Wednesday, November 30, 2016

Online CBT for Insomnia May Lead to Long-Lasting Sleep Improvements

Although cognitive-behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment for patients with chronic insomnia, there are a limited number of clinicians currently trained to deliver this therapy. A study published today in JAMA Psychiatry suggests that participation in an online CBT-I program may lead to long-lasting sleep improvements for adults with chronic insomnia.

“This study provides compelling evidence that the self-guided, web-based CBT-I intervention SHUTi can effectively treat insomnia,” Lee Ritterband, Ph.D., of the University of Virginia School of Medicine and colleagues wrote. “It extends findings that internet-delivered CBT-I can meaningfully improve insomnia symptoms and sleep variables, including when insomnia is comorbid with other conditions.”

Ritterband and colleagues randomly assigned 303 adults aged 21 to 65 with chronic insomnia to either SHUTi or an online patient education (PE) program. Participants in the SHUTi group were given access to six intervention “core” assignments, with a new assignment made available seven days after the completion of the previous one, to parallel traditional weekly CBT-I sessions; the program featured personalized goal-setting, feedback, and more. Participants in the PE group were given access to non-tailored material on insomnia, including information about symptoms and behavioral strategies to improve sleep. Participants in both groups had access to the online materials for nine weeks.

Self-reported ratings of insomnia severity (as measured by the Insomnia Severity Index) and online sleep diary-derived values for sleep-onset latency and wake after sleep onset symptoms were collected at the beginning of the study, and again at nine weeks, six months, and one year.

While participants in both intervention groups experienced significant improvements in insomnia symptom severity, sleep-onset latency, wake after sleep onset, and overall sleep quality, 52.6% of the SHUTi group experienced a reduction of greater than 7 points on the ISI (responders) from baseline to nine weeks compared with only 16.9% of the PE group. At the six-month follow-up, 59.7% of the SHUTi group and 35.7% of the PE group were considered to be responders, while 69.7% of the SHUTi group and 43.0% of the PE group were deemed responders at the one-year follow-up. Adherence to the SHUTi program was also good, with 60.3% of SHUTi participants completing all six cores of the program.

“Although their study excluded individuals with medium to high suicide risk, severe depression, bipolar disorder, alcohol or drug abuse in the past year, and those with medical comorbidities that were likely to worsen insomnia, their results provide an indication that the benefits conferred by SHUTi are not diminished by the presence of either psychiatric or medical comorbidities,” Andrew Krystal, M.D., of the University of California, San Francisco, and Aric Prather, Ph.D., of Duke University School of Medicine wrote in a related editorial. “Still, a true characterization of how SHUTi performs in patients seen in clinical practice will require evaluation in a setting where less-stringent eligibility criteria are applied.”

For related information, see the Psychiatric News article “Treat Chronic Insomnia With CBT-I, Says American College of Physicians.”



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