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25 Piloting modified cognitive behavioural therapy for insomnia (CBT-I) in a community mental health team (CMHT)
  1. Vinay Mandagere1,
  2. Phoebe Whishart2 and
  3. Jane Hicks2
  1. 1University of Bristol Medical School, Bristol, UK
  2. 2Avon and Wiltshire Mental Health NHS Partnership Trust, Bristol, UK


Introduction Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first line therapy for insomnia, a common risk factor in psychiatry. We investigated whether piloting a CBT-I programme within a Community Mental Health Team (CMHT) improves insomnia symptoms. Our programme consisted mainly of Sleep Restriction Therapy (SRT) determined by individual chronotypes. CBT-I is currently under-resourced in the UK. To our knowledge, this was the first NHS programme in Bristol secondary mental health.

Methods 10 participants were recruited. Participants underwent a therapist guided initiation on (a) Sleep education (b) Sleep hygiene (c) Stimulus Control. Individual sleep windows were determined by the participants’ chronotype: whether they were a ‘morning lark’ or ‘evening owl’. Participants then underwent a 6-week course of Sleep Restriction Therapy (SRT). Weekly follow up focussed around motivation and explanation was either by phone or face-to-face due to the COVID-19 pandemic. Outcome measurements used pre- and post-intervention sleep diaries; as well as insomnia, depression (PHQ-9) and general health questionnaires (SF-36).

Results There was little improvement in Total Sleep Time (TST) (d= -0.84 hours) and patient-reported sleep quality (d= -0.67) following a 6-week course of modified CBT-I. Despite this, average number of mid-sleep awakenings roughly halved (47.9%). ISI, PHQ-9 and SF-36 questionnaires demonstrated no difference between pre-intervention and post-intervention scores. Unstructured interviews revealed that patients’ thoughts and anxieties at night-time interfered with SRT.

Conclusions Our study suggests that modified CBT-I is a challenge for mental health populations. Solely SRT may not be sufficient to treat insomnia secondary to mental illness. Treating co-morbid insomnia may therefore require multi-component CBT-I to address sleep-related mental health issues, such as panic attacks, flashbacks and nightmares. CBT-I in secondary mental health services requires further development, with long-term follow up of patients to evaluate adherence to the programme and the behavioural changes needed.

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