This pilot study by Tomfohr-Madsen and colleagues found that cognitive behavioural therapy for insomnia improved sleep variables and reduced symptoms of depression, anxiety, and fatigue in pregnant women.
The researchers found that five weekly group sessions of a modified cognitive behavioural therapy for insomnia (CBT-I) protocol were associated with a significant reduction in insomnia symptoms, improvement on measures of subjective sleep, and improvement on actigraphy-assessed (human rest/activity cycles measured using an Actiwatch II device) sleep variables among pregnant women. They also found that the intervention was associated with significant reductions in symptoms of depression, anxiety, and fatigue. They state that these findings are important, as previous observational research suggests that without intervention, each of these variables tend to worsen as pregnancy progresses. They also note that this study was the first to assess CBT-I in pregnancy.
Lianne M. Tomfohr-Madsen, Zahra M. Clayborne, Codie R. Rouleau, and Tavis S. Campbell
University of Calgary, Alberta Children’s Hospital Research Institute for Child and Maternal Health, and Alberta Children’s Hospital, Canada
The researchers evaluated of the impact of a five-week, group CBT-I intervention for reducing symptoms of insomnia and improving subjective and objective measures of sleep quality and quantity. They also evaluated the impact of CBT-I on reducing the secondary outcomes of symptoms of depression, anxiety, and fatigue. Finally, they sought to establish the feasibility and acceptability of the intervention among pregnant women.
The researchers noted that pregnant women have traditionally been excluded from psychotherapy intervention research due to potential risks associated with exposure and behavioral treatment. Pregnant women have also been excluded from the insomnia treatment literature, prompting further development and evaluation of interventions to treat insomnia during pregnancy and the postpartum. The researchers claimed to their knowledge, only one pilot study to date had examined the effectiveness of CBT-I in the perinatal period. Despite the prevalence of insomnia in pregnancy, the demonstrated effectiveness of CBT-I for treatment of insomnia, and the reluctance of pregnant women to consider pharmacotherapy for the treatment of sleep problems, they stated that no trials to date had investigated the application of a CBT-I intervention to treat insomnia during pregnancy.
The researchers analysed the data from a final sample of 13 women who were in the second trimester of pregnancy (between 12 to 28 weeks pregnant) and experienced impairment associated with insomnia, and score > 7 on the Insomnia Severity Index (ISI). Participants completed questionnaires that assessed demographics, health practices, sleep, and psychological variables, and completed two nights of actigraphy monitoring before and after the 5-week CBT-I intervention.
ScientiFix tip: As the researchers have pointed out, this was open pilot study that did not have a control group. This means that there is no other group to which comparisons of the results on the sleep, fatigue, and mood measures following CBT-I can be made. Therefore, the researchers can not rule out that the CBT-I is better than standard CBT or another form of treatment or therapy for insomnia, nor can they rule out this is purely an effect of the treatment itself and not outside factors. That is because having a waitlist control group serves as a good comparison for a treatment group to establish that symptoms have not simply just improved over the duration of the trial. Therefore, while this is a very promising finding, the sample is quite small and a larger randomised controlled trial is necessary.