CBT for Insomnia in Black Women

Cognitive behavioral therapy for insomnia (CBT-I) may improve insomnia severity in Black women and is even more effective when culturally tailored, the results of a single-blind trial show.

To address the limited research on the efficacy of CBT-I in Black women, researchers invited participants in the Black Women’s Health Study to participate in a randomized clinical trial and assigned them to receive: (1) standard, internet-delivered CBT-I; (2) internet-delivered CBT-I that is culturally tailored; or (3) only patient education about sleep. The third group served as the control group.

Participants were enrolled in the trial from October 2019 to June 2020, and all study data were collected by March 2021. The trial’s primary outcome was insomnia severity, assessed by the Insomnia Severity Index (ISI). A reduction in score of 7 points was considered clinically significant improvement in severity.

The mean age of the study group, which included 333 participants, was 60 years (+8 yr). Those who received standard or culturally tailored CBT-I had greater reductions in ISI score at 6-month follow-up than those who received only sleep education (P<.01). More specifically, standard CBT-I produced a change in score of −10 points (95% CI, −11.2 to −8.7), culturally tailored CBT-I produced a change of −9.3 points (95% CI, −10.4 to −8.2), and patient education produced a change of −3.6 points (95% CI, −4.5 to −2.1).

“Almost 40% of [CBT-I] recipients experienced insomnia remission, and close to 50% reported clinically significant insomnia symptom improvements,” researchers noted.

In addition, more participants who received culturally tailored CBT-I completed the intervention than those who received standard CBT-I (86/110, or 78.2%, vs 70/108, or 64.8%, respectively;  P = .008), and those who completed all 6 modules of either CBT-I program had greater reduction in insomnia severity than those who did not complete the program (−10.4 points [95% CI, −11.4 to −9.4] vs −6.2 points [95% CI, −8.6 to −3.7]).

—Ellen Kurek

Reference:

Zhou ES, Ritterband LM, Bethea TN, Robles VP, Heeren TC, Rosenberg L. Effect of culturally tailored, internet-delivered cognitive behavioral therapy for insomnia in black women: a randomized clinical trial. JAMA Psychiatry. 2022;e220653. doi:10.1001/jamapsychiatry.2022.0653