Throwaway05
21hr ago
Looking at our mundane problems and existential threats (ex: climate change) the biggest problem is people not thinking long term.
Inheritance helps force people to think longer term than their own lives.
That has value!
Saying most effective in medicine is probably overstating my case, although if asked to justify that I could easily point to adherence issues being the primary point of failure for CBT-I and say something like "if only the patients actually followed the treatment it would work!" which is absolutely true but is a bit dickish.
If you look at your link in the key points section it says things like "CBT-I across several delivery modes improves global and sleep outcomes compared with passive control in the general adult population (moderate strength evidence). Evidence was insufficient to assess adverse effects of CBT-I."
Keep in mind that that the quotes you pulled out are looking at individual sleep metrics as opposed to global sleep outcomes. It is not unreasonable for a treatment method to have more impact on say sleep onset than sleep maintenance.
The AAFP guidelines note:
"Psychological interventions included stimulus control, sleep restriction, relaxation techniques, sleep hygiene education, and CBT for insomnia. CBT for insomnia is a combination of cognitive therapy, behavioral interventions (i.e., sleep restriction and stimulus control), and education (i.e., sleep hygiene). There were insufficient data to draw conclusions on the effectiveness of specific interventions alone (e.g., stimulus control, sleep restriction, relaxation techniques), but based on a meta-analysis of 20 trials, CBT for insomnia improved global and sleep outcomes in the general adult population."
Which is fair and measured.
That said if you change my quoted statement to "CBT-I is the most effective treatment modality for sleep" it becomes significantly more relevant and strictly speaking more accurate. All of the guidelines recommend CBT-I over medication in most circumstances because of severe safety/benefit issues with medication management.
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