Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial

Cheng, Philip; Luik, Annemarie I.; Fellman-Couture, Cynthia; Peterson, Edward L.; Joseph, Christine L.M.; Tallent, G; Tran, Kieulinh Michelle; Ahmedani, Brian K.; Roehrs, Timothy; Roth, Thomas; Drake, Christopher L.

doi:10.1017/s0033291718001113

Cited by 133 publications

(99 citation statements)

References 55 publications

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“…First and foremost, a wealth of evidence has demonstrated that dCBT for insomnia is reducing depressive symptomatology. This has been demonstrated by using dCBT for insomnia not only as an adjunct therapy [ 57 ], but also as stand-alone treatment in trials including participants with comorbid symptoms of insomnia and depression [ 41 , 55 , 59 ], independent of whether the treatment was fully automated or guided by healthcare professionals. The effects sizes are typically in the moderate-to-large range.…”

Section: Evidence For Dcbt For Insomniamentioning

confidence: 99%

“…This is however not unique to dCBT for insomnia; dCBT programs for other disorders have equal, or even larger, problems with attrition [ 74 ]. So far, it has proven difficult to find indicators of dropout; studies have suggested that a lower social economic status [ 55 ], a longer sleep duration, less severe insomnia complaints, and more depressive symptoms increase dropout [ 75 ].…”

Section: Evidence For Dcbt For Insomniamentioning

confidence: 99%

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Digital Delivery of Cognitive Behavioral Therapy for Insomnia

Luik

Zweerde

Straten

et al. 2019

Curr Psychiatry Rep

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Purpose of Review Digital cognitive behavioral therapy (dCBT) has been available for over a decade. We reviewed the evidence that accumulated over the past 5 years and discuss the implications for introducing dCBT into standard healthcare. Recent Findings Studies have consistently supported the use of dCBT to treat insomnia. Evidence is now demonstrating large short-term effects and smaller long-term effects up to 1.5 years after treatment across populations with various co-occurring health problems. The effects also extend into a range of psychological well-being factors. Mediators and moderators have been studied to understand mechanisms and create new opportunities to enhance effectiveness and reduce dropout. Incorporating personalized guidance in dCBT may further enhance effectiveness. Summary The evidence for dCBT for insomnia is strong and suggests that dCBT is ready for application in standard healthcare. Further research, digital innovation, and development of effective implementation methods are required to ensure dCBT fulfills its potential.

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Section: Evidence For Dcbt For Insomniamentioning

confidence: 99%

Section: Evidence For Dcbt For Insomniamentioning

confidence: 99%

Digital Delivery of Cognitive Behavioral Therapy for Insomnia

Luik

Zweerde

Straten

et al. 2019

Curr Psychiatry Rep

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“…IPSRT-inspired approaches may be additionally beneficial in supporting individuals with BPD where such social rhythm instability is apparent. Furthermore, as maladaptive sleep cognitions are common in BPD (50) and this may further perpetuate the severity of insomnia, cognitive behaviour therapy for insomnia (CBT-I) could be used to address dysfunctional beliefs and behaviours about sleep which has been shown to mediate improvement of depression and psychological well-being (68,69).…”

Section: Discussionmentioning

confidence: 99%

Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls

McGowan

Goodwin

Bilderbeck

et al. 2020

Acta Psychiatr Scand

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Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls.Objectives: To differentiate the relation between the structure and timing of rest-activity patterns and symptoms of impulsivity and mood instability in bipolar disorder (BD), borderline personality disorder (BPD) and healthy controls (HC). Methods: Eighty-seven participants (31 BD, 21 BPD and 35 HC) underwent actigraph monitoring for 28 days as part of the Automated Monitoring of Symptom Severity (AMoSS) study. Impulsivity was assessed at study entry using the BIS-11. Mood instability was subsequently longitudinally monitored using the digital Mood Zoom questionnaire. Results: BPD participants show several robust and significant correlations between non-parametric circadian rest-activity variables and worsened symptoms. Impulsivity was associated with low interdaily stability (r = À0.663) and weak amplitude (r = À0.616). Mood instability was associated with low interdaily stability (r = À0.773), greater rhythm fragmentation (r = 0.662), weak amplitude (r = À0.694) and later onset of daily activity (r = 0.553). These associations were not present for BD or HCs. Classification analysis using actigraphic measures determined that later L5 onset reliably distinguished BPD from BD and HC but did not sufficiently discriminate between BD and HC. Conclusions: Rest-activity pattern disturbance indicative of perturbed sleep and circadian function is an important predictor of symptom severity in BPD. This appears to validate the greater subjective complaints of BPD individuals that are sometimes regarded as exaggerated by clinicians. We suggest that treatment strategies directed towards improving sleep and circadian entrainment may in the future be investigated in BPD. Significant Outcomes• Objectively determined rest-activity patterns are strongly correlated with worsened symptoms of impulsivity and longitudinally monitored mood instability in BPD.• Sleep and circadian features may impact on the chronicity of symptoms in BPD above BD and HCs.• Future studies targeting rest-activity pattern modification in BPD are indicated. Limitations• Sample heterogeneity present for gender and number of unemployed individuals. • Relative small sample size restricts stratification for medication and comorbid diagnoses.

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“…Our benchmark for preliminary efficacy was at least 50% of participants demonstrating a clinically meaningful change in insomnia severity from baseline‐to‐posttreatment. The benchmark of 50% was selected based on previous studies reporting response rates between 39 and 65% after digital CBT‐I …”

Section: Methodsmentioning

confidence: 99%

Digital Cognitive Behavioral Therapy for Insomnia in Women With Chronic Migraines

et al. 2020

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Objective/Background.-Insomnia commonly co-occurs with chronic migraines (CM). Non-pharmacological treatments for insomnia in CM patients remain understudied. This is a proof-of-concept study, which aims to evaluate the feasibility, acceptability, and preliminary efficacy of a digital cognitive behavioral therapy for insomnia (dCBT-I) for individuals with CM and insomnia (CM-I) in the United States.Methods.-We recruited 42 females with CM-I symptoms from a U.S.-based observational cohort and from the general population via advertisements. Within a multiple baseline design, participants were randomized to receive dCBT-I after 2, 4, or 6 weeks of completing baseline sleep diaries. DCBT-I was scrutinized against benchmarks for completion rates (≥90% to complete dCBT-I), acceptability (≥80% to find dCBT-I acceptable), and posttreatment changes in insomnia symptoms (≥50% indicating a clinically relevant improvement in their insomnia symptoms). As a secondary measure, we also reported percentage of individuals reverting to episodic migraines. Results.-Out of 42 randomized, 35 (83.3%) completed dCBT-I within the 12 weeks provided. Of these completers, 33 (94.3%) reported being satisfied (n = 16) or very satisfied (n = 17) with treatment. Additionally, 65.7% of completers responded to treatment as per universally accepted criteria for insomnia. Lastly, 34% of completers reverted from CM to episodic migraine. Conclusion.-This study provides evidence for the feasibility and acceptability of dCBT-I in patients with CM-I complaints. Effects of improving insomnia and migraines were suggested. These results indicate that a randomized controlled trial is needed to determine the efficacy of dCBT-I in CM patients.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial

Abstract: Results provide evidence that the wide dissemination of dCBT-I may effectively target both insomnia and comorbid depression across a wide spectrum of the population.

Cited by 133 publications

References 55 publications

Digital Delivery of Cognitive Behavioral Therapy for Insomnia

Digital Delivery of Cognitive Behavioral Therapy for Insomnia

Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls

Digital Cognitive Behavioral Therapy for Insomnia in Women With Chronic Migraines

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