this population. Methods: Pragmatic, two-centre RCT of CBT versus treatment as usual (TAU). Patients meeting diagnostic criteria for persistent insomnia recruited after completion of active anti-cancer therapy for breast, prostate, colorectal or gynaecological cancer. Major assessments at baseline, post-treatment and 6-month follow-up. CBT comprised 5, weekly, 1-h, small group sessions led by a cancer nurse following a validated CBT manual. TAU comprised usual care. Outcomes measured using validated and reliable questionnaires/rating scales of dysfunctional thinking and attribution. Results: Data from 150 participants (103F; mean age 61 year) analysed on intention-to-treat basis. Significant reductions in subscales of the Dysfunctional Beliefs and Attitudes about Sleep scale (range of ES 5 0.65–1.04), and the Sleep Disturbance Questionnaire (range of ES 5 0.95–1.18), observed in CBT at post-treatment, relative to TAU. These ES increased to .95–1.33 for DBAS, and .82–1.37 for SDQ at follow up. Conclusion: Cognitive adjustment associated with successful CBT treatment for insomnia in cancer patients appears similar to that observed in primary insomnia, supporting the notion that insomnia associated with cancer may be treated similarly to the primary insomnia syndrome. Acknowledgement: Support This research was supported by Cancer Research UK and the Dr. Mortimer & Theresa Sackler Foundation.