title: Effectiveness of a cognitive behavioral self-help program for patients with primary insomnia in general practice - a pilot study.
abstract: OBJECTIVE
  This study was conducted to evaluate the effectiveness of a cognitive behavioral self-help program (SHP) in combination with pharmacotherapy in patients with primary insomnia in general practice.
  
  
  METHODS
  Patients were recruited from 31 general practitioners (GPs) in the Hamburg area, who were randomly assigned to the two different study conditions. Eighty patients completed the study. They had suffered from insomnia for several years and showed a high impairment according to the Pittsburgh Sleep Quality Index.
  
  
  METHODS
  According to assignment of their GP the patients either received a progressively reduced 4-week pharmacotherapy or a combination of pharmacotherapy and a SHP consisting of six chapters on progressive muscle relaxation, cognitive relaxation, modified stimulus control, thought stopping, and cognitive restructuring.
  
  
  RESULTS
  After study enrollment patients had short weekly consultations with their GPs during treatment to receive sleep medication and questionnaires. They completed questionnaires measuring general sleep quality and sleep-disruptive beliefs and also sleep diaries before treatment, during treatment, immediately following treatment, and at a 6-week and 6-month follow-up time point. For collection of changes in mood the Beck Depression Inventory was used. The whole sample showed reductions of sleep onset latency and time awake after sleep onset. Total sleep time increased and mood improved. Patients additionally working with the SHP showed significantly more improvements in sleep quality and negative sleep-related cognitions like ruminating and focusing on sleep. Treatment effects were significant at the end of therapy and remained stable at the six-week and six-month follow-up.
  
  
  CONCLUSIONS
  This study supports the use of a cognitive-behavioral SHP on primary insomnia in the setting of a general practice and should be investigated in more detail. Also, regular appointments and the utilization of sleep logs seem to have a positive influence on sleep disorders.
authors.affiliation: University of Lübeck, Department of Psychiatry and Psychotherapy, Ratzeburger Allee 160, 23538 Lübeck, Germany. Inga.Katofsky@psychiatrie.uk-sh.de
authors.forename: Inga
authors.initials: I
authors.lastname: Katofsky
authors.forename: Jutta
authors.initials: J
authors.lastname: Backhaus
authors.forename: Klaus
authors.initials: K
authors.lastname: Junghanns
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Rumpf
authors.forename: Michael
authors.initials: M
authors.lastname: Hüppe
authors.forename: Ulrich
authors.initials: U
authors.lastname: von Eitzen
authors.forename: Fritz
authors.initials: F
authors.lastname: Hohagen
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D058006:General Practice / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008140:Lorazepam / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; C023842:lormetazepam; D008140:Lorazepam