Individual cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover pilot study

Lavinia Fiorentino¹, John R McQuaid², Lianqi Liu³, Loki Natarajan⁴, Feng He⁴, Monique Cornejo³, Susan Lawton³, Barbara A Parker⁶, Georgia R Sadler⁵, Sonia Ancoli-Israel³

¹Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, CA, USA; ²Department of Psychiatry, University of California, San Francisco, CA, USA; ³Department of Psychiatry, ⁴Department of Family and Preventive Medicine, ⁵Department of Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA; ⁶Moores UCSD Cancer Center, La Jolla, CA, USA

Purpose: Estimates of insomnia in breast cancer patients are high, with reports of poor sleep lasting years after completion of cancer treatment. This randomized controlled crossover pilot study looked at the effects of individual cognitive behavioral therapy for insomnia (IND-CBT-I) on sleep in breast cancer survivors.

Patients and methods: Twenty-one participants were randomly assigned to either a treatment group (six weekly IND-CBT-I sessions followed by six weeks of follow up) or a delayed treatment control group (no treatment for six weeks followed by six weekly IND-CBT-I sessions). Of these, 14 participants completed the pilot study (six in the treatment group and eight in the delayed treatment control group).

Results: Self-rated insomnia was significantly improved in the treatment group compared to the waiting period in the delayed treatment control group. The pooled pre–post-IND-CBT-I analyses revealed improvements in self-rated insomnia, sleep quality, and objective measures of sleep.

Conclusions: These preliminary results suggest that IND-CBT-I is appropriate for improving sleep in breast cancer survivors. Individual therapy in a clinic or private practice may be a more practical option for this population as it is more easily accessed and readily available in an outpatient setting.

Keywords: insomnia, breast cancer, cognitive behavioral therapy