Adjunct Goal Clarification Session to Increase Early Treatment Adherence to Cognitive Behavioural Therapy for Insomnia
Bibliographic record
Abstract
Insomnia is a severe clinical problem with a multitude of individual and societal consequences. Cognitive behavioural therapy for insomnia (CBT-I) is the gold standard treatment (National Institutes of Health, 2005); however, with response rates ranging from 67 to 75% (Harvey et al., 2014; Sunnhed et al., 2020) there remains room for improvement. Suboptimal patient adherence to CBT-I is one purported mechanism that may diminish treatment outcomes (Matthews et al., 2013). To address this problem, a 1-hour adjunct intervention to the first treatment session of CBT-I was created for the present study, theoretically derived to target early treatment adherence. To test the efficacy of this adjunct, this study compared an intervention group to a control group on their degrees of adherence to therapy recommendations following the first treatment session. Several predictors of adherence were evaluated. Method. Eligible individuals with insomnia disorder (N = 50) were randomly assigned to groups. Prior to the first treatment session, participants in the Goal Clarification group received the 1-hour adjunct session and the control group received a 1-hour general information session. Following treatment session one, participants completed questionnaires assessing treatment readiness, ambivalence, therapeutic alliance, expectations, and perceived barriers. Adherence to specific behavioural strategies was assessed over the following two weeks using a modified version of the Adherence to Behavioural Strategies coding scheme (Tremblay et al., 2009). Results. The control group was significantly more adherent to the recommendation of using the bed only for sleep. No group differences were found on any other adherence index. Groups did not differ in readiness, ambivalence, therapeutic alliance, expectations, or perceived barriers. Of the expected predictors of adherence, treatment acceptability and ambivalence were the only factors that explained a significant amount of the variance in two adherence indices; however, the relationship for treatment acceptability and adherence was negative. Discussion. There are multiple ways to interpret these findings in the context of past literature, such as suboptimal variables being selected as intervention targets to improve participant adherence. However, conclusions are limited due to low statistical power. Further research into interventions for treatment non-responders, rather than improvements to existing CBT-I protocols, is encouraged.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".