Short and Long Term Effectiveness of Existing Insomnia Therapies for Patients Undergoing HD

Cognitive Behavioral Therapy

What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) is one of the most researched and scientifically supported forms of psychotherapy. It is used to treat many disorders, including depression and anxiety. Based on a large body of work in other populations, The American College of Physicians strongly recommends CBT as the first-line treatment for insomnia.

CBT is a short-term treatment that focuses on a patient’s current problems, and aims to help him or her learn how to deal with practical issues. It is based on the idea that unhelpful thinking impacts how each of us feels and behaves, a cycle that is often reinforcing. This pattern is often represented by the picture below.

Cognitive Behavioral Theraphy diagram, thought, behavior, feeling triangle

How does cognitive behavioral therapy work?

In CBT, the therapist first assists the patient in identifying unhelpful thoughts and the negative feelings and behaviors they produce. The patient and therapist focus on problems that the patient would like to address now. They work together to evaluate the patient’s current thought process in order to find more helpful ways to respond to problems in the future. Next, CBT focuses on the actual behaviors that contribute to the problem. The patient begins to learn and practice new skills that can be put into use in real-world situations. Patients also learn self-help skills that impact the way they think, feel and behave, and they practice these skills throughout treatment.

Cognitive behavioral therapy in the SLEEP-HD trial

In the SLEEP-HD trial, some patients participating in the treatment phase will be randomly assigned to receive CBT. CBT will be comprised of 6 sessions once a week, each session is anticipated to last 30-60 minutes. The sessions will take place over a video platform called Zoom, which is a secure, private means of patient and the therapist meeting face to face over video. Typically, patients must see therapists at a separate appointment, adding to a patient’s already busy schedule. In this study patients can meet with a therapist at a time that is convenient for them, without having to travel. They can choose to have a session while they are at the dialysis unit if they wish. We are hoping the flexibility of this modality will increase access to treatment for insomnia in HD patients.

It has been proven that CBT works, however, it may not be the best treatment option for all patients. That’s why we’re also researching the impact drug therapy has on patients with insomnia who are on hemodialysis.