Experiences of group-based cognitive behavioural therapy for insomnia among patients with rheumatoid arthritis: a qualitative study.

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease, with a prevalence of insomnia disorders in up to 70%. Patients' experiences of participating in group-based cognitive behavioural therapy for insomnia (CBT-I) are sparsely explored, and CBT-I has not been evaluated in patients with RA until now. Therefore, the aim was to explore patients' experiences of CBT-I and how the components of CBT-I were incorporated in sleep management. We conducted a qualitative study with semi-structured interviews. The interview guide was developed based on CBT-I, with questions that explicitly explored the participants' experiences of sleep education and the behavioural components of CBT-I. Interviews were conducted one-to-one at Center for Rheumatology and Spine Diseases, Copenhagen. Patients with RA who had received CBT-I as intervention in a randomised controlled trial (N=11). The analysis was based on a reflexive thematic method. Five themes were identified (1) <i>When knowledge contributes to an altered perception of sleep</i>, referring to the reduced misperception and increased motivation that followed sleep education, (2) <i>Overcoming habits and perceptions to accelerate sleep onset</i>, referring to barriers related to sleep behaviour and how stimulus control enabled them to find meaningful behaviour, (3) <i>The sleep window of challenges in learning how to sleep right</i> referring to that payoff from sleep restriction did not come easily or by magic, and commitment gave them confidence to continue, (4) <i>Relaxation becomes a behavioural habit and goes beyond sleep</i>, referring to a means to achieve a relaxed body and mind and how they thereby coped better with RA-related symptoms and (5) <i>Break the cycle and regain control</i> referring to how trust in one's own accomplishment was crucial to reducing worrying. The process towards eliminating insomnia was a bodily experience and involved a changed mindset that resulted in an alteration of behaviour and cognitions.