# Comparison of Tailored Versus Standard Group Cognitive Behavioral Therapy for Shift Worker Insomnia: A Randomized Controlled Trial

## TL;DR

A new approach to cognitive behavioral therapy for shift workers with insomnia was found to be as effective as standard therapy.

## Contribution

The study introduces a customized CBT approach that implicitly addresses sleep issues without focusing on insomnia.

## Key findings

- Customized treatment showed equivalent effectiveness to standard therapy in improving insomnia and sleep outcomes.
- No significant differences were found between the two treatments in primary and secondary outcomes.
- The implicit approach was non-inferior and equivalent to standard therapy, suggesting potential for further development.

## Abstract

Shift workers are at increased risk of insomnia. The standard treatment (cognitive behavioral therapy for insomnia) poses significant challenges for this demographic due to irregular work and sleep schedules. New approaches are still considered insufficient due to high attrition or insufficient effectiveness. Our preliminary study identified sleep-relevant state and trait factors (see secondary outcomes) for incorporation into an innovative manual that addresses sleep in an implicit manner. The objective was to reduce the focus on insomnia and to replace regularity-based interventions. With a sample of 55 insomniacs (67.74% male, mean age 41.62 years), standard and customized treatments were compared using pre-treatment, post-treatment, and three-month follow-up measurements (RCT, self-assessment data). Our linear mixed models revealed the main significant effects of the measurement point for the primary (insomnia severity, sleep quality, sleep onset latency, total sleep time, daytime sleepiness) and the secondary outcomes (selection: anxiety/depression, dysfunctional beliefs, arousal, emotional stability, concern). No main effects of the condition or interaction effects were identified. Non-inferiority and equivalence tests demonstrated that the customized treatment is equivalent to standard therapy, which is a favorable outcome in light of the implicit approach. Consequently, this innovative approach warrants further exploration, incorporating the present results.