Wednesday, January 22, 2020

Digital CBT Found Effective for Reducing Insomnia During Pregnancy

Digital cognitive-behavioral therapy (CBT) is a safe and effective approach for reducing insomnia symptoms in pregnant women, reports a study published today in JAMA Psychiatry.

“Although sleep disturbance during pregnancy may be viewed as normative and innocuous, research indicates that it is associated with an increased risk of adverse maternal outcomes, including depression and preterm birth,” wrote Jennifer Felder, Ph.D., of the University of California, San Francisco, and colleagues. “A digital CBT-I [CBT for insomnia] program may be of particular interest for pregnant women, who report a preference for mental health care that includes flexible options and for whom timely intervention may be particularly important.”

Felder and colleagues randomly assigned 208 women who were up to 28 weeks pregnant and had insomnia to receive either digital CBT-I or standard insomnia treatment for 10 weeks. The digital CBT-I program consisted of six weekly tutorials on topics including the following: proper sleep hygiene, relaxation techniques, and stimulus control (how to associate a bed as a cue for sleep). The CBT-I program provided automated reminders to complete each session and automated help based on a person’s progress. The participants also had access to a moderated online community and a library of sleep education materials. The women receiving standard care had access to treatments including prescription/over-the-counter sleep medications, herbal remedies, counseling, and/or peer support groups.

After 10 weeks, the women who received CBT-I reported significantly greater improvements in their insomnia symptoms compared with women receiving standard treatment. The average scores on the Insomnia Severity Index (ISI) of the women in the CBT-I group dropped 0.59 points every week, compared with 0.23 points a week for the standard-care group. Remission rates, defined as ISI scores of 7 or less, were significantly higher among those in the digital CBT-I group (44.0%) versus those in the standard treatment group (22.3%). Women receiving digital CBT-I also reported greater reductions in depressive symptom severity and anxiety symptom severity compared with women receiving standard treatment. Additionally, the benefits of CBT-I over standard care for insomnia, depression, and anxiety remained when the patients were re-assessed eight weeks later.

“Given the widespread nature of insomnia in pregnancy, the scalability of this intervention, its low-risk profile, and its demonstrated efficacy, digital CBT-I has great promise as a treatment for insomnia in pregnant women,” Felder and colleagues concluded.

To read more on this topic, see the Psychiatric News article “Online CBT for Insomnia Offers Long-Term Benefit.”

(image: iStock/damircudic)

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