title: Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?
abstract: OBJECTIVE
  To evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression.
  
  
  METHODS
  Prospective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms.
  
  
  RESULTS
  Participation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74-14.27, P<0.0001) after CBT and at follow-up (13.78, P<0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15-3.35, P<0.0001) and anxiety symptoms (4.52-3.95, P<0.0001), maintained at 3 months with mean depression symptoms (3.17, P<0.0001) and mean anxiety symptoms (3.62, P<0.0001). Sleepiness increased between baseline and the end of the group (6.67-7.24, P=0.015) followed by a reduction at 3 months (7.19-6.34 at 3 months, P=0.001). Initial ISI score but neither sex nor age were predictive of outcome.
  
  
  CONCLUSIONS
  A short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France; Hôpital Antoine-Béclère, sleep disorders center, AP-HP, 92140 Clamart, France. Electronic address: sarah.hartley@reseau-morphee.fr.
authors.forename: S
authors.initials: S
authors.lastname: Hartley
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France.
authors.forename: S
authors.initials: S
authors.lastname: Dagneaux
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France; EA 4047, hôpital Raymond-Poincaré, sleep center, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 92380 Garches, France.
authors.forename: V
authors.initials: V
authors.lastname: Londe
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France.
authors.forename: M-T
authors.initials: MT
authors.lastname: Liane
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: Aussert
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France; Hôpital Antoine-Béclère, sleep disorders center, AP-HP, 92140 Clamart, France.
authors.forename: C
authors.initials: C
authors.lastname: Colas des Francs
authors.affiliation: Réseau Morphée, 2, Grande-Rue, 92380 Garches, France; Hôpital Antoine-Béclère, sleep disorders center, AP-HP, 92140 Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Royant-Parola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology / Q000628:therapy; D006970:Disorders of Excessive Somnolence / Q000523:psychology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011615:Psychotherapy, Group; D012017:Referral and Consultation; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anxiety; Anxiété; CBT; Cognitive behavioural therapy; Depression; Dépression; Insomnia; Insomnie; Sleep disorders; TCC; Thérapie cognitivocomportementale; Troubles du sommeil