Short and long-term effects of unguided internet-based cognitive behavioral therapy for chronic insomnia in morning and evening persons: a post-hoc analysis

Lien, Mats; Bredeli, Einar; Sivertsen, Børge; Kallestad, Håvard; Pallesen, Ståle; Smith, Otto Robert Frans; Faaland, Patrick; Ritterband, Lee M.; Thorndike, Frances P.; Vedaa, Øystein

doi:10.1080/07420528.2019.1647435

Cited by 9 publications

(9 citation statements)

References 55 publications

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“…iCBT studies could be further subcategorized based on the type of comparison that was made. Of the 18 RCT studies in this category, 6 (33%) compared iCBT against a waitlist condition [ 2 , 20 , 31 - 33 , 37 ]; 5 (28%) studies compared unguided intervention with guided controls [ 21 , 24 , 26 , 38 , 39 ]; 8 (44%) studies compared iCBT with other types of interventions [ 19 , 25 , 27 - 30 , 36 , 37 ]; 1 (6%) study used a sensor-based approach and compared it to unguided iCBT without a sensor [ 22 ]. The 3 non-RCT studies were cross-sectional studies that used a single group to assess the feasibility, accessibility, and preliminary effectiveness of iCBT programs [ 23 , 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review

Saad¹,

Bruno²,

Camara³

et al. 2021

JMIR Ment Health

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Background Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. Objective This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient’s or at the technology’s end), so the patients can implement them without any support. Methods A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. Results We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. Conclusions There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates.

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Section: Resultsmentioning

confidence: 99%

Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review

Saad¹,

Bruno²,

Camara³

et al. 2021

JMIR Ment Health

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“…Their results showed significantly smaller improvement in depressive mood in E-types than in N-types, with N-types in turn showing significantly smaller improvement than M-types. In contrast, an internet-based CBTI intervention study using midlife adults by Lien et al (2019) found similar improvements in depressive mood and insomnia severity in both M-and E-types. Further exploration of the interaction between CBTIeffectiveness and chronotype is required.…”

Section: Discussionmentioning

confidence: 83%

Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students

Bradford

Biello

Russell

2021

Chronobiology International

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Chronotype describes a person's general preference for mornings, evenings, or neither. It is typically conceptualized as a continuous unidimensional spectrum from morningness to eveningness. Eveningness is associated with poorer outcomes across a myriad of physical and mental health outcomes. This preference for later sleep and wake times is associated with increased risk of depression, anxiety, and suicidal ideation in both clinical and community samples. However, the mechanisms underlying the negative consequences of this preference for evenings are not fully understood. Previous research has found that sleep disturbances may act as a mediator of this relationship. The present study aimed to explore the associations between chronotype and affective outcomes in a sample of students. Additionally, it aimed to investigate the potential role of insomnia as a mediator within these relationships. Participants (n = 190) completed an anonymous self-report survey of validated measures online which assessed chronotype, insomnia symptoms, and a range of affective outcomes (defeat, entrapment, suicide risk, stress, and depressive and anxious symptomology). Eveningness was associated with more severe or frequent experiences of these outcomes, with participants that demonstrated a preference for eveningness more likely to report poorer affective functioning and increased psychological distress. Mediation analysis found the relationship between chronotype and these outcome measures was completely or partially mediated by insomnia symptom severity measured by the validated Sleep Condition Indicator insomnia scale. Taken together, these findings add further evidence for the negative consequences of increased eveningness. Additionally, our results show that chronotype and sleep disturbances should be considered when assessing mental well-being. Implementing appropriate sleep-related behavior change or schedule alterations can offer a tool for mitigation or prevention of psychological distress in students that report a preference for later sleep and wake times.

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“…Their results showed significantly smaller improvement in depressive mood in E-types then N-types, with N-types in turn showing significantly smaller improvement than M-types. In contrast, an internet-based CBTI intervention study using midlife adults by Lien et al (2019) found similar improvements in depressive mood and insomnia severity in both M-and E-types. Further exploration of the interaction of CBTI-effectiveness and chronotype is required.…”

Section: Discussionmentioning

confidence: 83%

Insomnia Mediates the Association between Eveningness and Suicidal Ideation, Defeat, Entrapment, and Psychological Distress in Young Adults

Drr¹,

Biello²,

Russell³

2020

Preprint

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Chronotype describes a person's general preference for mornings, evenings or neither. It is typically conceptualized as a continuous unidimensional spectrum from morningness to eveningness. Eveningness is associated with poorer outcomes across a myriad of physical and mental health outcomes. This preference for later sleep and wake times is associated with increased risk of depression, anxiety, and suicidal ideation and behaviors in both clinical and community samples. However, the mechanisms underlying the negative consequences of this preference for evenings is not fully understood. Previous research has found that sleep disturbances may act as a mediator of this relationship. The present study aimed to explore the associations between chronotype and affective outcomes in a community sample of young adults. Additionally, it aimed to investigate the potential role of insomnia as a mediator within these relationships. Participants (n = 260) completed an anonymous self-report survey of validated measures online which assessed chronotype, insomnia symptoms, and a range of affective outcomes (defeat, entrapment, stress, suicide risk, and depressive and anxious symptomology). Eveningness was associated with more severe or frequent experiences of these outcomes, with young adults demonstrating a preference for eveningness more likely to report poorer affective functioning and increased psychological distress. Mediation analysis found the relationship between chronotype and these outcome measures were partially mediated by sleep disturbances as measured by the well-validated Sleep Condition Indicator insomnia scale. Taken together, these findings add further evidence for the negative consequences of increased eveningness. Additionally, our results show that chronotype and sleep disturbances should be considered when assessing mental well-being. Implementing appropriate sleep-related behavior change or schedule alterations can offer a tool for mitigation or prevention psychological distress in young adults who report a preference for later sleep and wake times.

show abstract

Short and long-term effects of unguided internet-based cognitive behavioral therapy for chronic insomnia in morning and evening persons: a post-hoc analysis

Cited by 9 publications

References 55 publications

Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review

Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review

Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students

Insomnia Mediates the Association between Eveningness and Suicidal Ideation, Defeat, Entrapment, and Psychological Distress in Young Adults

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