Psychological interventions with cultural adjustments that are more effective in treating sleep disorders

Cultural adjustments are likely to improve the effectiveness of psychological interventions for sleep disorders. These results from a systematic review were published in Sleep Medicine Reviews.

Columbia University researchers searched publication databases for randomized clinical trials of psychological interventions for sleep disorders conducted in the United States. A total of 56 studies were included in the final analysis.

These studies included an average sample size of 85.23 (range 11-219) people in the intervention and 38.40 (range 5-91) people in the control arms. The vast majority had 2-arm designs (91.07%) with an average duration of 7.69 weeks (range 2 weeks to 2 years).

These studies were dominated by female participants (mean 55.35%; standard deviation) [SD]43.22%) and white (mean 64.86%; SD 21.67%) and only 6.97% focused on underserved populations.

Participants had definitive diagnoses of a sleep disorder in 32 studies, 9 studies included people with likely sleep disorder and 15 with potential sleep disorder. Among the studies of patients with an established diagnosis, 75% examined insomnia, 9.38% poor sleep quality nightmares, 6.25% poor sleep quality, 3.12% restless leg syndrome, 3.12% nocturia, and 3.12% Nightmares with insomnia.

The primary outcome was sleep quality (n = 40), insomnia (n = 30), sleep efficiency (n = 21), sleep duration (n = 21), nightmares (n = 8), and drowsiness (n = 4).

The most frequently examined interventions included cognitive behavioral therapy for insomnia (CBT-I; n = 20), complementary and alternative medicine (n = 8) and behavioral therapy (n = 7) as well as cognitive behavioral therapy (n = 4) .

These interventions were tailored to their study populations through either superficial and / or profound cultural adjustments (64.29%). CBT-I was adapted most often (38.89%). Surface-level adjustments included changes in delivery modality, attitude, dosage, strategies involving ingredients, and language changes. In-depth adjustments were content-related, central components, socio-cultural and linguistic changes.

The studies with a cultural adjustment component generally found a significant improvement in insomnia compared to pharmacotherapy, but few found changes in nightmares, sleep efficiency, or sleep duration.

Participants who received CBT-I with superficial or deep cultural adaptation (n = 11 studies) had significantly improved symptoms of insomnia compared to different control groups, usual care, hygiene training, or education about healthy eating. A subset of these studies also reported improvements in sleep efficiency (n = 6) and sleep quality (n = 7).

Few studies of cultural adaptations at the surface or depth level for interventions in probable or possible sleep disorders have shown significant improvements in sleep.

These results were limited by the underlying study populations, which lacked diversity.

The study’s authors concluded that interventions on established sleep disorders that were culturally tailored to the population were more successful than control conditions or usual care.


Alcántara C, Cosenzo LG, McCullough E., Vogt T., Falzon AL, Ibarra IP. Cultural Adaptations of Psychological Interventions in Prevailing Sleep Disorders and Sleep Disorders: A Systematic Review of Randomized Controlled Trials in the United States. Sleep Med Rev. 2021; 101455. doi: 10.1016 / j.smrv.2021.101455

This article originally appeared on Psychiatry Advisor

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