Sleep-related metacognitions and cognitive behavioral therapy for insomnia

Abstract

Background: Cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice for chronic insomnia. In the metacognitive model of Ong et al., a current model of the pathogenesis of chronic insomnia, sleep-related metacognitions are considered to be an insomnia-promoting factor. Objective: The objective of this study is to investigate the role of metacognitions in insomnia and CBT‑I. Are metacognitions reduced by CBT-I? Can the pretreatment scores of sleep-related metacognitions predict the effectiveness of the therapy? Does treatment response improve when sleep-related metacognitions are directly addressed? Materials and methods: A total of 92 persons with chronic insomnia participated in CBT‑I with seven 90-min group sessions. Of these patients, 52 received CBT‑I and 40 received CBT‑I with integrated metacognitive elements (CBT-I + MCE). Sleep-related metacognitions and insomniac complaints were quantified using the Metacognitions Questionnaire—Insomnia (MCQ‑I 20) and the Insomnia Severity Index (ISI). Results: CBT‑I improved subjective sleep quality (effect sizes d > 2.0) and decreased sleep-related metacognitions (effect sizes d > 0.8). Neither the presence of comorbidities nor the extent of sleep-related metacognitions affected treatment response. Treatment response did not differ between the CBT‑I and CBT-I + MCE groups. Conclusion: Sleep-related metacognitions seem to play an important role in insomnia etiology but did not predict treatment response. The introduction of elements from metacognitive therapy (MCT) is as effective as the classical CBT‑I and might therefore be considered as an addition to the standard cognitive strategies of CBT‑I.