title: Effectiveness of a CBT Intervention for Persistent Insomnia and Hypnotic Dependency in an Outpatient Psychiatry Clinic.
abstract: OBJECTIVE
  To test cognitive-behavioral therapy for insomnia (CBT-I) in patients who not only receive psychiatric treatment in a outpatient psychiatry clinic but also continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. CBT-I included an optional module for discontinuing hypnotic medications.
  
  
  METHODS
  Patients were randomized to 5 sessions of individual CBT-I (n = 13) or treatment as usual (n = 10). Sleep parameters were assessed using sleep diaries at pre- and posttreatment. Questionnaires measuring depression, anxiety, and health-related quality of life were also administered.
  
  
  RESULTS
  CBT-I was associated with significant improvement in sleep, with 46% obtaining normal global sleep ratings after treatment. However, no changes in secondary outcomes (depression, anxiety, quality of life) were obtained and no patients elected to discontinue their hypnotic medications.
  
  
  CONCLUSIONS
  Patients with complex, chronic psychiatric conditions can obtain sleep improvements with CBT-I beyond those obtained with pharmacotherapy alone; however, sleep interventions alone may not have the same effect on mental health outcomes in samples with more severe and chronic psychiatric symptoms and dependency on hypnotic medications.
authors.affiliation: Rush University Medical Center.
authors.forename: Hannah Lund
authors.initials: HL
authors.lastname: Taylor
authors.affiliation: Virginia Commonwealth University.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Rybarczyk
authors.affiliation: Virginia Commonwealth University.
authors.forename: William
authors.initials: W
authors.lastname: Nay
authors.affiliation: Virginia Commonwealth University.
authors.forename: David
authors.initials: D
authors.lastname: Leszczyszyn
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy
chemical_list: D006993:Hypnotics and Sedatives
keywords: CBT for insomnia; comorbid insomnia; hypnotic dependency; insomnia; psychiatric comorbidity