Effects of Group Cognitive Behavioral Therapy for Insomnia on Insomnia, Depression, and Fatigue in Individuals with Multiple Sclerosis

Background: Sleep disorders and fatigue are highly prevalent in individuals diagnosed with multiple sclerosis (MS) and can have an impact on a person’s physical and mental health as well as quality of life. Studies have shown that about 70-80% of individuals with primary insomnia benefit from cognitive behavioral therapy interventions (CBT) (Morin et al., 2004). In regards to MS, a retrospective study previously conducted revealed that cognitive behavioral therapy for insomnia (CBT-I) has the potential to reduce symptoms of insomnia, fatigue, and depression in this population (Clancy et al. 2015). CBT-I is a multi-component treatment approach generally consisting of a combination of sleep hygiene education, stimulus control, sleep restriction, relaxation therapy, and cognitive restructuring. CBT-I has been adapted for other chronic conditions – e.g., cancer, chronic pain, HIV/AIDS, etc. – but to date there are no studies examining the effects of a modified version of CBT-I in MS patients.

Objectives:

1. To evaluate the effectiveness of group CBT-I on patient-reported outcome measures of insomnia, fatigue, mood, and quality of life on patients with MS.

2. To evaluate the effectiveness and feasibility of a modified version of CBT-I for patients with MS.

Methods: This is a prospective, single group, prospective study in patients with multiple sclerosis (MS) to evaluate the impact of cognitive behavioral therapy for Insomnia (CBT-I).  A sample size of 12 patients is planned.  Patients included in the study will follow a three-session CBT-I protocol delivered in a group setting. Groups will comprise of 4-8 participants. This modified version of CBT-I will consist of sleep hygiene education, modified stimulus control, sleep compression, relaxation therapy, stress and fatigue management, and cognitive restructuring. The intervention will be comprised of three 60-minute sessions carried out biweekly. Prior to and following the intervention, patient reported outcomes including the Insomnia Severity Index (ISI), the Patient Health Outcomes Questionnaire 9 (PHQ-9), Fatigue Severity Scale (FSS), and the Quality of Life in Neurological Disorders (Neuro-QoL) will be administered.  Subjective sleep diaries will also be collected prior, during, and at the end of the intervention to determine sleep efficiency. A follow-up call to gather similar information will be made one month and three months after completion of the intervention. 

Results: In progress.

Conclusions: Data obtained from this study will examine the utility of a modified approach to CBT-I for MS patients, which will help inform the development of effective interventions to address insomnia in this population and help improve quality of life and overall health.