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Comparative Study
, 20 (1), 262

Partner-assisted Cognitive Behavioural Therapy for Insomnia Versus Cognitive Behavioural Therapy for Insomnia: A Randomised Controlled Trial

Comparative Study

Partner-assisted Cognitive Behavioural Therapy for Insomnia Versus Cognitive Behavioural Therapy for Insomnia: A Randomised Controlled Trial

Alix Mellor et al. Trials.


Background: Insomnia is a prevalent sleep disorder associated with significant economic and personal burdens. Cognitive behavioural therapy for insomnia (CBTI) is considered the gold standard intervention for insomnia and its efficacy has been well demonstrated. However, the core treatment strategies of CBTI require significant behavioural change, which many individuals find challenging. As a result, although CBTI is efficacious, its effectiveness is reduced by modest levels of adherence in typical clinical settings. This is problematic as adherence is essential to attain desired treatment outcomes. Sleep is often a dyadic process, with approximately 60% of Australian adults sharing a bed. Hence, the present study aims to determine whether incorporating bed partners into treatment for insomnia increases treatment adherence and completion. The impact of adherence on symptoms of insomnia will also be examined.

Methods: This study is a mixed-effects randomised effectiveness trial of partner-assisted CBTI (PA-CBTI). It is an "effectiveness" (as opposed to "efficacy") trial, due to the focus on "real world" clinic-based clients and adherence/attrition as outcomes. Participants will include 120 clients with insomnia who are randomly assigned, in equal numbers, to PA-CBTI, traditional individual CBTI (i-CBTI), or partner-assisted sleep management therapy (PA-SMT; which serves as the control group). All interventions consist of seven weekly 1-h sessions. Treatment outcome is evaluated using clinician-rated treatment adherence, and diary-based adherence to stimulus control and sleep restriction. Clients and partners complete major assessments at pre- and post-treatment, and at 6-month follow-up. Secondary outcome variables include actigraphy, self-report measures related to sleep, comorbid psychopathology, and relationship functioning.

Discussion: This is the first randomised clinical trial to examine the impact of incorporating the bed partner in the treatment of insomnia. Results will provide new information about the role partners play in clients' insomnia presentation and treatment response, and better define the role of adherence in CBTI. This trial has the potential to optimise treatment outcomes for insomnia by improving adherence and reducing attrition. Results could have far-reaching impacts. Improvements in insomnia have been linked to improvements in mental and physical health and, given the high financial costs of insomnia, this study could have a positive economic impact.

Trial registration: ACTRN, ACTRN12616000586415 . Registered on 5 May 2016.

Keywords: Bed partner; CBTI; Couples; Insomnia; Partner-assisted interventions; Sleep.

Conflict of interest statement

Ethics approval and consent to participate

The trial protocol and amendments have been approved by the Ethics at Monash University Human Research Ethics Committee (MUHREC; approval number CF16/276–2,016,000,125) and is a registered clinical trial under the Australian New Zealand Clinical Trials Registry (ACTRN12616000586415).

Participation in the project is voluntary and requires written informed consent. Participants have the right to stop treatment and cease the trial at any stage. If one person in the couple decides to withdraw, the couple would have to withdraw from the trial. The randomisation of the treatment is considered ethical, as all treatments are active with benefits thought to be gained from all conditions.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) diagram for enrolment, allocation, follow-up, and analysis. Participant numbers noted are those anticipated, not those currently enrolled/completed. CBTI cognitive behavioural therapy for insomnia, I individual, PA partner-assisted, SMT sleep management therapy

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