Adjunct Goal Clarification Session to Increase Early Treatment Adherence to Cognitive Behavioural Therapy for Insomnia

Insomnia is a severe clinical problem with a multitude of individual and societal consequences. Cognitive behavioural therapy for insomnia (CBT-I) is the gold standard treatment (National Institutes of Health, 2005); however, with response rates ranging from 67 to 75% (Harvey et al., 2014; Sunnhed et al., 2020) there remains room for improvement. Suboptimal patient adherence to CBT-I is one purported mechanism that may diminish treatment outcomes (Matthews et al., 2013). To address this problem, a 1-hour adjunct intervention to the first treatment session of CBT-I was created for the present study, theoretically derived to target early treatment adherence. To test the efficacy of this adjunct, this study compared an intervention group to a control group on their degrees of adherence to therapy recommendations following the first treatment session. Several predictors of adherence were evaluated. Method. Eligible individuals with insomnia disorder (N = 50) were randomly assigned to groups. Prior to the first treatment session, participants in the Goal Clarification group received the 1-hour adjunct session and the control group received a 1-hour general information session. Following treatment session one, participants completed questionnaires assessing treatment readiness, ambivalence, therapeutic alliance, expectations, and perceived barriers. Adherence to specific behavioural strategies was assessed over the following two weeks using a modified version of the Adherence to Behavioural Strategies coding scheme (Tremblay et al., 2009). Results. The control group was significantly more adherent to the recommendation of using the bed only for sleep. No group differences were found on any other adherence index. Groups did not differ in readiness, ambivalence, therapeutic alliance, expectations, or perceived barriers. Of the expected predictors of adherence, treatment acceptability and ambivalence were the only factors that explained a significant amount of the variance in two adherence indices; however, the relationship for treatment acceptability and adherence was negative. Discussion. There are multiple ways to interpret these findings in the context of past literature, such as suboptimal variables being selected as intervention targets to improve participant adherence. However, conclusions are limited due to low statistical power. Further research into interventions for treatment non-responders, rather than improvements to existing CBT-I protocols, is encouraged.