Guided digital cognitive-behavioral therapy for insomnia: A (cost-)effective intervention for people with insomnia and psychological distress? Results of a randomized controlled trial.

IF 6 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of consulting and clinical psychology Pub Date : 2026-07-01 DOI:10.1037/ccp0001020

Joyce E Reesen, Savannah L C Ikelaar, Alex E van Keeken, Shanna van Trigt, Jeanne Leerssen, Roxanne E Bongers, Adriaan W Hoogendoorn, Judith E Bosmans, Neeltje M Batelaan, Jaap Lancee, Eus J W Van Someren

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引用次数: 0

Abstract

Objective: Insomnia is common in anxiety, posttraumatic stress disorder (PTSD), and borderline personality disorder (BPD), but cognitive-behavioral therapy for insomnia (CBT-I) is understudied in these conditions. We evaluated the (cost-)effectiveness of CBT-I in adults with insomnia and symptoms of anxiety, PTSD, or BPD.

Method: A total of 157 adults with insomnia and symptoms of anxiety, PTSD, or BPD were randomized to guided digital CBT-I or sleep diary control. Assessments at baseline, 2-month posttreatment, and 8-month follow-up included insomnia severity (Insomnia Severity Index), mental health symptoms, sleep diary measures, and positive health. Cost-effectiveness (Insomnia Severity Index-based) and cost-utility (quality-adjusted life years-based) were analyzed from a societal perspective.

Results: At posttreatment, CBT-I produced large reductions in insomnia severity versus control (d = -1.04; p < .001) and small effects on symptoms of anxiety and BPD (ds = -0.28; -0.36) but not of PTSD. At follow-up, effects on insomnia severity remained large (d = -0.98; p < .001), but effects on anxiety and BPD were no longer significant. Most sleep diary measures showed small-to-moderate improvements; positive health changes were minimal. CBT-I did not significantly reduce societal costs (-€826, 95% CI [-3,797, 2,144]) but showed a 94% probability of cost-effectiveness at €450 per Insomnia Severity Index point and 71% at €20,000 per quality-adjusted life year.

Conclusions: CBT-I is a (cost-)effective treatment for insomnia with co-occurring anxiety, PTSD, or BPD symptoms, although effects on anxiety and BPD are small, and none were found for PTSD. These findings support integrating CBT-I into routine care, potentially alongside targeted interventions for co-occurring psychological distress. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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引导数字认知行为疗法治疗失眠症：对失眠和心理困扰患者的一种（成本）有效的干预？随机对照试验结果。

目的：失眠在焦虑、创伤后应激障碍（PTSD）和边缘型人格障碍（BPD）中很常见，但认知行为疗法（CBT-I）在这些情况下的研究不足。我们评估了CBT-I在患有失眠和焦虑、创伤后应激障碍或BPD症状的成年人中的（成本-）有效性。方法：共有157名患有失眠和焦虑、创伤后应激障碍或BPD症状的成年人被随机分为引导的数字CBT-I组或睡眠日记组。基线、治疗后2个月和8个月的随访评估包括失眠严重程度（失眠严重指数）、心理健康症状、睡眠日记测量和积极健康。从社会角度分析成本-效果（基于失眠严重指数）和成本-效用（基于质量调整生命年）。结果：治疗后，与对照组相比，CBT-I显著降低了失眠严重程度（d = -1.04; p < .001），对焦虑和BPD症状的影响较小（d = -0.28; -0.36），但对PTSD没有影响。在随访中，对失眠严重程度的影响仍然很大（d = -0.98; p < .001），但对焦虑和BPD的影响不再显著。大多数睡眠日记显示出小到中等程度的改善；积极的健康变化很少。CBT-I并没有显著降低社会成本（- 826欧元，95% CI[-3,797, 2,144]），但在每个失眠严重指数点450欧元的成本效益概率为94%，在每个质量调整生命年20,000欧元的成本效益概率为71%。结论：CBT-I对于伴有焦虑、创伤后应激障碍或BPD症状的失眠患者是一种（成本）有效的治疗方法，尽管对焦虑和BPD的影响很小，并且没有发现对PTSD的影响。这些发现支持将CBT-I纳入常规护理，并可能与同时发生的心理困扰的有针对性干预措施一起。（PsycInfo数据库记录(c) 2026 APA，版权所有）。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.