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Randomized Controlled Trial
. 2023 Jun;17(3):826-835.
doi: 10.1007/s11764-022-01272-2. Epub 2022 Dec 3.

Does expectancy affect insomnia treatment response in cancer survivors receiving acupuncture and cognitive behavioral therapy?

Xiaotong Li  1 , Ting Bao  1 , Sheila N Garland  2 , Susan Q Li  1 , Jennifer Yu  3 , Yuelin Li  4 , Jun J Mao  5
Affiliations
Randomized Controlled Trial

Does expectancy affect insomnia treatment response in cancer survivors receiving acupuncture and cognitive behavioral therapy?

Xiaotong Li et al. J Cancer Surviv. 2023 Jun.

Abstract

Purpose: Insomnia negatively affects quality of life in cancer survivors. Expectations of insomnia treatment efficacy may influence response to intervention. We sought to determine whether pre-treatment outcome expectancy predicts response to two non-pharmacological interventions for insomnia among cancer survivors.

Methods: We analyzed data from a randomized clinical trial that compared acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) in cancer survivors. Patient expectancy was measured by the Mao Treatment Expectancy Scale (MTES) at baseline. Insomnia severity was assessed using the Insomnia Severity Index (ISI) at treatment completion (week 8). Multivariate linear regression was used to evaluate the associations between pre-treatment expectancy and ISI score at week, 8 adjusting for co-variates.

Results: Expectancy for acupuncture and CBT-I were similar at baseline (acupuncture: 13.3 ± 4.0; CBT-I: 13.2 ± 2.9, p = 0.17). Greater baseline expectancy scores were associated with a greater and statistically significant insomnia severity reduction at week 8 in the acupuncture group (beta coefficients [Coef.] = - 0.35, 95% confidence interval [CI] = - 0.6 to - 0.1, p = 0.016) adjusted for co-variates. Baseline expectancy was not statistically associated with insomnia severity reduction in the CBT-I group (Coef. = - 0.2, 95% CI = - 0.7 to 0.2, p = 0.31). High expectancy was significantly associated with greater proportion of treatment responders at week 8 in the acupuncture group (76% vs. 38%, p = 0.001) but not in the CBT-I group (83% vs. 70%, p = 0.21).

Conclusions: Higher pre-treatment outcome expectancy predicted significantly greater insomnia improvement in patients receiving acupuncture but not in those receiving CBT-I.

Implications for cancer survivors: Aligning treatment provision with expected outcomes may lead to personalized non-pharmacological insomnia management for cancer survivors.

Keywords: Acupuncture; Cancer; Cognitive behavioral therapy; Expectancy; Insomnia; Nonspecific effect.

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Conflict of interest statement

Declarations

Conflict of interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: JJM reports grants from Tibet CheeZheng Tibetan Medicine Co. Ltd. and from Zhongke Health International LLC outside the submitted work. Other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) diagram describing participant flow through the study
Fig. 2
Fig. 2
Insomnia Severity Index (ISI) change score over time by pre-treatment expectancy
Fig. 3
Fig. 3
Treatment response by high versus low expectancy
See this image and copyright information in PMC

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