Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2024-09-11 DOI:10.1111/imj.16521

Alexander Sweetman, Chelsea Reynolds, Cele Richardson

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Abstract

Background

Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended ‘first line’ treatment but is accessed by a minority of people with insomnia.

Aims

To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program.

Methods

An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used.

Results

Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diff_adj (95% CI) = 7.32 (5.0–9.6), P < 0.001, d = 1.64), depression (3.36 (1.3–5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5–7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group.

Conclusions

This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.

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澳大利亚社区样本中的失眠症数字认知行为疗法与数字睡眠教育对照：随机对照试验

背景失眠是澳大利亚的一种常见病，会增加出现抑郁和焦虑症状的风险。失眠认知行为疗法（CBT-i）是推荐的 "一线 "治疗方法，但只有少数失眠症患者能够接受该疗法。目的为了改善澳大利亚的CBT-i使用情况，我们旨在开发并测试一种自我指导的交互式数字CBT-i程序。方法在2022年8月至2023年8月期间进行了一项在线随机对照试验，以调查数字CBT-i与数字睡眠教育对照组相比，在8周随访时对失眠症状（ISI）、抑郁（PHQ-9）、焦虑（GAD-7）、疲劳、嗜睡和不良睡眠观念的影响。对照组在 8 周随访后接受干预。此外，还在 16 周和 24 周时进行了问卷调查。结果参与者包括 62 名有失眠症状的成年人（年龄 M (SD) = 52.5 (16.3)，82% 为女性，ISI = 18.6 (2.9)）。基线特征和缺失的 8 周数据（14.5%）在组间无差异。调整基线分数后，CBT-i 与较低的失眠（Diffadj (95% CI) = 7.32 (5.0-9.6)，P < 0.001，d = 1.64）、抑郁（3.36 (1.3-5.4)，P = 0.002，d = 0.84）、疲劳（5.2（2.5-7.9），P <0.001，d = 1.00）和对睡眠的不适应信念（11.0（4.1-18.0），P = 0.002，d = 0.82），但在 8 周时焦虑症状没有改善（1.84（-0.1 至 3.8），P = 0.060，d = 0.50）。与对照组相比，CBT-i 有更高的失眠缓解率（ISI <8; 0.0% vs 40.0%，P <0.001）和 8 周时的反应率（ISI 减少 ≥6; 7.1% vs 72.0%，P <0.001）。结论这项互动式数字 CBT-i 计划使澳大利亚成人失眠症状患者的失眠、抑郁、疲劳和不良睡眠观念得到了显著而持久的改善。要提高数字 CBT-i 的使用率和普及率，需要实施相关计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.