Cognitive Behavioral Therapy for Chronic Insomnia: Confronting the Challenges to Implementation

Editorials19 July 2016Cognitive Behavioral Therapy for Chronic Insomnia: Confronting the Challenges to ImplementationRoger G. Kathol, MD and J. Todd Arnedt, PhDRoger G. Kathol, MDFrom University of Minnesota, Minneapolis, Minnesota, and University of Michigan Medical School, Ann Arbor, Michigan. and J. Todd Arnedt, PhDFrom University of Minnesota, Minneapolis, Minnesota, and University of Michigan Medical School, Ann Arbor, Michigan.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0359 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this week's Annals, systematic reviews on pharmacotherapy (1) and psychological therapies (2) accompany new clinical practice guidelines for treatment of chronic insomnia from the American College of Physicians (ACP) (3). The ACP recommends cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment. Although the evidence clearly supports this recommendation, it raises several challenges for implementation.First, some clinicians do not recognize insomnia as a health problem, often considering it merely a symptom secondary to another condition. Second, many clinicians and their patients harbor biases against and are reluctant to consider "psychological" interventions (4). Third, the number of practitioners trained ...References1. Wilt TJ, MacDonald R, Brasure M, Olson CM, Carlyle M, Fuchs E, et al. Pharmacologic treatment of insomnia disorder: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med. 2016;165:103-12. doi:10.7326/M15-1781 LinkGoogle Scholar2. Brasure M, Fuchs E, MacDonald R, Nelson VA, Koffel E, Olson CM, et al. Psychological and behavioral interventions for managing insomnia disorder: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med. 2016;165:113-24. doi:10.7326/M15-1782 LinkGoogle Scholar3. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165:125-33. doi:10.7326/M15-2175 LinkGoogle Scholar4. Cheung JM, Bartlett DJ, Armour CL, Glozier N, Saini B. Insomnia patients' help-seeking experiences. Behav Sleep Med. 2014;12:106-22. [PMID: 23514322] doi:10.1080/15402002.2013.764529 CrossrefMedlineGoogle Scholar5. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34:601-8. [PMID: 21532953] CrossrefMedlineGoogle Scholar6. Gagnon C, Bélanger L, Ivers H, Morin CM. Validation of the Insomnia Severity Index in primary care. J Am Board Fam Med. 2013;26:701-10. [PMID: 24204066] doi:10.3122/jabfm.2013.06.130064 CrossrefMedlineGoogle Scholar7. Trockel M, Karlin BE, Taylor CB, Manber R. Cognitive behavioral therapy for insomnia with veterans: evaluation of effectiveness and correlates of treatment outcomes. Behav Res Ther. 2014;53:41-6. [PMID: 24412462] doi:10.1016/j.brat.2013.11.006 CrossrefMedlineGoogle Scholar8. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:629-40. [PMID: 15939840] CrossrefMedlineGoogle Scholar9. Zachariae R, Lyby MS, Ritterband LM, O'Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia—A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2015;30:1-10. [PMID: 26615572] doi:10.1016/j.smrv.2015.10.004 CrossrefMedlineGoogle Scholar10. Manderscheid R, Kathol R. Fostering sustainable, integrated medical and behavioral health services in medical settings. Ann Intern Med. 2014;160:61-5. [PMID: 24573665]. doi:10.7326/M13-1693 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Minnesota, Minneapolis, Minnesota, and University of Michigan Medical School, Ann Arbor, Michigan.Corresponding Author: Roger G. Kathol, MD, 3004 Foxpoint Road, Burnsville, MN 55337; e-mail, [email protected]com.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0359.Current Author Addresses: Dr. Kathol: 3004 Foxpoint Road, Burnsville, MN 55337.Dr. Arnedt: 1500 East Medical Center Drive, University of Michigan Medical School, Ann Arbor, MI 48109.This article was published at www.annals.org on 3 May 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPharmacologic Treatment of Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians Timothy J. Wilt , Roderick MacDonald , Michelle Brasure , Carin M. Olson , Maureen Carlyle , Erika Fuchs , Imran S. Khawaja , Susan Diem , Erin Koffel , Jeannine Ouellette , Mary Butler , and Robert L. Kane Psychological and Behavioral Interventions for Managing Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians Michelle Brasure , Erika Fuchs , Roderick MacDonald , Victoria A. Nelson , Erin Koffel , Carin M. Olson , Imran S. Khawaja , Susan Diem , Maureen Carlyle , Timothy J. Wilt , Jeannine Ouellette , Mary Butler , and Robert L. Kane Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Devan Kansagara , Mary Ann Forciea , Molly Cooke , Thomas D. Denberg , and Metrics Cited byThe effect of cognitive behavioural therapy for insomnia on sedative-hypnotic use: A narrative reviewEffectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus: A community-based randomized controlled trial in ChinaA Drosophila model of sleep restriction therapy for insomniaSleep TelemedicineThe European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatmentSummary of Insomnia CBTI Cases and Literature ReviewTraditional Chinese medicine non-pharmaceutical therapies for chronic adult insomniaAcceptability, tolerability, and potential efficacy of cognitive behavioural therapy for Insomnia Disorder subtypes defined by polysomnography: A retrospective cohort studyNon-pharmacological interventions for improving postpartum maternal sleep: A systematic review and meta-analysisIncreasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative reviewCognitive behavioral therapy (CBT) for preventing Alzheimer's disease 19 July 2016Volume 165, Issue 2Page: 149-150KeywordsBehaviorDisclosureDrug therapyHealth careInsomniaMedical servicesSleepSystematic reviewsTelemedicineTreatment guidelines ePublished: 3 May 2016 Issue Published: 19 July 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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