Mediators of cognitive therapy and behavior therapy for insomnia disorder : a test of the processes in the cognitive model

• Objective: To examine if the processes in the cognitive model mediate cognitive therapy (CT) and behavior therapy (BT) for insomnia.Method: Individuals diagnosed insomnia disorder (n=219) were randomized to telephone supported internet-delivered cognitive therapy (n=72), behavior therapy (n=73), or a waitlist (n=74). Cognitive processes (worry, dysfunctional beliefs, monitoring and safety behaviors) proposed to maintain insomnia and treatment outcome (insomnia severity; ISI) were assessed biweekly. Criteria for evaluating mediators were assessed via parallel process growth modeling and cross-lagged panel models.Results: Parallel process growth modeling showed that dysfunctional beliefs, monitoring and safety behaviors significantly mediated the effects of both CT and BT. Cross-lagged panel models confirmed that dysfunctional beliefs and monitoring, which approached significance, drove the change for CT. In BT, however, prior changes in ISI predicted later changes in worry and monitoring, and reciprocal influences among processes and outcomes were observed for dysfunctional beliefs and safety behaviors. The effect of safety behavior on outcome was significantly larger for BT compared to CT.Conclusion: Together, the findings support the role of dysfunctional beliefs and monitoring as processes of change in CT, and safety behaviors as a specific mediator in BT. Limited evidence was provided for worry as a mediator. These findings have relevance for the conceptualizations of insomnia, future research, and clinical management.

Subject headings

SAMHÄLLSVETENSKAP  -- Psykologi -- Tillämpad psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology -- Applied Psychology (hsv//eng)

Keyword

Behavior Therapy

Cognitive Therapy

Cognitive processes

Insomnia

internet-delivered

mediators.

psykologi

Psychology

Publication and Content Type

vet (subject category)

ovr (subject category)