Acceptance and Commitment Therapy for Insomnia

Study Overview
=================
Brief Summary
-----------------
Insomnia is a frequent complaint and is associated with impairments in physical and psychological health. Although Cognitive-Behavioral Therapy (CBT) demonstrates effective results for insomnia, there are those who do not respond to this type of intervention or present difficulties in adherence. Acceptance and Commitment Therapy (ACT) presents itself as a potentially useful intervention for the treatment of insomnia, for which, instead of focusing on controlling the symptoms, the respective approach focuses on accepting the feelings and thoughts associated, through value-based actions. The aim of this study is to evaluate the effectiveness of ACT for chronic insomnia in adults. Participants will be 150 adults aged between 18 and 59 years, diagnosed with chronic insomnia who will be randomly assigned to the ACT, CBT and wait list (WL) groups. For both groups (ACT and CBT), the intervention will be performed in six group and weekly sessions. Assessments of sleep patterns, insomnia, depression, anxiety, psychological flexibility, acceptance of sleep, beliefs about sleep, personality traits will be performed in the pre-treatment, post-treatment and six-month follow-up. After the intervention is completed, participants will respond to an inventory of compliance and satisfaction. Treatment effects will assessed using the fixed effects of group variables (ACT vs. CBT-I and ACT vs. waitlist) and their interaction with time (pre-test vs. post-test and pretest vs. six-month follow-up). Estimated pairwise contrasts to examine changes across time within groups will be used. Variables will analyzed using generalized mixed models (GMM).

Official Title
-----------------
Acceptance and Commitment Therapy for Chronic Insomnia in Adults

Conditions
-----------------
Insomnia

Intervention / Treatment
-----------------
* Behavioral: Acceptance and Commitment Therapy for Insomnia
* Behavioral: Cognitive Behavioral Therapy for Insomnia


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Clinical diagnosis of chronic insomnia Exclusion Criteria: Neurological degenerative disease Psychotic disorder sleep apnea, restless legs or periodic limb movements during sleep, or a circadian-based sleep disorder (e.g., delayed or advanced sleep phase syndrome) cognitive impairments unavailability in attending the sessions.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 59 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ACT for Insomnia<br> | Behavioral: Acceptance and Commitment Therapy for Insomnia<br>* ACT-I treatment group: Participants diagnosed with chronic insomnia will receive group treatment. The six sessions will be aimed at psychoeducation about sleep added to the therapeutic processes of acceptance, mindfulness, availability, values, defusion and commitment, used in ACT.<br>* Other names: ACT-I;|
| Active Comparator: CBT for Insomnia<br> | Behavioral: Cognitive Behavioral Therapy for Insomnia<br>* Active control group CBT-I: Participants diagnosed with chronic insomnia will receive treatment in a group. The six sessions will be aimed at cognitive-behavioral components, such as education and sleep hygiene, stimulus control, sleep restriction and demystification / restructuring of belief beliefs.<br>* Other names: CBT-I;|
| No Intervention: Wait List<br> | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the score of Insomnia Severity Index (ISI) | Change in the total score of Insomnia Severity Index (ISI) | baseline, 7 weeks and 24 weeks after treatment commencement. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Remission - categorical variable | a final ISI score under 8 points | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Treatment response - categorical variable | change or reduction in the ISI total score of 8 points or more | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Reduction in Sleep Onset Latency (SOL) | Reduction in Sleep Onset Latency (SOL) measured by sleep diary | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Reduction in Wake After Sleep Onset (WASO) | Reduction in Wake After Sleep Onset (WASO) measured by sleep diary | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Increase in Total Sleep Time (TST) | Increase in Total Sleep Time (TST) measured by sleep diary | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Increase in Sleep Efficiency (SE) | Increase in Sleep Efficiency (SE) measured by sleep diary | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Change in the Hospital Anxiety and Depression Scale (HADS) | Change in the total score for the anxiety variable (HADAS-A) and total score for the depression variable (HADAS-D) | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Change in the Acceptance and Action Questionnaire-II (AAQ-II) | Change in the the total score of Acceptance and Action Questionnaire-II (AAQ-II) | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Change in the Sleep Problem Acceptance Questionnaire (SPAQ) | Change in the the total score of Sleep Problem Acceptance Questionnaire (SPAQ) | baseline, 7 weeks and 24 weeks after treatment commencement. | 
| Change in the Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) | Change in the the total score of Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) | baseline, 7 weeks and 24 weeks after treatment commencement. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
INSOMNIA, acceptance and commitment therapy, Cognitive behavioral therapy, SLEEP