The management of insomnia by Australian psychologists: a qualitative study

Abstract

ABSTRACT Objective Although clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment for insomnia, many people with insomnia do not have access to CBTi and are prescribed sedative-hypnotic medicines by medical health professionals. Psychologists have training in CBT and may be well placed to deliver behavioural therapy for insomnia. However, the current treatment of insomnia, amount of sleep-specific training and knowledge of CBTi among Australian psychologists remains unknown. Method This qualitative study conducted semi-structured interviews with Australian psychologists. Interviews included case study scenarios to provide an in-depth exploration of psychologists’ knowledge and skills in the management of insomnia. Interview transcripts were analysed using thematic analysis to identify themes. Results Twenty-six psychologists participated in this study. Four themes were identified in the data: 1) Sleep is important but rarely a treatment priority; 2) Confusion about funding pathways discourages treatment of insomnia; 3) A variety of approaches are used in the management of insomnia; 4) Psychologists with experience in CBTi are rare. Conclusions Most Australian psychologists are not well equipped to manage insomnia effectively with CBTi. Along with other primary health care professionals, psychologists need training in the delivery of evidence-based insomnia treatment. KEY POINTS What is already known about this topic: The recommended treatment for insomnia is Cognitive Behavioural Therapy for insomnia (CBTi) but most people with insomnia do not receive this treatment The most common treatments for insomnia are sedative hypnotic medications and sleep hygiene education Most people with insomnia are not referred to a psychologist. What this topic adds: Most psychologists and other primary care professionals lack specific knowledge and training in insomnia and CBTi Insomnia is often regarded as a secondary problem and clients are not usually referred to psychologists for treatment of insomnia Psychologists use a range of treatments for insomnia, most common are sleep hygiene and relaxation.