INTRODUCTION Cognitive behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia. However, rates of nonresponse and nonremission are high and effects on quality of life are only small to moderate, indicating a need for novel treatment developments. We propose that Acceptance and Commitment Therapy (ACT) addresses core pathophysiological pathways of insomnia. ACT therefore has the potential to improve treatment efficacy when combined with bedtime restriction, the most effective component of CBT-I. The aim of this study was to compare the efficacy of ACT for insomnia combined with bedtime restriction (ACT-I) and CBT-I in improving insomnia severity and sleep-related quality of life. METHODS Sixty-three patients with insomnia disorder (mean age 52 years, 65% female, 35% male) were randomly assigned to receive either ACT-I or CBT-I in a group format. The primary outcomes were insomnia severity (Insomnia Severity Index) and sleep-related quality of life (Glasgow Sleep Impact Index). Outcomes were assessed before randomization (T0), directly after treatment (T1), and at 6-month follow-up (T2). RESULTS The results indicated significant, large pre-to-post improvements in both groups, for both primary and secondary outcomes. Improvements were maintained at the 6-month follow-up. However, there was no significant group by time interactions in linear mixed models, indicating an absence of differential efficacy. On a subjective treatment satisfaction scale, patients in the ACT-I group indicated significantly greater satisfaction with their improvement of several aspects of health including their energy level and work productivity. CONCLUSIONS The results suggest that ACT-I is feasible and effective, but not more effective than CBT-I for the improvement of insomnia severity and sleep-related quality of life. Future studies are needed to assess whether ACT-I is noninferior to CBT-I and to shed light on mechanisms of change in both treatments.

中文翻译：

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接受和承诺疗法，结合就寝时间限制，与失眠的认知行为疗法：随机对照试点试验。


简介 失眠认知行为疗法（CBT-I）是目前失眠的一线治疗方法。然而，无反应和无缓解率很高，对生活质量的影响也很小到中等，表明需要开发新的治疗方法。我们建议接受与承诺疗法（ACT）解决失眠的核心病理生理途径。因此，当与就寝时间限制（CBT-I 最有效的组成部分）相结合时，ACT 有可能提高治疗效果。本研究的目的是比较 ACT 治疗失眠联合就寝时间限制 (ACT-I) 和 CBT-I 在改善失眠严重程度和睡眠相关生活质量方面的功效。方法 63 名失眠症患者（平均年龄 52 岁，65% 女性，35% 男性）被随机分配接受 ACT-I 或 CBT-I 组治疗。主要结局是失眠严重程度（失眠严重指数）和睡眠相关生活质量（格拉斯哥睡眠影响指数）。在随机分组前 (T0)、治疗后立即 (T1) 和 6 个月随访时 (T2) 评估结果。结果 结果表明，两组的主要和次要结局均在术前和术后均有显着、较大的改善。 6个月的随访中仍保持改善。然而，线性混合模型中不存在显着的按时间分组的相互作用，表明不存在差异功效。在主观治疗满意度量表上，ACT-I 组的患者对健康几个方面的改善（包括精力水平和工作效率）表现出明显更高的满意度。 结论 结果表明，ACT-I 可行且有效，但在改善失眠严重程度和睡眠相关生活质量方面并不比 CBT-I 更有效。未来的研究需要评估 ACT-I 是否不劣于 CBT-I，并阐明两种治疗方法的变化机制。