Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet Treatment for Insomnia

Blom, Kerstin; Jernelöv, Susanna; Rück, Christian; Lindefors, Nils; Kaldo, Viktor

doi:10.5665/sleep.5850

Cited by 64 publications

(44 citation statements)

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“…Previously, only one study of CBT-i has had an equally long follow-up period, also reporting maintained improvements. 32 Another recent study, comparing antidepressants plus CBT-i to antidepressants plus a control treatment, had similar results: effects on depression were similar in both groups and effects on insomnia were larger in the CBT-i group. They also found that improvements in insomnia mediated depression outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…29 The original treatment included a module on sleep, which was removed for the purpose of this trial and allowed for a 9-week treatment window, with one module per week. The insomnia treatment, ICBT-i, has been tested in two RCTs, 30,31 including one 3-year follow-up, 32 using a treatment time of 8 weeks. More detailed information about the treatments can be found in the original article.…”

Section: Depression (Icbt-d)mentioning

confidence: 99%

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Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses

Blom¹,

Jernelöv²,

Rück³

et al. 2017

Sleep

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This 3-year follow-up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty-three participants were randomized to either treatment, in the form of Internet-delivered therapist-guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3-year follow-up. After 3 years, reductions on depression severity were similar in both groups (between-group effect size, d = 0.33, p = .45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p < .05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co-occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression.

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Section: Discussionmentioning

confidence: 84%

Section: Depression (Icbt-d)mentioning

confidence: 99%

Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses

Blom¹,

Jernelöv²,

Rück³

et al. 2017

Sleep

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“…Grundsätzlich zeigte sich in den Originalstudien bei erwachsenen Insomniepatienten direkt im Anschluss an die durchgeführte Therapie eine gute Effektivität der Onlinebehandlung. Zu den Followup-Messzeitpunkten ergab sich darüber hinaus auch eine Stabilität der erzielten Behandlungserfolge bis zu 3 Jahre nach Beendigung der eigentlichen Therapie [8,42,53]. Die Studie von Ritterband et al [42] zeigte beispielsweise auch in der Follow-up-Untersuchung nach einem Jahr noch große Effektstärken für die Schwere der insomnischen Symptomatik, die Einschlaflatenz und die nächtliche Wachzeit nach dem Einschlafen gegenüber Psychoedukation allein.…”

Section: Randomisierte Kontrollierte Studienunclassified

Digitale Behandlungsangebote für Insomnie – eine Übersichtsarbeit

et al. 2020

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ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei Erwachsenen durchweg sehr effektiv ist mit allenfalls leicht geringeren Effektstärken als die gleiche Behandlung mit physischer Präsenz von Therapeuten und Patienten. Behandlungseffekte zeigen sich dabei auch für sekundäre Outcome-Parameter wie Depressivität, Angst, Fatigue und Lebensqualität. Hingegen lassen die Forschung zur Wirksamkeit der internetbasierten KVT‑I bei Erwachsenen mit komorbiden psychischen Störungen oder körperlichen Erkrankungen sowie die Forschung zur Frage, wieviel Therapeutenkontakt in die Behandlung integriert werden sollte, anscheinend noch keine abschließenden Antworten zu. In diesen Bereichen scheint weitere Forschung notwendig zu sein scheint.

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“…This indicates that we did not need to overhaul the entire treatment, but that the treatment was good enough on it's own to warrant the use of an Adaptive Treatment Strategy instead. The reason this was not examined as part of Study I is that we already had good reason to believe that the treatment was good enough based on previous RCTs of the same treatment (Blom et al, 2016;Blom, Tillgren, et al, 2015;. In Study II, we found that a Balanced Accuracy of 67 % is potentially clinically sufficient for predicting treatment failure in an Adaptive treatment strategy based on it having been used in a fruitful way in a randomized trial of an Adaptive treatment strategy for ICBT-i.…”

Section: Main Findingsmentioning

confidence: 97%

Predicting treatment failure in regular care Internet-Delivered Cognitive Behavior Therapy for depression and anxiety using only weekly symptom measures.

Forsell

Isacsson

Blom

et al. 2020

Journal of Consulting and Clinical Psychology

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To my family Josefin, Selma and Oskar. Not only did they put up with me during the entire PhD journey, but they also spent the last two weeks of it in quarantine with me because of the coronavirus pandemic of 2020.ABSTRACT Background: Internet-delivered Cognitive Behavior Therapy (ICBT) is efficacious for a number of psychiatric disorders and can be successfully implemented in routine psychiatric care. Still, only about half of patients experience a good enough treatment outcome. Using data from the early part of treatment to identify patients with high risk of not benefitting from it, and target them with additional resources to prevent the predicted failure is a potential way forward. We call this an Adaptive Treatment Strategy, and a very important part of it is the ability to predict the outcome for a specific patient. Aims:To establish a proof of concept for an Adaptive Treatment Strategy in ICBT, and explore outcome prediction further by evaluating the accuracy of an empirically supported classification algorithm, the time point in treatment when acceptable accuracy can be reached, and the accuracy of ICBT-therapists' own predictions. Preliminary benchmarks regarding the clinical usefulness of prediction will be established. Studies:Four studies were performed: Study I was a randomized controlled trial (RCT; n=251) where patients' risk of treatment Failure (Red=high risk of failure, Green=low risk) was predicted during week 4 out of 9 in ICBT for Insomnia. Red patients (n=102) were then randomized to either continuing with standard treatment (n=51) or having their treatment individually adapted (n=51). In Study II, the classification algorithm from Study I was evaluated in terms of classification accuracy and the contribution of the different predictors used. In Study III, data from 4310 regular care ICBT-patients having received treatment for either Depression, Social anxiety disorder or Panic disorder were analyzed in a series of multiple regression models using weekly observations of the primary symptom measure as predictors to classify risk of Failure. As a contrast, Study IV examines ICBT therapists' own predictions on both categorical and continuous treatment outcomes, as they made predictions for each of their patients (n=897) during week 4 in the same three treatments as in Study III. Results:The RCT was successful in that Red patients receiving Adapted treatment improved significantly more than Red patients receiving standard treatment, and their odds of failure were nearly cut in half. Green patients did better than Red patients, indicating that the accuracy of the classification algorithm was clinically useful. Study II showed that the balanced accuracy of the classifier was 67% and that only 11 of 21 predictors correlated significantly with Failure. Notable predictors were symptom levels as well as different markers of treatment engagement. Study III and IV showed that acceptable predictions could be made halfway through treatment using only symptom scores and basic statistics, and that ICBT-...

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Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet Treatment for Insomnia

Abstract: The trial was registered, together with a parallel trial, at Clinicaltrials.gov as "Internet-CBT for Insomnia" registration ID: NCT01256099.

Cited by 64 publications

References 46 publications

Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses

Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses

Digitale Behandlungsangebote für Insomnie – eine Übersichtsarbeit

Predicting treatment failure in regular care Internet-Delivered Cognitive Behavior Therapy for depression and anxiety using only weekly symptom measures.

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