A Review of Digital Cognitive Behavioral Therapy for Insomnia (CBT-I Apps): Are They Designed for Engagement?

Abstract

There are different ways to deliver Cognitive Behavioral Therapy for Insomnia (CBT-I), of which in-person (face to face) is the traditional delivery method. However, the scalability of in-person therapy is low. Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is an alternative and there are tools on the market that are validated in clinical studies. In this paper, we provide a review of the existing evidence-based CBT-I apps and a summary of the published usability-oriented studies of these apps. The goal is to explore the range of interaction methods commonly applied in dCBT-I platforms, the potential impact for the users, and the design elements applied to achieve engagement. Six commercially available CBT-I apps tested by scientifically valid methods were accessed and reviewed. Commonalities were identified and categorized into interactive elements, CBT-I-related components, managerial features, and supportive motivational features. The dCBT-I apps were effectively assisting the users, and the type of interactions promoted engagement. The apps’ features were based on design principles from interactive product design, experience design, online social media, and serious gaming. This study contributes to the field by providing a critical summary of the existing dCBT-I apps that could guide future developers in the field to achieve a high engagement.

Common Sleep Disorders in Pregnancy

“…74 Unfortunately, insurance coverage is limited for digital CBT-I, but some employers will cover this treatment as part of wellness initiatives. 75 The U.S. Department of Veterans Affairs has developed a free, self-directed smart phone application, “Insomnia Coach” (https://mobile.va.gov/app/insomnia-coach), which provides a structured 5-week treatment plan with individualized recommendations for sleep restriction based on the patient's sleep diary. There is current research focused on the development of a digital CBT-I program directed to the pregnant population, which may be a promising management option in the future.…”

Effectivity of (Personalized) Cognitive Behavioral Therapy for Insomnia in Mental Health Populations and the Elderly: An Overview

“…Nowadays, there are various commercially available CBT-I apps on the market. Advantages of these digital platforms are: easier access, cost efficiency, provide instant support, and quick and easy insight into sleep data and progress [ 107 ]. Van der Zweerde and colleagues [ 108 ] showed that nurse-guided internet-delivered CBT-I in patients in general practice exerts large and persistent sleep improvements.…”

Digital Therapeutics for Insomnia: Assessing the Effectiveness of a Computerized Home-Based Cognitive Stimulation Program

“…The main objective of CBT is that the individual becomes aware of his or her thoughts, visualizes and analyzes the situation, and responds to it more effectively or adaptively. Although there is no established protocol and implementations of CBT-I (for the insomnia CBT program) tend to vary in content, methodology, and time of application [24,25], there are certain components shared by most of the CBT-I programs: sleep hygiene education, sleep restriction, stimulus control, cognitive restructuring, and relaxation training [26,27]. In addition to the main components mentioned above, some CBT-I programs incorporate, along with cognitive restructuring, the training of cognitive functions such as memory, attention, visuospatial skills, and executive functions, in other words, cognitive stimulation [28].…”