Acceptance and commitment therapy combined with behavioural strategies and self-compassion versus cognitive behavioural therapy for insomnia: Feasibility, acceptability, and randomized pilot.

Abstract

Objectives: This pilot randomized controlled trial (RCT) evaluated feasibility, acceptability, and preliminary clinical benefits of ACTCOM-I, a novel intervention combining Acceptance and Commitment Therapy with behavioural strategies and self-compassion, compared with CBT-I.

Methods: An analytic sample of 19 participants (63% women; M = 43.26 years, SD = 12.77) with chronic insomnia was randomized to ACTCOM-I (n = 10) or CBT-I (n = 9). Assessments occurred at baseline (T0), post-treatment (T1), 3-months (T2) and 6-months (T3) follow-ups. Measures included insomnia severity, beliefs, pre-sleep arousal, sleep effort, sleep diary, anxiety/depression, affect, quality of life, mindfulness, psychological flexibility, cognitive fusion, progress/obstructions to valued living, and self-compassion.

Results: Linear mixed models showed significant Time effects for insomnia severity (p < .001), with large within-group effect sizes maintained at follow-up. No significant between-group differences were found (p = .88), indicating similar improvement trajectories over time. Reliable change analysis (RCI) confirmed that 90% of ACTCOM-I and 89% of CBT-I participants achieved clinically significant improvements at post-treatment, with high response and remission rates. No participants deteriorated. Both interventions also led to comparable improvements in secondary sleep-related outcomes, anxiety/depression, and positive affect, while negative affect remained stable. Most process-related measures showed significant Time effects but no TimeXGroup interactions, further supporting similar patterns of change. Within-group analyses suggested greater improvements in psychological flexibility, cognitive fusion, obstructions to valued living and self-compassion in ACTCOM-I, particularly at follow-up. Despite high attrition, ACTCOM-I was feasible, well-accepted, and thematic analysis identified six overarching themes.

Conclusions: Results suggest that ACTCOM-I is feasible, well-accepted, and preliminary findings support further studies on its potential as a complementary treatment to chronic insomnia.