CBT-I CBT-I Treatment Outcomes & Research Evidence 2 — Questions and Answers
Question 1: Remission from insomnia after CBT-I is typically defined as:
- ISI score at or below 7 and sleep efficiency above 85% (Correct answer)
- Complete absence of any nighttime awakening
- Total sleep time of 8 or more hours nightly
- Patient report of feeling fully rested every morning
Correct answer: ISI score at or below 7 and sleep efficiency above 85%
Remission criteria typically include an ISI below the clinical threshold (≤7) and/or sleep efficiency exceeding 85%.
Question 2: Long-term follow-up studies of CBT-I typically assess durability of outcomes at:
- 2 weeks post-treatment
- 6-12 months post-treatment (Correct answer)
- 5 years post-treatment
- Daily for the first year
Correct answer: 6-12 months post-treatment
Most CBT-I trials assess durability at 6 and 12 months post-treatment, with some studies extending to 2 years.
Question 3: Meta-analyses on CBT-I consistently show the largest effect sizes for:
- Total sleep time
- Sleep onset latency and wake after sleep onset (Correct answer)
- Number of awakenings only
- Daytime napping behavior
Correct answer: Sleep onset latency and wake after sleep onset
Effect sizes for SOL and WASO are consistently the largest in CBT-I meta-analyses, reflecting the treatment's strong impact on nighttime wakefulness.
Question 4: Which predictor most consistently predicts better CBT-I outcomes in research studies?
- Younger age
- Higher baseline insomnia severity
- Greater treatment adherence (Correct answer)
- Lower baseline anxiety
Correct answer: Greater treatment adherence
Treatment adherence — particularly consistent use of sleep restriction and stimulus control — is the strongest predictor of CBT-I success.
Question 5: The Harvey cognitive model of insomnia identifies which maintaining factor as central?
- Reduced homeostatic drive
- Selective attention and monitoring for sleep-related threats (Correct answer)
- Circadian phase delay
- REM sleep abnormalities
Correct answer: Selective attention and monitoring for sleep-related threats
Harvey's cognitive model posits that selective attention to sleep-related cues and threats perpetuates arousal and maintains insomnia.
Question 6: In comparing CBT-I alone to sleep medication combined with CBT-I, research generally finds:
- Combined treatment is always superior in long-term follow-up
- CBT-I alone and combination therapy produce similar long-term outcomes, with some studies favoring CBT-I alone (Correct answer)
- Medication alone is superior at 12 months
- Combined therapy is significantly worse due to medication dependence
Correct answer: CBT-I alone and combination therapy produce similar long-term outcomes, with some studies favoring CBT-I alone
Studies including the Morin et al. landmark trial show that CBT-I alone produces outcomes equivalent to or better than combination therapy at long-term follow-up.
CBT-I CBT-I Treatment Outcomes & Research Evidence 2
Remission from insomnia after CBT-I is typically defined as: