Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic

Abstract

Study Objectives Stressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic. Methods COVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016-2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic. Results Insomnia symptoms were significantly associated with COVID-19 related disruptions, and those previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition. Conclusions Those who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic.

Overview of sleep management during COVID-19

“…Thirty-nine described disturbed sleep in the context of psychosocial and neuropsychiatric symptoms. As to specific management of sleep dysfunction during COVID-19, five studies of cognitive behavioral therapy (CBT) were available – two controlled trials of insomnia [ 11 , 12 ], one focused on worry and secondary insomnia [ 13 ], one case study [ 14 ] and a small online study in children [ 15 ]. Four similar treatment trials have begun or been proposed (see Table 1 ).…”

“…CBT-i increased health resilience. [ 12 ] Álvarez-García et al. Case report 42-year-old man with overwork, insufficient sleep syndrome with COVID-19 pandemic sleep restriction therapy, stimulus control therapy, sleep hygiene, and progressive muscle relaxation Five weekly sessions; Telepsychology Increased total sleep time and subjective sleep quality.…”

Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic

“…For example, Zhou and colleagues (2020) found a significant effect of their WeChat intervention for suspected quarantined COVID-19 patients in anxiety and depression reduction. Others have investigated the role of cognitive-behavioral therapy interventions delivered through digital tools and found promising results (Cheng, Casement, Kalmbach, Castelan, & Drake, 2020;Wahlund et al, 2020). Also, studies concerning new technologies to deliver mindfulness- based intervention for people during the COVID-19 pandemic showed a significant reduction of depression and anxiety (Kubo et al, 2020;Matiz et al, 2020;Pizzoli et al, 2020;Ritvo et al, 2020).…”

Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic

“…For example, Zhou and colleagues (2020) found a significant effect of their WeChat intervention for suspected quarantined COVID-19 patients in anxiety and depression reduction. Others have investigated the role of cognitivebehavioral therapy interventions delivered through digital tools and found promising results (Cheng et al, 2020;Wahlund et al, 2020). Also, studies concerning new technologies to deliver mindfulness-based intervention for people during the COVID-19 pandemic showed a significant reduction of depression and anxiety (Kubo et al, 2020;Matiz et al, 2020;Pizzoli et al, 2020;Ritvo et al,2020).…”