Culturally Adapted CBTI for Chinese Insomnia Patients: a One-Arm Pilot Trial Yoann Birling 1 & Jian Wang 1 & Guixia Li 1 & Enlai Wu 2 & Zhidan Yu 2 & Yunshu Feng 1 & Yuting Wu 2 # International Society of Behavioral Medicine 2018 Abstract Purpose Insomnia is a common mental disorder with severe consequences. Cognitive-behavioral therapy for insomnia (CBTI) has been proved effective against insomnia, but most of the research is limited to Western countries. This trial objective is to develop a Chinese culture-adapted CBTI program and assess its efficacy. Method An 8-week culturally adapted CBTI program was developed that included mixed group and individual session and culturally adapted relaxation and cognitive restructuring treatment components. A one-arm clinical trial was conducted at a public hospital between March 2016 and January 2017. Seventy-two Chinese adults (15 males, 57 females; mean age, 50 years) with insomnia disorder underwent the culturally adapted CBTI program. Sleep diaries and self-report scales, as well as polysomnography (PSG, for a subgroup only), were used to assess qualitative and quantitative measures of sleep, mental health status, and quality of life at baseline, post-treatment, and 4-month follow-up. Results Pre-post analyses showed significant changes in sleep diary sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time of respectively - 37.03 min (CI, - 48.90 to - 25.16), - 28.16 min (CI, - 40.22 to - 16.10), and + 27.49 min (CI, 10.51 to 44.47). Self-reported sleep quality, mental health, and quality of life improved compared to baseline. The self- reported outcomes were mainly stable at follow-up. PSG outcomes globally failed to show improvement. Conclusion The design of a CBTI program adapted to Chinese population was achieved. Culturally adapted CBTI showed promising results. More rigorously designed studies are needed to ensure efficacy. Keywords Insomnia . Clinical trial . Treatment . Cognitive-behavioral therapy . Cultural adaptation Introduction Insomnia is the most common sleep disorder, 6–15% of the general population suffers from insomnia according to diag- nosis criteria, and even 20–41.7% reports a lack of sleep [1]. According to a recent meta-analysis, the prevalence of insom- nia is 15% in China [2]. Insomnia induces functioning impair- ments in daytime activities and cognitive, social, and emotion- al domains [3], and is associated with daytime sleepiness and increased road accident risks [4]. Additionally, chronic insom- nia increases subsequent risk for somatic health problems, interpersonal problems, psychological problems, substance abuse, and suicide [5, 6], and decreases quality of life [7]. A Canadian study estimated the total annual cost of insomnia in Quebec at $6.6 billion, and the average per-person cost was estimated at $5010 for individuals with insomnia syndrome compared to $421 for good sleepers [8]. Cognitive-behavioral therapy for insomnia (CBTI) is de- signed to manage psychological and behavioral factors of in- somnia [9]; it includes various behavioral and cognitive tech- niques: stimulus control, sleep restriction, relaxation training, cognitive restructuring, and sleep hygiene [10]. Several meta- analyses have shown that CBTI can significantly improve sleep onset latency (SOL), wake time after sleep onset (WASO), and total sleep time (TST) [11–13]. Moreover, CBTI appears to have better long-term outcomes than phar- macotherapy [13–15]. In 2009, Espie [16] proposed a stepped care model for CBTI, and there is now evidence of efficacy for various treatment modalities as self-help treatment [17, 18], group therapy [19, 20], and individual therapy [21]. However, these studies were conducted in Western and developed countries, and there is little evidence of CBTI * Jian Wang wjmd@263.net 1 Guang’an Men Hospital, Beijing 100053, China 2 Institute of Psychology, Chinese Academy of Sciences, Beijing 100049, China International Journal of Behavioral Medicine https://doi.org/10.1007/s12529-017-9710-z