Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Randomized Waitlist Controlled Trial

Abstract

BackgroundThis study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia.ObjectiveThe objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial.MethodsWe recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant’s progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition.ResultsThe results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=–0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up.ConclusionsThis study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens.Trial RegistrationNetherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4)

The efficacy of smartphone‐based mental health interventions for depressive symptoms: a meta‐analysis of randomized controlled trials

“…For clinical populations, two studies Computer-aided training on how to use the apps; participants were also allocated a coach to help with app usage HADS recruited people with major depression 36,43 , two individuals with bipolar disorder 28,30 , one young people in primary care with any mental health condition 40 . Others recruited individuals from the general population with self-reported mild-to-moderate depression 26,27,39,41 , suicidal thoughts/tendencies 42 , probable attention-deficit/hyperactivity disorder (ADHD) 37 , anxiety disorders 29,33 , insomnia 31 , or symptoms of post-traumatic stress disorder (PTSD) 35 . One further study examined older adults with memory complaints 38 .…”

“…Depressive symptoms were measured as a primary outcome in 12 studies, and as a secondary outcome in six. The following tools were used: the Depression Anxiety Stress Scale 44 depression subscale in three studies 29,39,40 ; the Center for Epidemiological Studies Depression scale 45 in four 31,32,38,41 ; the Beck Depression Inventory II 46 in three 34,36,43 ; the Patient Health Questionnaire 47 in six 26,27,33,35,42,43 ; the Hamilton Rating Scale for Depression 48 in one 30 ; the Hospital Anxiety Depression Scale 49 in one 37 ; and the Montgomery-Å sberg Depression Rating Scale 50 in one 28 .…”

Effects of a Tailored Brief Behavioral Therapy Application on Insomnia Severity and Social Disabilities Among Workers With Insomnia in Japan

“…19 The low remission rate associated with CBTI without psychological support may be associated with its use in patients with more severe chronic insomnia disorder. These individuals are likely to require more intensive support from higher levels in the pyramid, such as 20,21 However, despite being highly effective, the second limitation of fully automated CBTI studies is the dropout rate, which has been reported as 39% to 45%, higher than that of face-to-face CBTI. 20,21 Therefore, the number of sessions that patients complete could be a crucial factor for the success of fully automated CBTI as an intervention.…”

Talk and Tools: the best of both worlds in mobile user interfaces for E-coaching

“…For an extended overview of the setup, the statistical analysis and the results of the RCT, we refer to [22]. In the RCT, 74 participants were allocated as an active treatment group to the SleepCare system and 77 participants to a waiting list group that received intervention after the active group.…”

“…To evaluate the acceptability of the system and the therapy process in real-life situations, we now turn to the testing and user evaluation phases. We distinguished four phases of testing and evaluation: (a) automated testing for error code [19]; (b) expert analysis; (c) user evaluation; and, finally, (d) a randomized controlled trial (RCT) with insomnia patients [22]. Below, we will summarize the methodology and some interesting findings.…”