title: Social Support, Insomnia, and Adherence to Cognitive Behavioral Therapy for Insomnia After Cancer Treatment.
abstract: While cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be efficacious in treating cancer survivors' insomnia, 30-60% of individuals have difficulty adhering to intervention components. Psychosocial predictors of adherence and response to CBT-I, such as social support, have not been examined in intervention studies for cancer survivors.
  
  
  
  Data from a randomized placebo-controlled 2 x 2 trial of CBT-I and armodafinil (a wakefulness promoting agent) were used to assess adherence. Ninety-six cancer survivors participated in the trial (mean age 56, 86% female, 68% breast cancer).
  
  
  
  CBT-I and armodafinil were administered over the course of seven weeks, and participants were assessed at baseline, during intervention, postintervention, and at a three-month follow-up. Social support was assessed using a Functional Assessment of Chronic Illness Therapy subscale, insomnia severity was assessed using the Insomnia Severity Index, and adherence was measured based on CBT-I sleep prescriptions.
  
  
  
  At baseline, social support was negatively correlated with insomnia severity (r = -0.30, p = 0.002) and associations between social support, CBT-I, and insomnia were maintained through the three-month follow-up. Social support was positively associated with adherence to CBT-I during intervention weeks 3, 4, and 5, and with overall intervention adherence. At postintervention, both social support and treatment with CBT-I independently predicted decreased insomnia severity (p < 0.01) when controlling for baseline insomnia severity.
  
  
  
  Higher social support is associated with better intervention adherence and improved sleep independent of CBT-I. Additional research is needed to determine whether social support can be leveraged to improve adherence and response to CBT-I.
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Charles
authors.initials: C
authors.lastname: Kamen
authors.affiliation: b Department of Psychology , Memorial University of Newfoundland , St. John's , Newfoundland and Labrador , Canada.
authors.forename: Sheila N
authors.identifier: 0000-0002-6119-318X
authors.initials: SN
authors.lastname: Garland
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Heckler
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Peoples
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Kleckner
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Calvin L
authors.initials: CL
authors.lastname: Cole
authors.affiliation: c Department of Psychiatry , University of Pennsylvania , Philadelphia , Pennsylvania.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Perlis
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Morrow
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Mustian
authors.affiliation: a Department of Surgery , University of Rochester Medical Center , Rochester , New York.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Roscoe
mesh_terms: D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D012944:Social Support; D016896:Treatment Outcome