Metacognition
Does insomnia therapy fix how people think about their thinking?
Open access · cc by · source: Europe PMC
Group CBT for insomnia improved sleep and sleep beliefs for everyone, but most patients still had problematic beliefs about their own thinking afterwards.
Study at a glance
- Design
- Cohort — Uncontrolled pre/post evaluation of seven-session group CBT-I in insomnia patients, plus a baseline comparison with healthy controls.
- N
- N=27 · 27 insomnia patients completed CBT-I and were assessed before and after; 23 healthy controls were measured once for the baseline comparison.
- Population
- Adults diagnosed with insomnia disorder at a sleep centre in Milan, Italy, plus healthy good sleepers.
- Outcome
- Sleep-related metacognition (MCQ-I), dysfunctional sleep beliefs (DBAS-16), insomnia severity (ISI) and sleep-diary measures.
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Key findings
Patients scored higher than controls on both belief measures, and both measures correlated with insomnia severity across the whole sample. After CBT-I, insomnia severity and sleep beliefs improved strongly and metacognition improved modestly on average, but 63% of patients were still above the clinical cut-off for metacognitive problems and 29.6% had equal or worse metacognition scores. Patients who stayed above the cut-off still improved on insomnia symptoms and sleep beliefs, but not on metacognition.
Methodology
Insomnia patients took part in seven 90-minute group sessions of cognitive-behavioural therapy for insomnia (CBT-I), covering sleep education, relaxation, stimulus control, sleep restriction and challenging unhelpful sleep beliefs. Before and after treatment they completed questionnaires on insomnia severity, beliefs about sleep (seen as 'primary arousal') and metacognitive beliefs about their own sleep-related thinking (seen as 'secondary arousal'), and kept sleep diaries. A group of healthy sleepers completed the same questionnaires once for comparison.
Limitations
There was no untreated or waitlist control group, so improvements cannot be attributed to CBT-I rather than time, regression to the mean or expectation. The sample was small and from one clinic, and patients were older than controls. There was no follow-up, so the authors' idea that leftover metacognitive problems predict relapse is a hypothesis, not a finding. All outcomes were self-report.
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