Culturally Adapted CBTI for Chinese Insomnia Patients: a One-Arm Pilot Trial
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.
KeywordsInsomnia 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.
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 was obtained from all the individual participants included in the study.
- 2.Cao XL, Wang SB, Zhong BL, Zhang L, Ungvari GS, Ng CH, et al. The prevalence of insomnia in the general population in China: a meta-analysis. PLoS One. 2017;12(2):1–11.Google Scholar
- 10.Perlis ML, Jungquist C, Smith MT, Posner D. Cognitive–behavioral treatment of insomnia: a session-by-session guide. New York: Springer; 2005.Google Scholar
- 17.Lancee J, van den Bout J, Sorbi MJ, van Straten A. Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: a randomized trial. Behaviour Res Ther. 2013;51(12):797–805. https://doi.org/10.1016/j.brat.2013.09.004.CrossRefGoogle Scholar
- 19.Espie CA, MacMahon KM, Kelly H, Broomfield NM, Douglas NJ, Engleman HM, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007;30(5):574–84. https://doi.org/10.1093/sleep/30.5.574.CrossRefPubMedGoogle Scholar
- 25.Lee YJ. Sleep disorders in Chinese culture: experiences from a study of insomnia in Taiwan. Psychiatry Clin Neurosci. 1995;49(2):103–6. https://doi.org/10.1111/j.1440-1819.1995.tb01870.x.CrossRefPubMedGoogle Scholar
- 26.Xiang YT, Ma X, Cai ZJ, Li SR, Xiang YQ, Guo HL, et al. The prevalence of insomnia, its sociodemographic and clinical correlates, and treatment in rural and urban regions of Beijing, China: a general population-based survey. Sleep. 2008;31(12):1655–62. https://doi.org/10.1093/sleep/31.12.1655.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association; 2013.Google Scholar
- 32.Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561–71. https://doi.org/10.1001/archpsyc.1961.01710120031004.CrossRefPubMedGoogle Scholar
- 36.Fu S, Ou H, Lu S. Reliability and validity of the brief version of dysfunctional beliefs and attitudes about sleep. Chin J Behav Med Brain Sci. 2014:369–71.Google Scholar
- 37.Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ, et al. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14(8):1943–52. https://doi.org/10.1007/s11136-005-4346-x.CrossRefPubMedGoogle Scholar
- 39.Shek DT. Reliability and factorial structure of the Chinese version of the Beck Depression Inventory. J Clin Psychol. 1990;46(1):35–43. https://doi.org/10.1002/1097-4679(199001)46:1<35::AID-JCLP2270460106>3.0.CO;2-W.CrossRefPubMedGoogle Scholar
- 40.Kin-wing SC. A study of psychometric properties, normative scores and factor structure of Beck Anxiety Inventory—the Chinese version. Chin J Clin Psychol. 2002;10(1):4–6.Google Scholar
- 46.Tang CR, Dong XB, Birling Y, Feng F, Tian CC, Wang WD. The interpretation of clinical application to Wang integrated insomnia questionnaire. World J Sleep Med. 2016;3(5):310–5.Google Scholar
- 48.Birling Y, Tang CR, Wang WD. A questionnaire survey on the sleep characteristics of sleep department insomnia patients. World J Sleep Med. 2015;2(6):328–9.Google Scholar
- 51.Newell J, Mairesse O, Verbanck P, Neu D. Is a one-night stay in the lab really enough to conclude? First-night effect and night-to-night variability in polysomnographic recordings among different clinical population samples. Psychiatry Res. 2012;200(2):795–801. https://doi.org/10.1016/j.psychres.2012.07.045.CrossRefPubMedGoogle Scholar
- 56.Wang W. Low resistance thought induction psychotherapy: a guide to theory and practice. Beijing: People’s Medical Publishing House; 2012.Google Scholar
- 57.Wang WD, Li GX, Hong L, Liu YJ, Zhao Y, Lin YN, et al. Low resistance thought induction sleep-regulating technique (tip3-2) combined with medication for primary insomnia: a randomized controlled trial. Int J Behav Med. 2014;21(4):618–28. https://doi.org/10.1007/s12529-014-9415-5.CrossRefPubMedGoogle Scholar