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

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.

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366 Predictors of Dropout in University Students Participating in an 8-week E-mail Based Cognitive Behavioral Therapy for Insomnia

SLEEP ◽

10.1093/sleep/zsab072.365 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A145-A146

Author(s):

Hyojin Nam ◽

Jinyoung Chang ◽

Rachel Manber ◽

Mickey Trockel ◽

Isa Okajima ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Psychological Intervention ◽

Behavioral Therapy ◽

Severity Index ◽

Cognitive Behavioral ◽

Depression Anxiety Stress Scale ◽

Insomnia Severity Index ◽

Before And After ◽

E Mail ◽

Insomnia Severity

Abstract Introduction As dropout from treatment potentially diminishes its therapeutic effect and poses clinical concern, it is important to find out which characteristics of participants are suitable for online-based treatment. Therefore, we aimed to identify factors that predicted a dropout in the e-mail based cognitive behavioral therapy (REFRESH) developed by Stanford University for the purpose of psychological intervention for insomnia. Methods Participants who participated in the REFRESH program consisted of 158 university and graduate students aged 18 to 30 in Hong Kong and Korea who scored higher than 10 on the Insomnia Severity Index (ISI), and the intervention was delivered in 8 weekly sessions sent via weekly e-mails. Among them, 110 were women (70%) and the average age was 22 (±2.71) years old. All participants were asked to answer the following self-reporting questionnaires before and after the intervention: Insomnia Severity Index; ISI, Depression Anxiety Stress Scale 21; DASS-21, Sleep Hygiene Practice Scale; SHPS, Dysfunctional Beliefs and Attitude about Sleep 16; DBAS-16. Descriptive statistics and ROC decision tree analysis were conducted to address our aim. Results Of the 158 participants, 68 completed the program, and 90 participants (57%) dropped out. The best predictor of dropout was DASS score with an optimal cup-point of <34. Of the 107 participants who reported DASS <30, 70(65.4%) dropped out. In contrast, of the 50 participants who reported DASS ≥34, 12(38%) dropped out. The second-level predictor was expectations for sleep score with a cut-point of <18. Among participants with DASS <34 and expectations for sleep score <18, 57(73.1%) dropped out. Of the 29 participants who reported DASS <34 and expectations for sleep score ≥18, 13(44.8%) dropped out. Conclusion Mild levels of depression, anxiety and stress and expectations for sleep appear to be predictive of dropout in an e-mail based intervention. People with mild symptoms may experience less distress and impairment, which may result in lower motivation to receive treatment. This may lead to inability to complete treatment and higher rates of dropout. Support (if any):

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Randomized Placebo-Controlled Trial of Cognitive Behavioral Therapy and Armodafinil for Insomnia After Cancer Treatment

Journal of Clinical Oncology ◽

10.1200/jco.2014.57.6769 ◽

2015 ◽

Vol 33 (2) ◽

pp. 165-171 ◽

Cited By ~ 24

Author(s):

Joseph A. Roscoe ◽

Sheila N. Garland ◽

Charles E. Heckler ◽

Michael L. Perlis ◽

Anita R. Peoples ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Quality ◽

Cancer Survivors ◽

Behavioral Therapy ◽

Controlled Trial ◽

Severity Index ◽

Cognitive Behavioral ◽

Placebo Capsule ◽

After Cancer ◽

Insomnia Severity

Purpose Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone. Patients and Methods We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions. Results Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584). Conclusion CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality.

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Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Insomnia during Quarantine of Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic: A Controlled Trial

Journal of Sleep sciences ◽

10.18502/jss.v5i3.6920 ◽

2021 ◽

Author(s):

Hossein Farrokhi ◽

Behnaz Shid Anbarani ◽

Seyyed Iman Seyyedzadeh ◽

Atiyeh Taghavi Bojnordi ◽

Mahnaz Amini

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Cognitive Behavioral Therapy ◽

Relaxation Training ◽

Behavioral Therapy ◽

Controlled Trial ◽

Drop Out ◽

Cognitive Behavioral ◽

Control Group ◽

Insomnia Severity

Background and Objective: In the late 2019, an acute respiratory syndrome [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] resulted in a pandemic coronavirus disease (COVID-19). This study was designed to compare the efficacy of internet-based cognitive behavioral therapy for insomnia (ICBT-I) with online relaxation training for management of insomnia during SARS-CoV-2 pandemic. Materials and Methods: This controlled trial was conducted on adults (18-65 years) with the complaint of insomnia who called psychology call centers in Mashhad, Iran, from March to June 2020. Participants with insomnia symptoms starting after SARS-CoV-2 pandemic who had Insomnia Severity Index (ISI) scores of ≥ 15 were included in the study. Five weekly sessions of ICBT-I as the intervention were compared with 5 weekly online relaxation training sessions in the control group. ISI before and after 5 weeks of follow-up was compared in both groups. Results: From a total cohort of 144 subjects included in the study, 98 were excluded and the remainder were allocated to 23 cases and 23 control subjects. During follow-up period, 5 individuals (21.7%) dropped out in each group. The mean ISI scores improved after therapy (20.6 to 8.5 and 21.8 to 13.0 for intervention and control groups, respectively). Conclusion: ICBT-I significantly improved insomnia severity during home quarantine of SARS-CoV-2 pandemic. We suggest that ICBT-I could be an effective and feasible alternative in pandemic of an infectious disease. Clients accepted ICBT-I with a minor drop-out in our study.

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Patient Uptake, Experiences, and Process Evaluation of a Randomized Controlled Trial of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States

Frontiers in Medicine ◽

10.3389/fmed.2021.771646 ◽

2021 ◽

Vol 8 ◽

Author(s):

Eldre W. Beukes ◽

Gerhard Andersson ◽

Vinaya Manchaiah

Keyword(s):

United States ◽

Clinical Trial ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Controlled Trial ◽

The United States ◽

Cognitive Behavioral ◽

English Speakers ◽

Control Group ◽

Wide Range

Introduction: An internet-based cognitive behavioral therapy (ICBT) offers a way to increase access to evidence-based tinnitus care. To increase the accessibility of this intervention, the materials were translated into Spanish to reach Spanish as well as English speakers. A clinical trial indicated favorable outcomes of ICBT for tinnitus for the population of the United States. In view of later dissemination, a way to increase the applicability of this intervention is required. Such understanding is best obtained by considering the perspectives and experiences of participants of an intervention. This study aimed to identify the processes that could facilitate or hinder the clinical implementation of ICBT in the United States.Methods: This study evaluated the processes regarding enrolment, allocation, intervention delivery, the outcomes obtained, and the trial implementation. The study sample consisted of 158 participants who were randomly assigned to the experimental and control group.Results: Although the recruitment was sufficient for English speakers, recruiting the Spanish participants and participants belonging to ethnic minority groups was difficult despite using a wide range of recruitment strategies. The allocation processes were effective in successfully randomizing the groups. The intervention was delivered as planned, but not all the participants chose to engage with the materials provided. Compliance for completing the outcome measures was low. The personal and intervention factors were identified as barriers for the implementation whereas the facilitators included the support received, being empowering, the accessibility of the intervention, and its structure.Conclusion: An understanding regarding the factors contributing to the outcomes obtained, the barriers and facilitators of the results, engagement, and compliance were obtained. These insights will be helpful in preparing for the future dissemination of such interventions.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04004260. Registered on 2 July 2019.

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RELATED FACTORS TO RELAPSE IN DEPRESSED PATIENTS AFTER COGNITIVE BEHAVIOURAL THERAPY DURING ONE YEAR PROSPECTIVE FOLLOW-UP

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.5.2 ◽

2011 ◽

pp. 13-19

Author(s):

Nhu Minh Hang Tran ◽

Huu Cat Nguyen ◽

Dang Doanh Nguyen ◽

Van Luong Ngo ◽

Vu Hoang Nguyen ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Relapse Rate ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Control Group ◽

Controlled Clinical Trial ◽

Related Factors ◽

Depressed Patients ◽

One Year

Objectives: To determine factors impact on the relapse in depressed patients treated with Cognitive Behavioral Therapy (CBT) during one year follow-up. Materials and Methods: 80 depressed patients divided into two groups, group 1: included 40 patients treated with CBT; group 2: 40 patients on amitriptyline. Non-randomized controlled clinical trial, opened, longiditual and prospective research. Results and Conclusions: relapse rate after CBT during 1 year follow-up is 10% (compared to 25% in control group), related factors to relapse rate in depression after CBT are age and education. Shared predictors between 2 groups are severity and recurrence of depression. Key words: Depression, relapse, Cognitive Behavioral Therapy (CBT)

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Study of the Effectiveness of the Cognitive Behavioral Therapy on Self Efficacy and Pain among Children Suffering from Cancer

Global Journal of Health Science ◽

10.5539/gjhs.v9n5p33 ◽

2016 ◽

Vol 9 (5) ◽

pp. 33

Author(s):

Kosar Bardideh ◽

Fatemeh Bardideh ◽

Keivan Kakabaraee

Keyword(s):

Cognitive Behavioral Therapy ◽

Self Efficacy ◽

Behavioral Therapy ◽

Pain Scale ◽

Cognitive Behavioral ◽

Control Group ◽

Children With Cancer ◽

Research Population ◽

Quasi Experimental ◽

Experimental Group

OBJECTIVE: The aim of the present study is to investigate the effectiveness of the cognitive behavioral therapy on pain reduction and the elevation of self efficacy among children who suffer from cancer.METHOD: The present study adopts a quasi experimental pretest-posttest two group design .The research population consists of all 9-11 year old children with cancer who admitted to Tehran specialized cancer treatment centers in 2015. From those eligible in this study 40 were selected at hand and were randomly divided to two experimental and control groups (20 for experimental group and 20 for control group). Kuris self-efficacy questionnaire and Oucher pain scale were employed for data collection and multivariate and single-variant analyses of covariance have been used for data analysis.RESULTS: The results showed that the cognitive behavioral therapy has resulted in ease of pain and rise of efficacy among the experimental group (P˂ 0.01).CONCLUSION: Based on findings it can be deduced that cognitive behavioral therapy has a significant impact on this group of patients and this treatment can be employed as an appropriate solution in order to reduce the symptoms of children with cancer and ultimately to treat cancer.

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Effectiveness of Cognitive-Behavioral Therapy on Distress Tolerance and Coping with the Child’s Illness in Parents of Children with Thalassemia Major

10.32592/ajnpp.2020.7.4.105 ◽

2020 ◽

pp. 231-235

Keyword(s):

Cognitive Behavioral Therapy ◽

Distress Tolerance ◽

Group Membership ◽

Behavioral Therapy ◽

Thalassemia Major ◽

Cognitive Behavioral ◽

Control Group ◽

Statistical Population ◽

Physical Disorders ◽

Guilty Feeling

Introduction and Objectives: Major Thalassemia can be considered one of the biggest chronic physical disorders, which causes some psychological and social problems to patients and their families. This study aimed to investigate the effect of cognitive-behavioral therapy on the distress tolerance and level of coping with a child’s illness among the parents of children with major thalassemia. Materials and Methods: This study was conducted based on a semi-experimental design with pretest and posttest. The statistical population consisted of all parents of Children with major thalassemia in Zahedan, Iran, during 2016. A total of 40 parents were selected based on convenience sampling and randomly divided into two experimental (n=20) and control groups (n=20). They were then requested to complete the distress and resistance questionnaires, and they participated weekly in eight 90-min intervention sessions based on cognitive behavioral therapy Data were analyzed in SPSS software (version 20) through multivariate covariance analysis. Results: The results show that cognitive-behavioral therapy improves distress (F=9.82, P<0.004), tolerance (F=5.12, P<0.030), absorbed (F=7.43, P<0.010), assessment (F=4.73, P<0.037), and adjustment (F=6.70, P<0.014) dimension scores, and has an effect on group membership. Moreover, cognitive-behavioral therapy improved the level of coping with the disease dimension (F=32.61, P<0.0001) and the first factor (F=5.53, P<0.025). Additionally, this technique had a significant effect on posttest scores and group membership. Conclusion: The results showed that cognitive-behavioral therapy increased the level of distress tolerance and improved the level of coping with the childchr('39')s disease, compared to the control group. Evidence suggests that the parents of children with major thalassemia patients face many problems that can lead to high levels of anxiety and depression, tolerance of distress at a low level, despair and disappointment, as well as guilty feeling

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The Efficacy of Transdiagnostic Cognitive Behavioral Therapy on Migraine Headache: A Randomized Clinical Trial

10.21203/rs.3.rs-1143097/v1 ◽

2022 ◽

Author(s):

Forouzandeh Soleimanian-Boroujeni ◽

Negin Badihian ◽

Shervin Badihian ◽

Vahid Shaygannejad ◽

Yousef Gorji

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Intervention Group ◽

Cognitive Behavioral ◽

Control Group ◽

Post Intervention ◽

Therapy Termination ◽

Protocol Registration ◽

And Control

Abstract Introduction: Psychological interventions are shown to be effective in migraine, but not utilized routinely yet. We aimed to evaluate the efficacy of transdiagnostic cognitive behavioral therapy (TCBT) on people with migraine (PwM). Method: This study was conducted on 40 PwM aged 20-50 years. We randomly assigned participants to two groups of intervention, receiving 10 sessions of TCBT, and control. Days with headache, headache severity, migraine-related disability and effects on daily life, number of pain-relivers taken for headache, depression, and anxiety were assessed pre-intervention, post-intervention (three-month follow-up), and one-month after TCBT termination (four-month follow-up).Results: Thirty-five participants suffering moderate to severe migraine completed the study (16 and 19 in TCBT and control groups, respectively). TCBT improved all measured items between study time-points (p<0.05) in the intervention group, while such an improvement was not observed in the control group. Between group comparisons revealed superiority of TCBT group compared to the control group in most measured items at three- and four-month follow-ups (p<0.05).Conclusion: Ten sessions of TCBT improved migraine severity, associated disability, anxiety, and depression in PwM, with persistent effects after one month of therapy termination. TCBT is an affordable, practical, and feasible intervention to be utilized for PwM.Protocol registration: The study protocol was registered in clinicaltrial.gov (NCT03701477) prior to enrollment.

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Trauma informed interventions: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0252747 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252747

Author(s):

Hae-Ra Han ◽

Hailey N. Miller ◽

Manka Nkimbeng ◽

Chakra Budhathoki ◽

Tanya Mikhael ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Health Inequities ◽

The United States ◽

Psychological Outcomes ◽

Cognitive Behavioral ◽

Health Concern ◽

Ptsd Symptoms ◽

Wide Range ◽

Trauma Informed

Background Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. Methods We performed database searches— PubMed, Embase, CINAHL, SCOPUS and PsycINFO—to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. Results More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). Conclusions There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

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Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study (Preprint)

10.2196/preprints.18723 ◽

2020 ◽

Author(s):

Anita Lungu ◽

Janie Jihee Jun ◽

Okhtay Azarmanesh ◽

Yan Leykin ◽

Connie E-Jean Chen

Keyword(s):

Cognitive Behavioral Therapy ◽

Real World ◽

Behavioral Therapy ◽

Anxiety Symptoms ◽

Cognitive Behavioral ◽

Depression And Anxiety ◽

Symptoms Of Depression ◽

Care Intervention ◽

Blended Care ◽

Over Time

BACKGROUND The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. OBJECTIVE This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. METHODS This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. RESULTS The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, P<.001 and β=–.64, P<.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P<.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). CONCLUSIONS Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

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