Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women

Abstract

IMPORTANCE Black women are at risk for insomnia disorder. Despite interest in addressing sleep health disparities, there is limited research investigating the efficacy of criterion-standard treatment (cognitive behavioral therapy for insomnia [CBT-I]) among this racial minority population. OBJECTIVE To compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS In this single-blind, 3-arm randomized clinical trial, participants in a national, longitudinal cohort (Black Women's Health Study [BWHS]) were recruited between October 2019 and June 2020. BWHS participants with elevated insomnia symptoms were enrolled and randomized in the current study. INTERVENTIONS Participants were randomized to receive (1) an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education (PE) about sleep. MAIN OUTCOMES AND MEASURESThe primary outcome was insomnia severity (Insomnia Severity Index [ISI]). Index score ranged from 0 to 28 points, with those scoring less than 8 points considered to not have clinically significant insomnia symptoms and a score of 15 points or higher suggesting insomnia disorder. An ISI score reduction of more than 7 points was considered a clinically significant improvement in insomnia symptoms. The SHUTi-BWHS program was hypothesized to be more effective at significantly decreasing insomnia severity compared with the SHUTi program and PE.RESULTS A total of 333 Black women were included in this trial, and their mean (SD) age was 59.5 (8.0) years. Those randomized to receive either SHUTi or SHUTi-BWHS reported significantly greater reductions in ISI score at 6-month follow-up (SHUTi: −10.0 points; 95% CI, −11.2 to −8.7; SHUTi-BWHS: −9.3 points; 95% CI, −10.4 to −8.2) than those randomized to receive PE (−3.6 points; 95% CI, −4.5 to −2.1) (P < .001). Significantly more participants randomized to SHUTi-BWHS completed the intervention compared with those randomized to SHUTi (86 of 110 [78.2%] vs 70 of 108 [64.8%]; P = .008). Participants who completed either intervention showed greater reductions in insomnia severity compared with noncompleters (−10.4 points [95% CI, −11.4 to −9.4] vs −6.2 points [95% CI, −8.6 to −3.7]). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, both the SHUTi and SHUTi-BWHS programs decreased insomnia severity and improved sleep outcomes more than PE. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program, as a greater proportion completed the full intervention. Program completion was associated with greater improvements in sleep.

Digital tools for the assessment of pharmacological treatment for depressive disorder: State of the art

“…idently a major discriminator. On the other hand, the availability of apps and other digital tools in multiple languages, and tailoring applications to specific target populations has been shown to benefit the impact of digital tools in treatment optimization ( Escobar-Viera et al, 2021 ;Zhou et al, 2022 ).…”

“…Different features of depression can be captured by different digital tools in a context of digital phenotyping. This table highlights some examples, the traits they measure and their phenotypic correlates, throughout the different stages of pharmacological treatment ( Ayers et al, 2017 ;Birk and Mandryk, 2019 ;Bernert et al, 2017 ;Büscher et al, 2020 ;Brietzke et al, 2019 ;Cohen et al, 2020a ;Colder Carras et al, 2018 ;Cho et al, 2019 ;Cheng et al, ;Dissing et al, 2018 ;Doryab et al, 2019 ;Faurholt-Jepsen et al, 2013Henry et al, 2020;Wallace et al, 2017 ;Insel, 2018 ;Izmailova et al, 2018 ;Jacobson et al, ;Kalantarian et al, 2016 ;Kivelä et al, 2019 ;Kramer et al, 2014 ;Minaeva et al, 2020 ;Pennebaker et al, 2003 ;Pratap et al, 2019 ;Perna et al, 2020 ;Pham et al, 2022 ;Philip et al, 2020;Vaidyam et al, 2019 ;Rohatagi et al, 2016 ;Stange et al, 2018 ;Sinnenberg et al, 2017 ;Sano et al, 2018 ;Sachan, 2018 ;Torous et al, 2021 ;Washington et al, ;Widdershoven et al, 2019 ;Yoshikawa et al, 2021 ;Zhou et al, 2022 ;Zulueta et al, 2018 ;Zijp et al, 2019 ).…”

Waking Up to the Importance of Sleep: Opportunities for Policy Makers

“…In addition to the access, treatments are rarely culturally tailored to minority populations, which may impact engagement and adherence. In a recent study addressing this gap, Zhou and colleagues created a culturally tailored, stakeholder informed version of digital CBT-I for Black women and compared its efficacy against a similar but not culturally tailored version and a control condition (Zhou et al, 2022). While both active treatments produced significant improvements in insomnia symptoms relative to the control condition, those randomized to the culturally tailored version were significantly more likely to adhere and complete treatment.…”

Associations between 24-h Movement Behavior and Internet Addiction in Adolescents: A Cross-Sectional Study

“…With significant internet use and a significant increase in online access, internet addiction has become more frequent in society [ 2 ]. In the 47th most recent statistics on Internet development in China, 989 million people used the Internet by December 2020 [ 3 ], of these people, 14.8% were aged 10 to 18, showing that the Internet has become an inseparable part of adolescents’ lives [ 4 ]. Internet addiction (IA) can be defined as a cognitive control disorder that does not involve specific drugs [ 5 ].…”