Culturally Adapted CBTI for Chinese Insomnia Patients: a One-Arm Pilot Trial

  • Yoann Birling
  • Jian Wang
  • Guixia Li
  • Enlai Wu
  • Zhidan Yu
  • Yunshu Feng
  • Yuting Wu



Insomnia is a common mental disorder with severe consequences. Cognitive-behavioral therapy for insomnia (CBTI) has been proved effective against insomnia, but most of the research is limited to Western countries. This trial objective is to develop a Chinese culture-adapted CBTI program and assess its efficacy.


An 8-week culturally adapted CBTI program was developed that included mixed group and individual session and culturally adapted relaxation and cognitive restructuring treatment components. A one-arm clinical trial was conducted at a public hospital between March 2016 and January 2017. Seventy-two Chinese adults (15 males, 57 females; mean age, 50 years) with insomnia disorder underwent the culturally adapted CBTI program. Sleep diaries and self-report scales, as well as polysomnography (PSG, for a subgroup only), were used to assess qualitative and quantitative measures of sleep, mental health status, and quality of life at baseline, post-treatment, and 4-month follow-up.


Pre-post analyses showed significant changes in sleep diary sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time of respectively − 37.03 min (CI, − 48.90 to − 25.16), − 28.16 min (CI, − 40.22 to − 16.10), and + 27.49 min (CI, 10.51 to 44.47). Self-reported sleep quality, mental health, and quality of life improved compared to baseline. The self-reported outcomes were mainly stable at follow-up. PSG outcomes globally failed to show improvement.


The design of a CBTI program adapted to Chinese population was achieved. Culturally adapted CBTI showed promising results. More rigorously designed studies are needed to ensure efficacy.


Insomnia Clinical trial Treatment Cognitive-behavioral therapy Cultural adaptation 



This study was funded by the projects “clinical pathways and comprehensive intervention model of insomnia pharmacological and psychological treatment” supported by the Beijing Municipal Commission of Science and Technology (Grant No. Z121107001012034) and “insomnia clinical research bases on the courage determining judgment and response” (Grant No. 2016S358) supported by the Guang’an Men Hospital.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This study was approved by Guang’an Men hospital ethical board. All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all the individual participants included in the study.


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Copyright information

© International Society of Behavioral Medicine 2018

Authors and Affiliations

  1. 1.Guang’an Men HospitalBeijingChina
  2. 2.Institute of PsychologyChinese Academy of SciencesBeijingChina

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