Impact of treatment credibility and expectancy on cognitive behavioral therapy for insomnia outcomes among cancer survivors

Abstract

Objectives

Cognitive Behavioral Therapy for Insomnia (CBT-I) can effectively improve insomnia among cancer survivors. This secondary analysis explored what factors were associated with higher beliefs about credibility and expectancy and examined the impact of perceived treatment credibility and expectancy on outcomes.

Methods

As part of a randomized waitlist-controlled trial, cancer survivors (N = 132) with insomnia received 7 weekly virtual sessions of CBT-I. Credibility and expectancy beliefs were assessed at baseline for insomnia and perceived cognitive impairment (PCI) using the Credibility Expectancy Questionnaire. We examined which factors were associated with greater credibility and expectancy beliefs and whether credibility and expectancy moderated change in symptoms. Semi-structured interviews explored patient perceptions.

Results

Only younger age was associated with higher pre-treatment expectations for both insomnia and PCI (p = 0.009; p = 0.008). The magnitude of expectancy for insomnia and cognitive functioning were similar. Neither beliefs about credibility nor expectancy acted as moderators of change in symptoms of insomnia (p = 0.972; p = 0.502) or PCI (p = 0.143; p = 0.283), respectively. Qualitative results suggest credibility and expectancy can be optimized by: 1) promoting an understanding of sleep; 2) setting appropriate pre-treatment beliefs that foster optimism and mitigate skepticism; 3) promoting consistent engagement with treatment; and 4) fostering positive therapeutic relationships.

Conclusion/implications

CBT-I is effective regardless of pre-existing beliefs and expectations. While these factors may play a role in the decision to pursue CBT-I, our results suggest that clients are likely to see benefits if they engage in the therapy.