ACT as an adjunct or alternative to CBT-I review article

Summary

This narrative review compares components of ACT and CBT-I alongside research outcomes. explores the application of acceptance and commitment therapy (ACT) as an adjunct or alternative to cognitive behavioural therapy for insomnia (CBT-I). While CBT-I is the standard treatment for insomnia, adherence can be challenging due to its counterintuitive components. ACT, with it’s emphasis on mindfulness, acceptance, and values-based living, can offer a potentially effective approach to managing insomnia symptoms. This review also includes helpful information about structuring interventions, as well as comparing this to CBT-I.

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Key findings

1. Effectiveness of ACT: Studies show ACT interventions improve sleep quality, reduce insomnia severity, and enhance quality of life. ACT’s emphasis on psychological flexibility and values-based approaches appears particularly beneficial for those who struggle with adherence to CBT-I.
2. Integration with behavioural components: ACT can be effectively combined with CBT-I strategies such as sleep restriction and stimulus control for a holistic treatment approach.
3. Tailored for diverse populations: ACT’s adaptability makes it suitable for individuals with specific challenges such as trauma, chronic pain, or cultural considerations.
4. Addressing insomnia-specific behaviours: Through mindfulness, acceptance, and cognitive defusion, ACT helps reduce counterproductive sleep efforts, reduces cognitive arousal, and improves adherence to behavioural recommendations.
5. Promising outcomes: Pilot studies of ACT-based interventions such as the ABC-I programme demonstrate significant improvements in sleep outcomes, including reduced sleep disruption and increased adherence.

Practice recommendations

• Clinicians can use ACT as a standalone treatment or in conjunction with CBT-I for those struggling with traditional insomnia treatments.
  ACT-based interventions should incorporate mindfulness, cognitive defusion, and acceptance while addressing behavioural insomnia components like sleep restriction.
  Emphasise values-based goal setting to motivate adherence to treatment and improve quality of life.
  Tailor treatment to individuals with comorbid conditions or unique cultural and personal values, ensuring a patient-centred approach.
  Training in ACT may benefit practitioners working with populations that face challenges with traditional CBT-I adherence.

Reference

Saldaña, K. S., McGowan, S. K., & Martin, J. L. (2023). Acceptance and commitment therapy as an adjunct or alternative treatment to cognitive behavioural therapy for insomnia. Sleep Medicine Clinics, 18(1), 73–83. https://doi.org/10.1016/j.jsmc.2022.09.003