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Treating insomnia in people who are incarcerated: a feasibility study of a multicomponent treatment pathway.

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Thibaut, Bethan 
Pattison, Natalie 
Campbell, Sean James 


Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardized, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomized controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-participants pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioral therapy for insomnia (CBTi). Assessment measures for insomnia, well-being, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake, and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to posttreatment in insomnia severity (d = -1.81, 95% CI: 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, well-being, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted. This paper is part of the Sleep and Circadian Health in the Justice System Collection.


Acknowledgements: Thank you to Care UK Health in Justice and User Voice who were key partners in our project. Special thanks go to Sarah Bromley, Dawn Jessop, Adam Horner, and Ruth Burnett for believing in the project and who helped take it forward. Additional thanks to Bryony Sheaves who provided the CBTi training, study support, and clinical supervision to the CBTi therapist. We would also like to say a big thank you to all participants who took time out of their lives to be in our study, Care UK staff and the patient and public involvement advisory groups in the high-secure prison who helped co-produce our sleep booklets, advised on the research design and made changes to the pathway. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Funder: Health Research Biomedical Research Centre


cognitive behavioral therapy, incarceration, insomnia, non-pharmacological, peer support, prison, sleep, stepped-care, treatment pathway

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Sleep Adv

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Oxford University Press (OUP)
Health Foundation (453229)