Treating Insomnia

It has always been difficult to specify what does and does not work as psychotherapy.

First, you need to be treating people who are suffering from exactly the same condition. And second, you need to be offering each subject the same treatment.

Considering the confusion that surrounds many forms of talk therapy, it is not a simple task.

So, researchers decided to run a test on people who were suffering from insomnia.

The New York Times reports:

Poor sleep is associated with increased inflammation, which may contribute to heart disease and a variety of other ailments. A new study has shown that cognitive behavioral therapy and tai chi, the Chinese exercise technique, may reduce both insomnia and inflammation.

Researchers studied 123 people with insomnia who were over age 55. They were randomized to one of three groups. The first received two hours a week of cognitive behavioral therapy over four months, the second the same amount of tai chi practice, and the third, a control group, a four-month educational program about sleep hygiene, aging and insomnia. The study was published in Biological Psychiatry.

Both cognitive therapy and tai chi were measurably effective. The educational program, designed, one imagines, to promote understanding of the sleep process was not.

The Times continues:

At one year after the treatment, compared with the control group, those on cognitive behavioral therapy and tai chi had reduced blood levels of C-reactive protein and reduced production of pro-inflammatory cytokines, both indicators of inflammation.

Using blood samples, the researchers also found that both the treatment groups had lower expression of genes related to inflammation and increased expression of genes related to antibody response compared with the control group.

“Tai chi and cognitive therapy are used to treat insomnia because, unlike medication, they produce no unwanted side effects,” said the lead author, Dr. Michael R. Irwin, a professor of psychiatry at the University of California, Los Angeles.

“With the improvement in insomnia,” he added, “there’s a reversal of inflammation at the systemic level and the genetic level. Inflammation contributes to cardiovascular disease, depression and cancer.”

I would underscore Dr. Irwin’s point: cognitive treatment and tai chi are superior to medication because they do not produce any unwanted side effects.

I see this as added information about what does and does not work as therapy. Anyone who is wondering why they did not put some of the subjects into Freudian psychoanalysis are not living in the real world.