Self-Guided Online CBT May Benefit Patients With Insomnia

People with insomnia may find significant relief of their symptoms through self-guided, internet-based cognitive-behavioral therapy (iCBT), a study in the Journal of Affective Disorders suggests. This could help address a need in communities where mental health professionals are in short supply, the researchers wrote.

Ashlee B. Grierson of St. Vincent’s Hospital in Sydney, Australia, and colleagues measured the effectiveness of an iCBT program consisting of four online lessons. The lessons were presented as an illustrated story about a male character with insomnia who learns about the condition and ways to manage his symptoms. After each lesson, participants were asked to download a summary of key concepts introduced in the lesson and practice activities. Of the 317 people who enrolled in the program, 118 completed all four lessons.

Participants completed the Insomnia Severity Index (ISI) and the Kessler 10-item Psychological Distress Scale online before each lesson. They also took the World Health Organization 5-item Well-Being Index assessment before the first lesson, and those who completed the program took it again before the fourth lesson.

Overall, the participants reported large improvements in their insomnia symptoms, moderate improvements in their psychological distress, and small improvements in their general well-being. Among the participants who started the study with ISI scores 15 or above (considered the cutoff for clinical insomnia), 65% remitted (ISI below 15) following iCBT treatment.

The authors noted that their findings suggest that iCBT is a scalable and cost-effective way to disseminate the psychotherapy considered to be the gold standard for insomnia. “Unguided iCBT-I offers the benefits of being accessible at times convenient to the user (for example, outside of business hours), at a low cost, and in a confidential and private environment. Additionally, treating as many patients as possible with the least intensive but still clinically effective care allows for more substantial resources (for example, face-to-face and guided online programs) to be allocated to those who require additional care.”

For related information, see the American Journal of Psychiatry article “Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients.”

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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.”

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