Objective: Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder. Despite strong evidence supporting the efficacy of CBT-I, a limited number of studies investigated dropout-related factors during treatment. This study aims to test the efficacy of CBT-I and to provide an assessment of predictors for drop-out to treatment in a sample of young adults with chronic insomnia.
Method: A total of 86 young adult patients with chronic insomnia (mean age 24.85 ± 3.83 years, 51 females (59.3%)) were assessed before and after CBT-I with a sleep diary and a battery of questionnaires designed to investigate insomnia severity (Insomnia Severity Index, ISI), sleepiness, dysfunctional sleep-related thoughts, chronotype, depressive symptoms, and perceived stress. Those patients who interrupted therapy before the fourth session were classified as drop-outs. In addition, patients with an ISI decrease ≥ 8 were classified as responders, and patients with a final ISI total score < 8 were classified as remitters.
Results: The results showed significant improvements after treatment in insomnia severity and sleep diaries indices, except for total sleep time. Evening chronotype and prolonged sleep onset latency predicted drop-out from treatment. Vice versa, a high number of awakenings was associated with a higher response rate to CBT-I. Similarly, a reduction in sleepiness, sleep-related dysfunctional thoughts, and an increase in total sleep time were associated with symptom remission.
Conclusions: A tailored treatment focused on the application of behavioral strategies appropriate for evening chronotype in young adult patients could reduce the drop-out rate.
Key words: chronic insomnia, cognitive-behavioral therapy for insomnia, drop-out, young adults
DOI: 10.36131/COGNCL20230104