title: Sequential treatment for chronic insomnia: a pilot study.
abstract: This article explores the efficacy of sequential treatment involving medication and cognitive behavioral treatment (CBT) for insomnia. In a multiple baseline across-subjects design, 6 participants with primary chronic insomnia received 1 of the following treatment sequences: (a) concurrent combination of medication and CBT for the 10-week treatment duration (Combined); (b) medication for the first 5 weeks, with introduction of CBT at week 4 and medication withdrawal after the 5th week resulting in treatment overlap during weeks 4 and 5 (Overlapping: Medication --> Combined --> CBT); and (c) medication alone for the first 5 weeks followed by CBT alone for an additional 5 weeks (Medication --> CBT). Each sequence led to significant sleep improvements, but these improvements occurred at different times during the intervention. Participants in the Combined and in the Overlapping sequences improved their sleep during the 1st phase of treatment, whereas those in the Medication --> CBT sequence improved mostly during the 2nd phase of treatment. These preliminary results suggest that a sequential treatment is effective for chronic insomnia. In addition, the results suggest that sleep improvements are more likely to emerge when CBT is introduced, with an Overlapping sequence showing a slight advantage over the other sequences. Additional clinical trials should be conducted with larger samples to replicate these preliminary findings.
authors.affiliation: Ecole de Psychologie, Université Laval, Québec, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Vallières
authors.forename: Charles M
authors.initials: CM
authors.lastname: Morin
authors.forename: Bernard
authors.initials: B
authors.lastname: Guay
authors.forename: Célyne H
authors.initials: CH
authors.lastname: Bastien
authors.forename: Mélanie
authors.initials: M
authors.lastname: LeBlanc
mesh_terms: D000328:Adult; D053961:Azabicyclo Compounds; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004594:Electrophysiology / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010879:Piperazines / Q000627:therapeutic use; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*
chemical_list: D053961:Azabicyclo Compounds; D010879:Piperazines; C515050:zopiclone