Angelillo Marie, Lancee Jaap, Hertenstein Elisabeth
Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
J Sleep Res. 2025 Oct;34(5):e14470. doi: 10.1111/jsr.14470. Epub 2025 Jan 31.
Insomnia disorder, characterized by a complaint of reduced sleep quality or quantity and associated daytime impairment, is highly prevalent and associated with reduced quality of life and productivity. Cognitive behavioural therapy for insomnia (CBT-I) is the current first-line treatment for chronic insomnia disorder. Here, we outline our perspective for the future optimization of psychotherapeutic treatment for insomnia. We identified the following areas as the most promising: first, optimizing efficacy of the CBT-I protocol; second, developing diagnostic and therapeutic approaches for non-responders and partial responders; and third, advancing widespread implementation of psychotherapy for insomnia. More specifically, we outline how the current CBT-I protocol could be optimized through an improved understanding of treatment mechanisms, and discuss the potential of adaptive treatment strategies. Another promising approach for improving the current CBT-I protocol is using add-ons such as physical exercise or circadian-based interventions. Both may be promising in certain subgroups of patients with insomnia. In terms of non-response, we identify acceptance and commitment therapy for insomnia (ACT-I) as a promising treatment for non-responders to CBT-I. ACT-I, however, still needs to be evaluated in actual non-responders to CBT-I. Implementing CBT-I in clinical practice is still one of the major challenges at hand. We outline how brief treatment, targeted treatment for challenging patient groups, and digital treatment may help improve implementation. For a future research agenda, we suggest that further research into treatment mechanisms, randomized-controlled trials in non-responders to CBT-I, and a focus on implementation science have a potential to bring the field forward.
失眠障碍的特征是睡眠质量或睡眠时间减少的主诉以及相关的日间功能损害，其极为常见，且与生活质量和生产力下降相关。失眠的认知行为疗法（CBT-I）是目前慢性失眠障碍的一线治疗方法。在此，我们概述了对失眠心理治疗未来优化的观点。我们确定了以下最有前景的领域：第一，优化CBT-I方案的疗效；第二，为无反应者和部分反应者开发诊断和治疗方法；第三，推进失眠心理治疗的广泛实施。更具体地说，我们概述了如何通过更好地理解治疗机制来优化当前的CBT-I方案，并讨论了适应性治疗策略的潜力。另一种改进当前CBT-I方案的有前景的方法是使用附加疗法，如体育锻炼或基于昼夜节律的干预措施。两者在某些失眠患者亚组中可能都很有前景。就无反应情况而言，我们确定失眠的接纳与承诺疗法（ACT-I）是对CBT-I无反应者的一种有前景的治疗方法。然而，ACT-I仍需在实际对CBT-I无反应者中进行评估。在临床实践中实施CBT-I仍然是当前面临的主要挑战之一。我们概述了简短治疗、针对具有挑战性患者群体的靶向治疗以及数字化治疗如何有助于改善实施情况。对于未来的研究议程，我们建议对治疗机制进行进一步研究、对CBT-I无反应者进行随机对照试验以及关注实施科学，这些有可能推动该领域向前发展。
