Thérapie cognitivo-comportementale pour l’insomnie chez des adultes souffrant d’un trouble de la personnalité du groupe B et d’insomnie : une étude de faisabilité (étude INSOPERSO)

Abstract

Introduction

Insomnia is highly prevalent among individuals with Group B personality disorders (GBPD). Cognitive-behavioral therapy for insomnia (CBT-I) is the most recommended treatment for chronic insomnia; however, no study has examined this approach in patients with GBPD. This study aimed to assess the feasibility of a CBT-I program for this patient population, focusing on acceptability, gathering preliminary measures of effectiveness, and collecting participant experiences to enhance treatment.

Method

This pilot study employs a mixed methods design without a control group. Twenty-two adult participants diagnosed with GBPD and experiencing insomnia were recruited from a specialized program for personality disorders. The four-session CBT-I program was specifically designed for patients with GBPD to enhance treatment retention and therapeutic response. Quantitative measures included recruitment and retention rates and self-administered questionnaires assessing insomnia and comorbidities, collected before, during and three months after treatment. Per protocol and intention-to-treat analyses were conducted on data from these questionnaires. Qualitative data were gathered through group discussions and semi-structured interviews, and the qualitative data were analyzed using thematic content analysis.

Results

Twenty-two participants were recruited, with an initial goal of 24. The treatment retention rate was 45%. Among the eight participants who completed the study as intended, a significant reduction in insomnia (−9 points on the ISI), depression (−6 points on the PHQ-9), and anxiety (−3.6 on the GAD-7) was observed from the time of inclusion to three months post-therapy. In discussions about the collection of qualitative data, six main themes were identified among four participants: content, functioning, therapist, group format, therapy effect, and factors influencing motivation,

Discussion

The retention rate achieved is lower than what is found in the literature. Factors impacting motivation, such as momentum, external influences on therapy, and group dynamics, are identified. The initial measures of therapy effectiveness align with the literature, indicating a reduction of about 50% in the ISI at three months. The ISI score declined after therapy concluded, in line with participants’ perception of having the tools to enhance their sleep further.

Conclusion

This is the first pilot project evaluating a CBT-I program for Group B personality disorder patients. It has shown that a short-duration group CBT-I protocol for this clientele is feasible but not entirely acceptable. The low retention rate observed suggests a need for reflection to enhance acceptability, particularly regarding the recruitment process and individual support. Moreover, the preliminary results regarding clinical outcomes are promising and align with existing evidence. Methodological improvements are planned for subsequent research, including the integration of a control group to strengthen the internal validity of the conclusions.