Comparison of ACT and CBT for chronic insomnia: A pilot randomised controlled trial

This pilot randomised controlled trial compared the efficacy of acceptance and commitment therapy (ACT) with cognitive behaviour therapy for insomnia (CBT-I) in adults with chronic primary insomnia. Over a four-week period, participants received either ACT or CBT-I through a combination of four face-to-face therapy and four online consultations. Both interventions significantly improved sleep quality, insomnia severity, and depressive symptoms. However, ACT demonstrated additional benefits in reducing anxiety, underscoring its potential as an alternative for individuals not responding to CBT-I or those with high sleep-related anxiety.

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Key findings

• Improvements in sleep and mood: Both ACT and CBT-I effectively reduced insomnia severity, improved sleep quality, and alleviated depressive symptoms.
• Reduction in anxiety: Anxiety symptoms improved significantly in the ACT group but not in the CBT-I group, suggesting ACT’s advantage for individuals with high levels of anxiety.
• Sleep efficiency and latency: Both groups showed improvements in sleep onset latency (SOL), while sleep efficiency (SE) improved significantly in the ACT group.
• Dysfunctional beliefs versus emotional regulation: CBT-I had stronger effects on reducing dysfunctional beliefs about sleep, whereas ACT was more effective at addressing anxiety and depressive symptoms.

Recommendations

• For patients with insomnia who experience significant anxiety related to their sleep, ACT may provide a more suitable alternative to traditional CBT-I.
• Clinicians should consider incorporating ACT, particularly for individuals who struggle with the behavioural components of CBT-I, such as sleep restriction or stimulus control.
• ACT’s focus on acceptance, mindfulness, and psychological flexibility offers unique benefits, particularly for patients with mood-related symptoms that exacerbate insomnia.
• Future treatments could integrate both approaches, leveraging CBT-I’s strength in addressing dysfunctional beliefs and ACT’s effectiveness in managing emotional and psychological factors.

Reference

Shin, J. W., Kim, S., Shin, Y. J., Park, B., & Park, S. (2023). Comparison of acceptance and commitment therapy (ACT) and cognitive behaviour therapy (CBT) for chronic insomnia: A pilot randomized controlled trial. Nature and Science of Sleep, 15, 523–531. https://doi.org/10.2147/NSS.S409981