An Investigation of the Rate and Predictors of Initiating and Attending Group Cognitive Behavioral Therapy for Insomnia After Referral

Although group Cognitive Behavioral Therapy for Insomnia (CBT-I) is an efficacious and well-studied treatment, rela-tively less is known about its clinical effectiveness in community outpatient settings. Prior research has suggested that drop -out from CBT-I may be high in treatment settings vs. clinical trials. The current study therefore investigated the rates and predictors of initiating and attending CBT-I group within an outpatient psychiatry clinic. Participants were 75 consec-utive outpatients presenting for treatment at a specialty sleep and anxiety clinic who completed an evaluation and were referred to CBT-I group. Participants completed self-report measures at initial evaluation, and their attendance throughout treatment was tracked. The majority ofpatients attended > 1 session, with a mean of 3/5 sessions completed for initiators. Those with poorer global sleep quality and longer sleep onset latency were less likely to attend group and attended fewer sessions. Those with more severe anxiety and depression were less likely to initiate attendance and attended fewer sessions. The majority of patients referred to CBT-I initiated group and attended at least half of the sessions. Further, demographics do not seem to impact these rates. Unfortunately, those with the most severe symptoms, and thus in most need for treatment, are least likely to initiate and attend. This may be due to comorbid anxiety or depression symptoms. Future research should replicate these findings, as well as explore how to encourage those most in need of treatment to initiate and attend CBT-I.