Examining the Utility of a Sleep Resource in Transdiagnostic Internet-Delivered Cognitive Behavior Therapy: An Observational Study

Abstract

Patients seeking transdiagnostic internet-delivered cognitive behavior therapy (T-ICBT) for anxiety or depression often have sleep difficulties. A brief resource that includes sleep psychoeducation and strategies for improving sleep (e.g., stimulus control and sleep restriction) may address comorbid insomnia without the need for an insomnia-specific ICBT course. This observational study explored patient use and feedback of a brief sleep resource available to all patients (N = 763) enrolled in an 8-week T-ICBT course. Overall, 30.1% of patients (n = 230) reviewed the resource and were older, more engaged with the ICBT course (i.e., more likely to complete the program, more logins, and greater number of days enrolled in the course) and had higher pretreatment insomnia symptoms than those who did not review the resource. Resource reviewers did not report larger improvements in symptoms of insomnia than non-reviewers, even among patients with clinical levels of insomnia, and average insomnia levels remained above the clinical cutoff at posttreatment. While patients were satisfied with the resource and it was beneficial to some patients, more research is needed to further explore how it may be integrated into T-ICBT and how therapists can encourage the use of the resource among patients who may benefit from the resource.

Treating comorbid insomnia in patients enrolled in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy for anxiety and depression: A randomized controlled trial

“…Nevertheless, it is important to note that by 20-week follow-up, both the Standard Wellbeing Course and Sleep-Enhanced Course had similar large effects for insomnia. It does appear that the Standard Wellbeing Course alone positively impacts insomnia symptoms, which was also found in a subsequent observational study of the Wellbeing Course ( Peynenburg et al, 2022 ). It is possible that patients with insomnia symptoms make use of general cognitive strategies from the Wellbeing Course, such as thought challenging, to target unhelpful beliefs about sleep.…”

Evaluation of additional resources used in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy

“…A shared finding across the three studies was that clients who downloaded each of the resources were more engaged with the ICBT course compared to non-reviewers (i.e., more likely to complete all core lessons and sent more messages to their therapists). However, accessing the resource was not associated with additional improvements in symptoms from pre-treatment to post-treatment ( Horse et al, 2023 ; Peynenburg et al, 2022 , Peynenburg et al, 2023 ). These three studies offer helpful information about predictors of accessing specific additional resources and clients' experiences with each of the resources and suggest that a single additional resource is unlikely to significantly impact clients' outcomes at pre-treatment.…”

“…Recently, several studies were conducted to examine predictors of clients accessing specific additional resources, clients' perceptions of the resources, and the association between accessing certain resources and client outcomes at post-treatment. Each of these studies focused on a single resource including building motivation ( Horse et al, 2023 ), managing insomnia symptoms ( Peynenburg et al, 2022 ), and managing problematic alcohol use ( Peynenburg et al, 2023 ), that were available to clients during an 8-week transdiagnostic ICBT course. Out of 763 clients, 15 % downloaded an additional resource focused on building motivation ( Horse et al, 2023 ).…”

“…In the study examining a resource on managing insomnia symptoms ( Peynenburg et al, 2022 ), 30.1 % of clients downloaded the resource and reviewers were older and had more severe insomnia symptoms at pre-treatment compared to non-reviewers. Finally, 10.8 % of clients downloaded the resource on managing problematic alcohol use ( Peynenburg et al, 2023 ).…”

“…Clients provided positive feedback about each of the three additional resources, with 94 % ( Horse et al, 2023 ), 92 % ( Peynenburg et al, 2022 ), and 88.2 % ( Peynenburg et al, 2023 ) of clients who reported using the respective resources indicating that the resource was worth their time. A shared finding across the three studies was that clients who downloaded each of the resources were more engaged with the ICBT course compared to non-reviewers (i.e., more likely to complete all core lessons and sent more messages to their therapists).…”