Digital Cognitive Behavioral Therapy Effective for Individuals With Insomnia
This research supports the legitimacy of digital cognitive behavioral therapy as a treatment method for individuals with insomnia.
Per study data published in JAMA Psychiatry, digital cognitive behavioral therapy (dCBT) was associated with improvements in functional health, psychological well-being, and sleep-related quality of life in individuals with insomnia.
Researchers conducted an online 2-arm parallel-group randomized trial comparing dCBT for insomnia with sleep hygiene education (SHE). dCBT was delivered through a web and/or mobile channel; SHE was delivered through a website and downloadable booklet. Patients with insomnia were randomly assigned to receive either dCBT (n=853) or SHE (n=858) in addition to treatment as usual. Online assessments were performed at baseline, 4 weeks (mid-treatment), 8 weeks (post-treatment), and 24 weeks (follow-up). Online assessments captured self-reported measures of functional health, psychological well-being, and sleep-related quality of life. As secondary outcomes, the assessments also included measures of mood, fatigue, sleepiness, cognitive failure, work productivity, and relationship satisfaction.
Study participants were primarily women (77.7%) and white (91.1%); these percentages were similar across both study arms. In the dCBT group, 80.8% completed at least 1 session, 57.6% completed at least 4 sessions, and 48.4% completed all 6 sessions. SHE was accessed at least once by 88.5% of study arm participants.
At each time point, dCBT was associated with significant improvements in global health and sleep-related quality of life compared with SHE (P <.001). In addition, dCBT was associated with greater improvements in mental well-being over SHE at Week 4 (P =.007), Week 8, and Week 24 (both P <.001). Insomnia improvements had significant mediating effects on the association between dCBT and primary outcome measures (all P <.001). Specifically, insomnia mediated 84% of functional health, 75% of well-being, and 66% of sleep-related quality of life at 24 weeks' follow-up.
For the secondary outcome measures, dCBT was generally associated with greater improvements compared with SHE. In particular, self-reported life satisfaction was significantly greater at the 8-week and 24-week time points for the dCBT arm compared with the SHE arm (both P <.001).
These data provide evidence that insomnia may be an effective intervention site for mental health and overall well-being. The relatively homogenous study population may limit the generalizability of these conclusions. Still, these data confirm the legitimacy of dCBT as a treatment method for individuals with insomnia.
Espie CA, Emsley R, Kyle SD, et al. Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: A randomized clinical trial [published online September 25, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.2745