Acceptance and commitment therapy combined with behavioural strategies and self-compassion versus cognitive behavioural therapy for insomnia: feasibility, acceptability, and randomized pilot

OBJECTIVES: This pilot randomized controlled trial (RCT) evaluated feasibility, acceptability, and preliminary clinical benefits of ACTCOM‐I, a novel intervention combining Acceptance and Commitment Therapy with behavioural strategies and self‐compassion, compared with CBT‐I. METHODS: An analytic sample of 19 participants (63% women; M = 43.26 years, SD = 12.77) with chronic insomnia was randomized to ACTCOM‐I (n = 10) or CBT‐I (n = 9). Assessments occurred at baseline (T0), post‐treatment (T1), 3‐months (T2) and 6‐months (T3) follow‐ups. Measures included insomnia severity, beliefs, pre‐sleep arousal, sleep effort, sleep diary, anxiety/depression, affect, quality of life, mindfulness, psychological flexibility, cognitive fusion, progress/obstructions to valued living, and self‐compassion. RESULTS: Linear mixed models showed significant Time effects for insomnia severity (p < .001), with large within‐group effect sizes maintained at follow‐up. No significant between‐group differences were found (p = .88), indicating similar improvement trajectories over time. Reliable change analysis (RCI) confirmed that 90% of ACTCOM‐I and 89% of CBT‐I participants achieved clinically significant improvements at post‐treatment, with high response and remission rates. No participants deteriorated. Both interventions also led to comparable improvements in secondary sleep‐related outcomes, anxiety/depression, and positive affect, while negative affect remained stable. Most process‐related measures showed significant Time effects but no TimeXGroup interactions, further supporting similar patterns of change. Within‐group analyses suggested greater improvements in psychological flexibility, cognitive fusion, obstructions to valued living and self‐compassion in ACTCOM‐I, particularly at follow‐up. Despite high attrition, ACTCOM‐I was feasible, well‐accepted, and thematic analysis identified six overarching themes. CONCLUSIONS: Results suggest that ACTCOM‐I is feasible, well‐accepted, and preliminary findings support further studies on its potential as a complementary treatment to chronic insomnia.