scholarly journals Weekly Self-Ratings of Treatment Involvement and Their Relation to Symptom Reduction in Internet Cognitive Behavioral Therapy for Insomnia

2020 ◽  
Author(s):  
Martin Kraepelien ◽  
Kerstin Blom ◽  
Susanna Jernelöv ◽  
Viktor Kaldo
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Treatment Effects ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Control Treatment ◽  
Knowledge Gain ◽  
Ctrl Group ◽  
Subjective Knowledge ◽  
Homework Quality ◽  
Insomnia Severity

Abstract Background Treatment involvement, including involvement with written material as well as homework assignments, has previously been associated with better outcomes in cognitive behavioral therapy, but there is a lack of knowledge on which specific aspects of involvement that are the most promising for use as predictors of treatment effects. Methods The objective of this study was to use a battery of weekly self-rated questions regarding different aspects of participant involvement during 8 weeks of either guided internet cognitive behavioral therapy for insomnia (ICBT-i, n = 73), or an active internet-delivered control treatment also including homework (ICBT-ctrl, n = 75), to predict reductions in insomnia severity after treatment. The markers of involvement were single questions on amount of time spent on treatment, amount of text read, amount of subjective knowledge gained and index scores of homework quantity (based on ratings of how many times specific techniques were used) and homework quality (based on ratings of the understanding, used as intended, and helpfulness of each specific technique). Results While none of the markers predicted reductions in insomnia severity for participants in the ICBT-ctrl group, text read, subjective knowledge gain, and homework quality predicted larger reductions in insomnia severity for participants in ICBT-i. Amount of subjective knowledge gained was a particularly useful marker in the ICBT-i group, since weekly ratings from the first half of treatment sufficed to explain a rather large proportion of variance in insomnia severity post treatment (14%). Conclusions The results strengthen subjective knowledge gain as a candidate for use as a predictor of treatment effects in ICBT-i.

scholarly journals Cognitive behavioral therapy for insomnia among young adults who are actively drinking: a randomized pilot trial

SLEEP ◽  
2020 ◽  
Author(s):  
Mary Beth Miller ◽  
Chelsea B Deroche ◽  
Lindsey K Freeman ◽  
Chan Jeong Park ◽  
Nicole A Hall ◽  
...  
Keyword(s):  
Young Adults ◽  
Alcohol Use ◽  
Cognitive Behavioral Therapy ◽  
Binge Drinking ◽  
Behavioral Therapy ◽  
Pilot Trial ◽  
Cognitive Behavioral ◽  
Wrist Actigraphy ◽  
Insomnia Severity

Abstract Study Objectives More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) has not been tested among individuals who are actively drinking. This study tested (1) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (2) improvement in insomnia as a predictor of improvement in alcohol use outcomes. Methods Young adults (ages 18–30 years, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to 5 weekly sessions of CBT-I (n = 28) or single-session sleep hygiene (SH, n = 28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, posttreatment, and 1-month follow-up. Results Of those randomized, 43 (77%) completed posttreatment (19 CBT-I, 24 SH) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 SH). CBT-I participants reported greater posttreatment decreases in insomnia severity than those in SH (56% vs. 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on posttreatment insomnia severity. Conclusions CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted. Trial Registration U.S. National Library of Medicine, https://clinicaltrials.gov/ct2/show/NCT03627832, registration #NCT03627832

scholarly journals Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial

2017 ◽  
Vol 23 (11) ◽  
pp. 1542-1553 ◽  
Author(s):  
Lizanne E van den Akker ◽  
Heleen Beckerman ◽  
Emma H Collette ◽  
Jos WR Twisk ◽  
Gijs Bleijenberg ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomized Controlled Trial ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Cognitive Behavioral ◽  
Control Treatment ◽  
Post Intervention ◽  
Randomized Controlled ◽  
Societal Participation

Background: Fatigue is a common symptom in multiple sclerosis (MS) and often restricts societal participation. Cognitive behavioral therapy (CBT) may alleviate MS-related fatigue, but evidence in literature is inconclusive. Objective: To evaluate the effectiveness of CBT to improve MS-related fatigue and participation. Methods: In a multi-center, assessor-masked, randomized controlled trial, participants with severe MS-related fatigue were assigned to CBT or control treatment. CBT consisted of 12 individual sessions with a psychologist trained in CBT, the control treatment consisted of three consultations with a MS nurse, both delivered over 16 weeks. Assessments were at baseline, 8, 16 (i.e. post-intervention), 26, and 52 weeks post-baseline. Primary outcomes were the Checklist Individual Strength-fatigue subscale (CIS20r fatigue) and the Impact on Participation and Autonomy questionnaire (IPA). Data were analyzed according to the intention-to-treat principle, using mixed-model analysis. Results: Between 2011 and 2014, 91 patients were randomized (CBT: n = 44; control: n = 47). Between-group analysis showed a positive post-intervention effect for CBT on CIS20r fatigue (T16: −6.7 (95% confidence interval (CI) = −10.7; −2.7) points) that diminished during follow-up (T52: 0.5 (95% CI = −3.6; 4.4)). No clinically relevant effects were found on societal participation. Conclusion: Severe MS-related fatigue can be reduced effectively with CBT in the short term. More research is needed on how to maintain this effect over the long term.

scholarly journals Guided internet cognitive behavioral therapy for insomnia compared to a control treatment – A randomized trial

2015 ◽  
Vol 71 ◽  
pp. 90-100 ◽  
Author(s):  
Viktor Kaldo ◽  
Susanna Jernelöv ◽  
Kerstin Blom ◽  
Brjánn Ljótsson ◽  
Maria Brodin ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Randomized Trial ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Control Treatment

scholarly journals A blended eHealth intervention for insomnia following acquired brain injury study protocol for a randomized controlled trial

2020 ◽  
Author(s):  
Marthe Ford ◽  
Gert J. Geurtsen ◽  
Erny Groet ◽  
Coen A.M. Van Bennekom ◽  
Eus J.W. Van Someren
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Behavioral Therapy ◽  
Cognitive Functioning ◽  
Behavioral Therapy ◽  
Acquired Brain Injury ◽  
Cognitive Behavioral ◽  
Face To Face ◽  
Trial Register ◽  
Insomnia Severity

Abstract Background: Up to a third of stroke patients and patients with traumatic brain injury suffer from insomnia, including problems to fall asleep or stay asleep at night. Insomnia may exacerbate other brain damage-related problems, for example regarding cognitive functioning and emotional well-being, may lead to poorer quality of life, and may complicate recovery processes. Cognitive behavioral therapy for insomnia, delivered face-to-face or online, is found to be effective in the general population. However, despite the high prevalence and serious consequences of insomnia following acquired brain injury, studies on the efficacy of face-to-face cognitive behavioral treatment in this population are scarce, and this applies even more for studies on online cognitive behavioral therapy. Therefore, this study aims to evaluate the efficacy of a newly developed guided online cognitive behavioral therapy for insomnia following acquired brain injury.Methods: A multicenter, prospective, randomized, open-label, blinded end point study (PROBE) will be conducted, in which 48 patients diagnosed with stroke or traumatic brain injury, and insomnia will be randomly allocated to the online cognitive behavioral therapy for insomnia treatment group or the treatment as usual group. The treatment consists of 6 online cognitive behavioral therapy sessions given on a weekly basis and personalized feedback after each session, combined with 2 face-to-face sessions. Outcomes will be assessed at baseline, immediately after the intervention period and at 6 weeks follow up. The primary outcome is the insomnia severity assessed with the insomnia severity index. Secondary outcome measures include sleep quality, sleep features derived from the sleep diary, fatigue, anxiety and depression, subjective cognitive functioning and societal participation.Discussion: This study will provide insight on the efficacy of online cognitive behavioral therapy for insomnia following stroke and traumatic brain injury.Trial Register: Netherlands Trial Register, NTR7082, 12 March 2018

scholarly journals The Implementation and Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia in Primary Care: A Pilot Study

2021 ◽  
Vol 2 ◽  
pp. 263348952110536
Author(s):  
Eric D.A. Hermes ◽  
Robert A. Rosenheck ◽  
Laura Burrone ◽  
Greg Dante ◽  
Carrie Lukens ◽  
...  
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Cognitive Behavioral Therapy ◽  
Clinical Outcomes ◽  
Implementation Strategy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Low Intensity ◽  
Phone Calls ◽  
Insomnia Severity

Background Digital interventions delivering Cognitive Behavioral Therapy for insomnia (Digital CBTi) may increase utilization of effective care for a common and serious condition. A low-intensity implementation strategy may facilitate digital CBTi use in healthcare settings. This pilot study assessed the feasibility of implementing a digital CBTi in Veterans Health Administration (VA) primary care through iterative modifications to a low-intensity implementation strategy, while evaluating clinical outcomes of a specific digital CBTi program. Methods A self-directed digital CBTi was implemented in the primary care clinics of a single VA facility using a cohort trial design that iteratively modified an implementation strategy over three 8-month phases. The phase 1 implementation strategy included (1) provider education; (2) point-of-care information via pamphlets; and (3) provider referral to digital CBTi through phone calls or messages. Phases 2 and 3 maintained these activities, while (1) adding a clinic-based coach who performed initial patient education and follow-up support contacts, (2) providing additional recruitment pathways, and (3) integrating the referral mechanism into provider workflow. Implementation outcomes included provider adoption, patient adoption, and acceptability. Clinical outcomes (insomnia severity, depression severity, and sedative hypnotic use) were compared among enrollees at baseline and 10 weeks. Results Across all phases 66 providers (48.9%) made 153 referrals, representing 0.38% of unique clinic patients. Of referrals, 77 (50.3%) enrolled in the study, 45 (29.4%) engaged in the program, and 24 (15.7%) completed it. Provider and patient adoption did not differ meaningfully across phases. Among enrollees, digital CBTi was acceptable and the Insomnia Severity Index decreased by 4.3 points (t = 6.41, p < 0.001) and 13 (18.6%) reached remission. The mean number of weakly sedative-hypnotic doses decreased by 2.2 (35.5%) (t = 2.39, p < 0.02). Conclusions Digital CBTi implementation in VA primary care is feasible using low-intensity implementation strategy, resulting in improved clinical outcomes for users. However, iterative implementation strategy modifications did not improve adoption. The trial was registered at clinicaltrials.gov (NCT03151083).

scholarly journals Efficacy of Online Versus In-Person Cognitive Behavioral Therapy for Insomnia

2020 ◽  
Vol 3 ◽  
Author(s):  
Emily Wilson ◽  
Aaron Roberts
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Adult Population ◽  
Severity Index ◽  
The United States ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Insomnia Severity ◽  
Over Time

Background and Hypothesis: Up to 30% of the adult population may suffer from insomnia symptoms. Insomnia not only diminishes the individual’s quality of life, but also has a broad financial impact, costing the United States over $100 billion per year. Systemic barriers limit access to cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia. However, newly developed internet CBT-I (iCBT-I) programs, if effective, may reduce this disparity. In this study, we hypothesized that there is no difference in the efficacy of the experimental iCBT-I and the control CBT-I interventions in reducing insomnia severity over time.    Project Methods: A projected 120 participants will be recruited for this non-inferiority prospective cohort study. 60 patients will be assigned to each arm of the study (CBT-I and iCBT-I). The control group will attend 6 in-person CBT-I sessions over 6 weeks. The experimental group will complete the iCBT-I program Go! To Sleep over 6 weeks. Participants will complete the Insomnia Severity Index (ISI) before and after treatment, as well as 3, 6, and 12 months after finishing the program. The Kruskal-Wallis statistical test will utilize ISI data to compare efficacy of the interventions over time.     Results: Based on previous literature, the projected results of this study align with the hypothesis that there will be no difference in efficacy of the CBT-I and iCBT-I interventions over time.    Potential Impact: If indeed there is no difference in effectiveness between the iCBT-I program and in-person CBT-I, this result would have implications in clinical decision-making. Improved access to iCBT-I may reduce prescriptions for addictive pharmacologic treatments, as well as offer an inexpensive, convenient, and effective treatment for insomnia. Future studies could compare efficacy of iCBT-I in patients with co-morbidities, such as anxiety or depression.  

scholarly journals 0483 Predictors of Cognitive Behavioral Therapy for Insomnia (CBT) Outcomes in Active Duty U.S. Army Personnel

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A185-A185
Author(s):  
K E Pruiksma ◽  
W Hale ◽  
J Mintz ◽  
A Peterson ◽  
S Young-McCaughan ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Medical Research ◽  
Behavioral Therapy ◽  
Active Duty ◽  
Cognitive Behavioral ◽  
Depression Symptoms ◽  
Predictors Of Response ◽  
The Impact ◽  
Insomnia Severity ◽  
The U.S

Abstract Introduction Cognitive behavioral therapy for insomnia (CBTi) is well established as the first-line treatment for the management of chronic insomnia. Identifying predictors of response to CBTi should enable the field to efficiently utilize resources to treat those who are likely to respond and to personalize treatment approaches to optimize outcomes for those who are less likely to respond to traditional CBTi. Although a range of studies have been conducted, no clear pattern of predictors of response to CBTi has emerged. Methods The purpose of this study was to examine the impact and relative importance of a comprehensive group of pretreatment predictors of insomnia outcomes in 99 active duty service members who received in-person CBTi in a randomized clinical trial. Results Results indicated that higher levels of baseline insomnia severity and total sleep time predicted greater improvements on the Insomnia Severity Index (ISI) following treatment. Higher depression symptoms and a history of head injury predicted a worse response to treatment (i.e., smaller improvements on the ISI). Conclusion Clinically meaningful improvements, as measured by the reliable change index (RCI), were found in 59% of the sample. Over and above baseline insomnia severity, only depressive symptoms predicted this outcome. Future studies should examine if modifications to CBTi based on these predictors of response can improve outcomes. Support This study was conducted with support from the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program award W81XWH-10-1-0828 (PI: Dr Taylor).

scholarly journals Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial

2019 ◽  
Vol 111 (12) ◽  
pp. 1323-1331 ◽  
Author(s):  
Sheila N Garland ◽  
Sharon X Xie ◽  
Kate DuHamel ◽  
Ting Bao ◽  
Qing Li ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Confidence Interval ◽  
Cognitive Behavioral Therapy ◽  
Cancer Survivors ◽  
Comparative Effectiveness ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Hypnotic Medication ◽  
Insomnia Severity

AbstractBackgroundInsomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown.MethodsThis randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided.ResultsThe mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P &lt; .001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: −8.31 points, 95% confidence interval = −9.36 to −7.26; CBT-I: −10.91 points, 95% confidence interval = −11.97 to −9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P &lt; .001), white (P = .003), highly educated (P &lt; .001), and had no pain at baseline (P &lt; .001).ConclusionsAlthough both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.

scholarly journals A Pilot Randomized Controlled Trial to Assess Feasibility and Treatment Effect of a Web-Based Delivered Cognitive Behavioral Therapy for Insomnia Program in Individuals with Multiple Sclerosis

2020 ◽  
Author(s):  
Catherine F. Siengsukon ◽  
Eber Silveira Beck ◽  
Michelle Drerup
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Behavioral Therapy ◽  
Sleep Quality ◽  
Treatment Effect ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Chronic Insomnia ◽  
Web Based ◽  
Phone Calls ◽  
Insomnia Severity

Abstract Background: At least 40% of individuals with multiple sclerosis (MS) experience chronic insomnia. Recent studies indicate that cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia symptoms in individuals with MS. CBT-I delivered using web-based applications has been shown to be effective and may increase access to CBT-I for individuals with MS who have mobility difficulties, fatigue, or live in rural areas. Therefore, the purpose of this study was to assess the feasibility and treatment effect of CBT-I delivered using a web-based application with or without biweekly phone calls to improve sleep quality and fatigue in individuals with MS and symptoms of insomnia. Methods: Forty-one individuals with MS and symptoms of insomnia were randomized into either a group that participated in a 6-week web-based CBT-I program (wCBT-I) or a group that participated in a web-based CBT-I program and received biweekly support phone calls (wCBT-I+PC). Participants completed surveys online to assess insomnia severity, sleep quality, fatigue, sleep self-efficacy, depression, anxiety, and motivation to change their sleep behavior. Results: The overall retention rate was 48.8%, and the adherence rate was 96.34%. Both groups had a significant improvement in insomnia severity, sleep quality, anxiety, and sleep self-efficacy. Only the wCBT-I group had a significant improvement in depression and fatigue. Conclusions: Web-delivered CBT-I is feasible and effective in improving sleep outcomes and concomitant symptoms in individuals with MS. Web-based CBT-I may increase the accessibility of CBT-I treatment and provide a stepped-care approach to treating chronic insomnia in individuals with MS.

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