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Liu XQ, Guo YX, Zhang XR, Zhang LX, Zhang YF. Digital interventions empowering mental health reconstruction among students after the COVID-19 pandemic. World J Psychiatry 2023; 13:397-401. [PMID: 37383289 PMCID: PMC10294129 DOI: 10.5498/wjp.v13.i6.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/13/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
With the gradual end of the coronavirus disease 2019 (COVID-19) pandemic, the reconstruction of students’ mental health is urgently necessary. Digital interventions offer advantages such as high accessibility, anonymity, and accurate identification, which can promote the reconstruction of students’ mental health through the provision of psychological support platforms, psychological assessment tools, and online mental health activities. However, we recognize that digital interventions must undergo many adjustments, and corresponding ethical norms require further clarification. It is crucial for different stakeholders to collaborate and work toward maximizing the effectiveness of digital interventions for the reconstruction of mental health after the COVID-19 pandemic.
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Affiliation(s)
- Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
| | - Yu-Xin Guo
- School of Education, Tianjin University, Tianjin 300350, China
| | - Xin-Ran Zhang
- School of Education, Tianjin University, Tianjin 300350, China
| | - Lin-Xin Zhang
- School of Education, Tianjin University, Tianjin 300350, China
| | - Yi-fan Zhang
- School of Education, Tianjin University, Tianjin 300350, China
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Ren R, Zhang Y, Shi Y, Zhang H, Vitiello MV, Tang X. The beneficial effects of integrating a personalized telephone-delivered component into digital cognitive behavioral therapy for insomnia in a large, hospital-based population. Sleep Med 2023; 106:25-32. [PMID: 37037053 DOI: 10.1016/j.sleep.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Although digital cognitive behavior therapy for insomnia (D-CBTI) has been shown to be a viable treatment for insomnia, lacking flexibility of response and direct practitioner-to-patient contact and comfort potentially limited its efficacy. Integrating personalized telephone sessions into D-CBTI may overcome these obstacles, potentially providing additional clinical benefit to chronic insomnia patients. We evaluate the clinical effectiveness of telephone plus D-CBTI (TD-CBTI) versus D-CBTI alone. METHODS Insomnia patients were selected consecutively from the Sleep Medicine Center, West China Hospital from March 2020 to February 2021. Insomnia was defined by Diagnostic and Statistical Manual for Mental Disorders criteria with symptoms lasting ≥3 months. Standard D-CBTI was administered through the APP "SUMIAN," which provided fully automated, interactive and standard CBTI over six weekly treatments. TD-CBTI added weekly 10-15 min personalized telephone-based sessions to D-CBTI. RESULTS One hundred and seven patients received D-CBTI and 465 patients received TD-CBTI. Pre-to posttreatment differences of ISI and most sleep diary reported sleep indexes were comparable between groups. However, TD-CBTI patients showed significantly increased odds of SE based remission (167%, OR = 2.67, 95% CI 1.34-5.23), and significantly increased odds of reduction of sleep medications (352%, OR = 4.52, 95% CI 1.27-10.05). CONCLUSIONS This study demonstrates that integration of personalized telephone sessions into D-CBTI treatment, provides increased clinical benefit to insomnia patients, particularly for successful discontinuation of sleep medications.
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Affiliation(s)
- Rong Ren
- Sleep Medicine Center, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, 98195-6560, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Paradoxic Intention as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2023; 18:9-19. [PMID: 36764790 DOI: 10.1016/j.jsmc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Paradoxic intention (PI) was one of the first psychological interventions for insomnia. Historically, PI has been incorporated in cognitive behavioral therapy for insomnia (CBT-I) or delivered as a sole intervention for insomnia. PI instructions have varied over the years, but a common denominator is the instruction to try to stay awake in bed for as long as possible. This article reviews and discuss treatment rationales and theoretic frameworks for PI, the current evidence base for PI, its clinical relevance, and considerations needed when PI is used as an adjunct treatment to CBT-I, or as a second-line intervention for insomnia.
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Retzer L, Reindl R, Zauter S, Richter K. Bevorzugen Frauen Face-to-Face-Beratung bei Insomnie? SOMNOLOGIE 2021. [DOI: 10.1007/s11818-020-00292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Germain A, Markwald RR, King E, Bramoweth AD, Wolfson M, Seda G, Han T, Miggantz E, O’Reilly B, Hungerford L, Sitzer T, Mysliwiec V, Hout JJ, Wallace ML. Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial. Trials 2021; 22:46. [PMID: 33430955 PMCID: PMC7798254 DOI: 10.1186/s13063-020-04974-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. Despite its effectiveness, CBTI has limited scalability. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise; rigid, resource-intensive treatment formats; and limited capacities for just-in-time monitoring and treatment personalization. Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. METHODS This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™'s Clinician-Operated Assistive Sleep Technology (COAST™). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM's sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM's sleep experts and local champions). The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. DISCUSSION Digital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. TRIAL REGISTRATION ClinicalTrials.gov NCT04366284 . Registered on 28 April 2020.
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Affiliation(s)
- Anne Germain
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Rachel R. Markwald
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
| | - Erika King
- Mental Health Division, Air Force Medical Readiness Agency, 2261 Hughes Ave, Suite 153, JBSA Lackland AFB, TX 78236-9853 USA
| | - Adam D. Bramoweth
- VA Pittsburgh Healthcare System, Research Office Building (151RU), University Drive C, Pittsburgh, PA 15240 USA
| | - Megan Wolfson
- NOCTEM, LLC, 218 Oakland Avenue, Pittsburgh, PA 15213 USA
| | - Gilbert Seda
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Tony Han
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Erin Miggantz
- Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106 USA
- Leidos, Inc., 4161 Campus Point Ct., San Diego, 92121 USA
| | - Brian O’Reilly
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431 USA
| | - Lars Hungerford
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
- Defense and Veterans Brain Injury Center, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134 USA
| | - Traci Sitzer
- Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Vincent Mysliwiec
- Division of Behavioral Medicine, Department of Psychiatry, UT Health San Antonio, 7703 Floyd Curl Drive, MC 7747, San Antonio, TX 78229-3900 USA
| | - Joseph J. Hout
- Knowesis, Inc., 816 Camaron St. Suite 231, San Antonio, TX 78212 USA
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Ludwig R, Vaduvathiriyan P, Siengsukon C. Does cognitive-behavioural therapy improve sleep outcomes in individuals with traumatic brain injury: a scoping review. Brain Inj 2020; 34:1569-1578. [PMID: 33112696 DOI: 10.1080/02699052.2020.1831070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Insomnia symptoms are common after a traumatic brain injury (TBI). Cognitive-behavioural therapy (CBT) to treat sleep disturbances and insomnia (CBT-I) has been used to improve sleep outcomes. It is unclear if CBT/CBT-I is efficacious in individuals with a TBI. This review was performed to evaluate the use of CBT/CBT-I in individuals with a TBI who also endorse insomnia and concomitant symptoms. METHODS Literature searches were conducted in June 2019. A total of 861 articles were found. The full text of 14 articles was reviewed for inclusion/exclusion criteria. Quality appraisal was conducted to assess the risk of bias. RESULTS Five articles met the criteria. Two articles were pilot-randomized control trials and three were case studies. The review indicates that individuals participating in CBT/CBT-I reported increased sleep efficiency, sleep quality, and reduced insomnia symptoms and concomitant symptoms. The major source of bias is a limited number of participants across all studies. CONCLUSION This review provides evidence that CBT/CBT-I following a TBI can improve sleep outcomes and reduce concomitant symptoms. More robust studies are needed due to limited number of randomized control trials to determine if CBT/CBT-I is an effective treatment in individuals with TBI.
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Affiliation(s)
- Rebecca Ludwig
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center , Kansas City, Kansas, USA
| | | | - Catherine Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center , Kansas City, Kansas, USA
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Moloney ME, Martinez AI, Badour CL, Moga DC. Internet-Based Cognitive Behavioral Therapy for Insomnia in Appalachian Women: A Pilot Study. Behav Sleep Med 2020; 18:680-689. [PMID: 31470745 PMCID: PMC7048659 DOI: 10.1080/15402002.2019.1661249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE/BACKGROUND Appalachian women are disproportionately affected by insufficient sleep but live in a healthcare shortage area with prevalent prescription drug abuse. A self-administered, non-pharmacologic intervention such as Internet-based cognitive behavioral therapy for insomnia (CBT-I) may be ideal in this population, but psycho-social characteristics (e.g., high depression rates) and cultural norms (e.g., suspicion of technology) necessitate a pilot study. We evaluated the effectiveness of Sleep Healthy Using the Internet (SHUTi) on insomnia severity, sleep quality, perceived stress, depression symptoms, and sleep aid use in Appalachian women ages 45 +. PARTICIPANTS Forty-six women enrolled; 38 completed the six-week intervention in 2018 (mean age 55 years). METHODS We employed a single group, pre/post-test, mixed-methods design. Participants completed an online survey and a qualitative interview pre- and post-intervention. Quantitative data were analyzed using one-way repeated measures ANOVA or generalized estimating equations. Interviews were qualitatively analyzed using a multi-stage coding process. RESULTS Positive and statistically significant (p < .01) improvements were observed on mean scores for the Insomnia Severity Index (15.1 to 6.5), the Pittsburgh Sleep Quality Index (12.1 to 8.5), the Perceived Stress Scale (20 to 14.6), and the Center for Epidemiologic Studies Depression Scale Revised (9.8 to 5.2). The odds of reporting sleep medication use post-intervention were significantly lower than pre-intervention (OR 0.28 [95% CI 0.11-0.74]). Interviews highlighted most and least helpful intervention components and suggested that participants benefitted from SHUTi. CONCLUSIONS Internet-based CBT-I may be a useful, non-pharmacologic treatment that reduces insomnia severity, perceived stress, depression symptoms, and sleep aid use in middle-aged Appalachian women.
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Affiliation(s)
| | - Ashley I Martinez
- Department of Pharmacy Practice and Science, University of Kentucky , Lexington
| | | | - Daniela C Moga
- Department of Pharmacy Practice and Science, University of Kentucky , Lexington
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Siengsukon CF, Beck ES, Drerup M. Feasibility and Treatment Effect of a Web-Based Cognitive Behavioral Therapy for Insomnia Program in Individuals with Multiple Sclerosis: A Pilot Randomized Controlled Trial. Int J MS Care 2020; 23:107-113. [PMID: 34177382 DOI: 10.7224/1537-2073.2019-122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background At least 40% of individuals with multiple sclerosis (MS) experience chronic insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia symptoms in individuals with MS. Delivery of CBT-I 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, experience 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 telephone 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 6-week Web-based CBT-I program and received biweekly support telephone calls (wCBT-I + calls). 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 significant improvement in insomnia severity, sleep quality, sleep self-efficacy, and anxiety. Only the wCBT-I group had 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 access to CBT-I treatment and provide a stepped-care approach to treating chronic insomnia in individuals with MS.
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