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Ownby RL, Thomas-Purcell K, Purcell D, Caballero J, Tewary S, Davenport R, Simonson M. A mobile app providing individually-tailored psychoeducation about sleep for older adults with chronic health conditions and low health literacy. JOURNAL OF PSYCHIATRY RESEARCH REVIEWS & REPORTS 2024; 6:10.47363/jpsrr/2024(6)163. [PMID: 38770111 PMCID: PMC11103247 DOI: 10.47363/jpsrr/2024(6)163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Objective This paper reports on a study of a mobile app that provides tailored information about sleep to individuals aged 40 and older who have chronic health conditions and low health literacy. Methods The sleep module was a part of a multitopic app focused on chronic disease self-management. Participants were randomly assigned to receive sleep psychoeducation at reading levels equivalent to 3rd, 6th or 8th grade. The primary outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was completed at baseline, after the intervention, and again three months later. Outcomes were assessed using repeated measures mixed effects models. Results Most participants were Black, Indigenous, or Other Persons of Color (BIPOC; 87%); they had average reading level at the 7th grade. Health literacy, socioeconomic status, and number of health conditions were related to the PSQI. The PSQI score decreased over the course of the three study visits for all groups, consistent with a small to medium effect size (d = 0.40). No effect of treatment group was observed. Participants were positive about the usefulness and helpfulness of the app. Conclusion Results suggest that a brief tailored information intervention may be beneficial for individuals aged 40 and older who have low health literacy and chronic health conditions. Further development of the intervention may enhance its clinical effectiveness.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Kamilah Thomas-Purcell
- Department of Health Science, College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Donrie Purcell
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA. Now at Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Joshua Caballero
- Department of Clinical and Administrative Science, College of Pharmacy, Larkin University, Miami, Florida, USA. Now at Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia, USA
| | - Sweta Tewary
- Department of Geriatric Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rosemary Davenport
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Michael Simonson
- Instructional Technology and Distance Education Program, Fischler College of Education, Nova Southeastern University, Fort Lauderdale Florida, USA
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Treacy T, O'Meara Y, Galligan MC, Henry AL, Lensen SF, Higgins MJ, Hickey M, Brennan DJ. The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients - Trial protocol of a randomised controlled trial. Contemp Clin Trials 2024; 136:107337. [PMID: 37741507 DOI: 10.1016/j.cct.2023.107337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
AIMS This study will assess the efficacy of digital CBT for insomnia (dCBT-I) compared to sleep hygiene education (SHE) for the management of insomnia in women with cancer. BACKGROUND 30% of patients with cancer meet insomnia diagnostic criteria and this can be detrimental to health outcomes. Insomnia disorder comprises a dissatisfaction with sleep quantity or quality characterized by difficulty initiating sleep, frequent awakenings, or early morning wakening without the ability to return to sleep, at least 3 nights per week, for at least 3 months, causing significant impairment or distress in areas of functioning. METHODS We will recruit 308 women with a current or prior cancer diagnosis who are currently experiencing insomnia; defined as a score of 16 or less on the Sleep Condition Indicator (SCI). Participants will be randomised to dCBT-I or SHE. dCBT-I will be delivered online via 6 sessions. SHE will be provided in an online format. Assessments of sleep and other related parameters, through validated questionnaires, will be taken at 12 and 24 weeks following intervention. Once 24 week assessments are completed, participants will crossover to the alternate arm (either SHE or dCBT-I) and undergo a final assessment at week 36. OUTCOMES The primary outcome will be the mean continuous change in SCI score in the intervention arm compared to the control arm at 24 weeks. Additionally, the proportion of women with an SCI > 16 at 24 weeks will be assessed. Secondary outcomes include fatigue, sleep related quality of life, depression, anxiety, and hot flush interference. REGISTRATION This study is registered on ClinicalTrials.gov with number NCT05816460.
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Affiliation(s)
- Teresa Treacy
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Yvvonne O'Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Marie C Galligan
- UCD Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Sarah F Lensen
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Michaela J Higgins
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Donal J Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland; UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
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Marilac Soalheiro L, de Jesus Brandão B, Paiva RVN, Dias Carvalho L, Menezes Paranhos RD, Ribeiro Barbosa PC, Guerrero-Vargas NN, Tamura EK. Familiarity of Brazilian psychologists with basic concepts in sleep science and chronobiology. Chronobiol Int 2023; 40:1072-1083. [PMID: 37661786 DOI: 10.1080/07420528.2023.2250870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
Desynchronization of circadian rhythms and sleep-wake patterns impacts biochemical, physiological, and behavioral functions, including mental processes. The complex relationship between circadian rhythms and mental health makes it challenging to determine causality between circadian desynchronization and mental disorders. Regarding the fact that psychologists act as the front line for initial mental health care, we aimed to assess the knowledge and use of sleep science and basic chronobiology by professional psychologists in Brazil. Data were collected via an online questionnaire completed by 1384 professional psychologists between October 2018 and May 2019. Our findings revealed that ±80% of psychologists reported that at least half of their patients presented some sleep-related complaints; however, only ±27% routinely inquired about sleep quality even in the absence of patient complaints. Additionally, only ±66% initiated treatments to understand these complaints, potentially influenced by the lack of prior academic exposure to biological rhythms as reported by ±76% of Brazilian psychologists interviewed. Importantly, ±15% did not believe in an association between mental health and biological rhythms, and even a significant ±67% were unfamiliar with the term chronobiology and ±63% were not able to describe any other biological rhythm except for the sleep-wake cycle. These results demonstrate that fundamental concepts in chronobiology and sleep science are unknown to a substantial proportion of Brazilian psychologists. In conclusion, we propose that this subject could be more effectively integrated into psychologists' academic training, potentially promoting benefits through the incorporation of a chronobiological approach in mental health practice.
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Affiliation(s)
| | | | | | - Lázaro Dias Carvalho
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, Brazil
| | | | - Paulo César Ribeiro Barbosa
- Department of Human Sciences and Philosophy, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | - Natali N Guerrero-Vargas
- Department of Anatomy, Faculty of Medicine, Universidad Nacional Autonóma de México, México City, México
| | - Eduardo Koji Tamura
- Department of Health Sciences, Universidade Estadual de Santa Cruz, Ilhéus, Brazil
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Quality-adjusted life years for digital cognitive behavioural therapy for insomnia (Sleepio): a secondary analysis. BJGP Open 2022; 6:BJGPO.2022.0090. [PMID: 36216367 PMCID: PMC9904772 DOI: 10.3399/bjgpo.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Insomnia is common, and difficulty with daytime functioning is a core symptom. Studies show cognitive behavioural therapy (CBT) improves functioning, but evidence is needed on its value for money. Quality-adjusted life years (QALYs), capturing length and quality of life, provide a standard metric by which to judge whether a treatment is worth its cost. Studies have found QALY gains with therapist-delivered and therapist-guided CBT, but most have not reached statistical significance. Estimates of QALY gains with fully automated digital CBT (dCBT) for insomnia are lacking. AIM To assess whether dCBT (Sleepio) for insomnia is associated with gains in QALYs compared with a sleep hygiene education control. DESIGN & SETTING A secondary analysis of a large effectiveness trial of 1711 participants from the UK, US, and Australia. METHOD EQ-5D scores, the National Institute for Health and Care Excellence's (NICE's) preferred measure of health-related quality of life (HRQoL), were predicted (mapped) from the 10-item Patient-Reported Outcomes Measurement Information System (PROMIS-10) Global Health scores and used to determine QALYs from baseline to 24 weeks (controlled), and to 48 weeks (uncontrolled). RESULTS At week 24, QALYs were significantly higher for the dCBT group, with mean QALYs 0.375 and 0.362 in the dCBT and control groups, respectively. The mean difference was 0.014 (95% confidence interval [CI] = 0.008 to 0.019), and this difference was maintained over the 48-week study period (0.026, 95% CI = 0.016 to 0.036). The difference of 0.026 QALYs is equivalent to 9.5 days in perfect health. CONCLUSION Sleepio is associated with statistically significant gains in QALYs over time compared with control. Findings may be used to power future studies and inform cost-effectiveness analyses of automated dCBT for insomnia scaled to a population level.
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Wiedemann F, Porzsolt F. Measuring Health-Related Quality of Life in Randomised Controlled Trials: Expected and Reported Results Do Not Match. Pragmat Obs Res 2022; 13:9-16. [PMID: 35431592 PMCID: PMC9012498 DOI: 10.2147/por.s350165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The assessment of health-related quality of life (hrQoL) may need to be reconsidered due to important differences between efficacy (the effect of a treatment under experimental study conditions) and effectiveness (the effect of a treatment under real-world conditions). We presume that most researchers intend to describe effects under real-world conditions when investigating hrQoL as an endpoint. Unfortunately, most studies are designed to confirm two theories: the efficacy of a new intervention under experimental study conditions and the real-world effectiveness of this intervention on hrQoL under non-experimental study conditions. Conflicting information emerges when the outcomes are supposed to describe effects under real-world conditions, but the assessment generates results obtained under experimental conditions. This paper examines the existing conflict between efficacy and effectiveness in a sample of 100 studies investigating hrQoL. Methods We analysed a sample of freely available publications of clinical studies listed in PubMed between April 2015 and August 2016 which assessed quality of life as an outcome. We assessed the following four characteristics that should differ in studies measuring either efficacy or effectiveness: 1) specification of the study as a randomised controlled trial or not, 2) description of the study design as pragmatic or not, 3) classification of the study as an efficacy or an effectiveness study and 4) number of selected inclusion and exclusion criteria. Results 91% of the studies assessed hrQoL under experimental conditions (in a randomised controlled trial), but not under real-world conditions. The important difference between efficacy and effectiveness was not described in 60% of the studies. Only 6% of studies classified the study as a pragmatic trial. The difference between inclusion and exclusion criteria was not addressed in any of the investigated studies. Conclusion The results of the four criteria confirmed our hypothesis that hrQoL studies are conducted mainly as experimental, but not pragmatic, trials indicating that the meaningfulness of the important difference between efficacy and effectiveness requires further discussion. Keywords pragmatic trial, experimental study conditions, real-world conditions, efficacy, effectiveness, pragmatic.
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Affiliation(s)
- Felicitas Wiedemann
- Department of General and Visceral Surgery, Stuttgart, 70176, Germany
- Institute of Clinical Economics (ICE) e.V., Ulm, 89081, Germany
- Correspondence: Felicitas Wiedemann, Department of General and Visceral Surgery, Diakonie-Klinikum Stuttgart, Markelstraße 44, Stuttgart, Baden-Württemberg, Germany, Tel +491781731296, Email
| | - Franz Porzsolt
- Institute of Clinical Economics (ICE) e.V., Ulm, 89081, Germany
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Liu CY, Zhao YN, Wang XQ, Qin S, Wan QY, Zheng SY, Wu WZ. Acupuncture combined with traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for chronic insomnia: study protocol for a randomized controlled trial. Trials 2022; 23:86. [PMID: 35090540 PMCID: PMC8796488 DOI: 10.1186/s13063-022-06012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/08/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The incidence of insomnia is getting higher and higher. Long-term insomnia seriously affects people's health. Drug use is usually accompanied with adverse events. Both acupuncture and cognitive behavioral therapy for insomnia (CBT-I) have been proven to be safe and effective non-pharmacological treatments for insomnia. As the insomniacs' bad sleep behavior and wrong cognition have not been effectively corrected, acupuncture has a quick effect, high patient compliance but unstable long-term efficacy, while CBT-I is complex, time-consuming, and expensive; additionally, patient compliance is low, and the number of trained therapists is limited, making it difficult to carry out. Therefore, this study aims to use the insomnia TCM system to construct a convenient and feasible traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for Chinese people, and combine the advantages of acupuncture and TCM-eCBT-I for maintaining long-term efficacy, and three treatments will be evaluated to provide clinicians with a more effective clinical protocol METHODS AND ANALYSIS: This study is a single-center, open-label, randomized controlled trial. Ninety subjects will be recruited and randomly assigned to three groups: the acupuncture group, the TCM-eCBT-I group, and the acupuncture combined with TCM-eCBT-I group, in a ratio of 1:1:1. We will evaluate the Pittsburgh Sleep Quality Index (PSQI) and Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Insomnia Severity Index (ISI), sleep diary, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Fatigue Scale-14 Scale (FS-14) scales. All adverse reactions will be assessed through the ADVERSE event table. All outcomes will be evaluated online at 0 weeks, 4 weeks, 8 weeks, 16 weeks, and 28weeks. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of the Affiliated Hospital of Nanjing University of Chinese Medicine (2020 NL-018-02). Informed consent will be obtained from all the subjects. The results will be shared with sleep researchers, public, and relevant academic institutions through high-impact peer-reviewed publications. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000032960. Registered on 17 May 2020.
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Affiliation(s)
- Cheng-Yong Liu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Ya-Nan Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiao-Qiu Wang
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Shan Qin
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Qing-Yun Wan
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Shi-Yu Zheng
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China
| | - Wen-Zhong Wu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155, Hanzhong Road, Qinhuai District, Nanjing, Jiangsu, China.
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Ellis TD, Earhart GM. Digital Therapeutics in Parkinson's Disease: Practical Applications and Future Potential. JOURNAL OF PARKINSONS DISEASE 2021; 11:S95-S101. [PMID: 33646177 PMCID: PMC8292155 DOI: 10.3233/jpd-202407] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Digital therapeutics, treatments delivered remotely and enabled by modern technology, facilitate the provision of personalized, evidence-based, interdisciplinary interventions to manage the complexities associated with Parkinson’s disease. In the context of the COVID-19 pandemic, the need for digital therapeutics has arguably never been greater. However, despite new advances in technology and a heightened interest due to the pandemic, digital therapeutics remain underdeveloped and underutilized. In this paper, we briefly review practical applications and emerging advances in digital therapeutic platforms that target motor and non-motor signs and healthy lifestyle behaviors such as regular exercise, a healthful diet and optimal sleep hygiene habits. Future applications which could transform personalized self-management and patient care are presented. Opportunities, drawbacks and barriers to access are discussed.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy & Athletic Training, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Department of Neurology, Department of Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Fredericks S, Miranda J, Sidani S, Abdul-Ali Farooqui M. Identifying evidence informed psychological interventions during the COVID-19 pandemic: Rapid review of the literature. Brain Behav Immun Health 2020; 9:100171. [PMID: 33169116 PMCID: PMC7641538 DOI: 10.1016/j.bbih.2020.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Less than a quarter of psychological interventions are developed based on evidence. Evaluation of the effectiveness of existing online mental health resources is required. Front-line healthcare providers experienced severe mental distress during COVID-19.
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Affiliation(s)
- Suzanne Fredericks
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, USA
| | - Joyal Miranda
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, USA
| | - Souraya Sidani
- Canada Research Chair in Design and Evaluation of Health Interventions (Tier 1), Daphne Cockwell School of Nursing, USA
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Waters F, Chiu VW, Dragovic M, Ree M. Different patterns of treatment response to Cognitive-Behavioural Therapy for Insomnia (CBT-I) in psychosis. Schizophr Res 2020; 221:57-62. [PMID: 32317223 DOI: 10.1016/j.schres.2020.03.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
People with psychosis benefit enormously from Cognitive Behavioural Therapy for Insomnia (CBTI), although some variability exists in treatment outcomes. While recent efforts have focused on profiling sleep at treatment initiation, an alternative methodological approach involves using treatment response as a starting point to better understand what constitutes an effective treatment. This study used Grade of Membership analysis (GoM) to estimate the occurrence of unique treatment outcomes and associated patient characteristics. Outcome measures included changes in sleep (self-reported latency, efficiency, duration, quality), functional outcomes (daytime dysfunction, negative mood, need for sleep medication) and treatment goal, collected in 50 individuals with a psychotic disorder and insomnia who underwent CBT-I treatment. Three distinct profiles were identified: (1) Strong responders, who met their treatment goals and showed broad improvements in both sleep and functional domains; (2) Partial responders, who showed sleep improvements (particularly in total sleep time), without noticeable gains in function, and who were predominantly female; and (3) Non-responders who showed little treatment response and failed to meet their treatment goals. This group was also more likely to have greater psychopathology (high levels of negative mood and psychotic symptoms, and antipsychotic medication dosage). These findings suggest that (i) CBT-I can serve to improve sleep and daytime function (although sleep can improve independently from function), (ii) client-elicited treatment goals are a key predictor of CBT-I response, (iii) other important variables associated with treatment response include sleep profile, clinical acuity, and sex.
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Affiliation(s)
- Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Perth, Australia; School of Psychological Science, University of Western Australia, Perth, Australia.
| | - Vivian W Chiu
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Perth, Australia
| | - Milan Dragovic
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Perth, Australia; Division of Psychiatry, University of Western Australia, Perth, Australia
| | - Melissa Ree
- School of Psychological Science, University of Western Australia, Perth, Australia; Sleep Matters, Subiaco, Perth, Australia
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Miralles I, Granell C, Díaz-Sanahuja L, Van Woensel W, Bretón-López J, Mira A, Castilla D, Casteleyn S. Smartphone Apps for the Treatment of Mental Disorders: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e14897. [PMID: 32238332 PMCID: PMC7163422 DOI: 10.2196/14897] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/05/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.
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Affiliation(s)
| | | | | | | | - Juana Bretón-López
- Universitat Jaume I, Castellón de la Plana, Spain.,CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Diana Castilla
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
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Luik AI, Marsden A, Emsley R, Henry AL, Stott R, Miller CB, Espie CA. Long‐term benefits of digital cognitive behavioural therapy for insomnia: Follow‐up report from a randomized clinical trial. J Sleep Res 2020; 29:e13018. [DOI: 10.1111/jsr.13018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Annemarie I. Luik
- Department of Epidemiology Erasmus MC University Medical Center Rotterdam The Netherlands
- Sleep and Circadian Neuroscience Institute Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
| | - Antonia Marsden
- Centre for Biostatistics School of Health Sciences The University of Manchester Manchester UK
| | - Richard Emsley
- Biostatistics and Health Informatics Department Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Alasdair L. Henry
- Sleep and Circadian Neuroscience Institute Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
- Big Health Inc. San Francisco CA USA
| | | | - Christopher B. Miller
- Sleep and Circadian Neuroscience Institute Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
- Big Health Inc. San Francisco CA USA
| | - Colin A. Espie
- Sleep and Circadian Neuroscience Institute Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
- Big Health Inc. San Francisco CA USA
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Morton E, Murray G. Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review. Clin Psychol Psychother 2020; 27:364-377. [DOI: 10.1002/cpp.2433] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Emma Morton
- Department of Psychiatry, Faculty of MedicineUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
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Yang Y, Luo X, Paudel D, Zhang J, Li SX, Zhang B. Effects of e-aid cognitive behavioural therapy for insomnia (eCBTI) to prevent the transition from acute insomnia to chronic insomnia: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e033457. [PMID: 31740476 PMCID: PMC6886949 DOI: 10.1136/bmjopen-2019-033457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Previous evidence suggested that online self-guided sleep intervention is efficacious in improving treatment outcomes in patients with chronic insomnia [corrected]. However, research on online sleep interventions targeting acute insomnia [corrected] has been scarce. This study aims to evaluate the effectiveness of brief e-aid cognitive behavioural therapy for insomnia (eCBTI) in preventing transition from acute insomnia to chronic insomnia [corrected]. METHODS AND ANALYSIS This is a pragmatic two-arm multicentre, randomised controlled trial comparing eCBTI with treatment as usual (TAU) in outpatients. Two hundred patients with acute insomnia [corrected] (as defined by DSM-5) will be recruited. Patients will be randomly assigned to receive 1 week eCBTI via a Smartphone application, or to receive TAU. Treatment effects will be assessed at 1 week and 3 months after intervention. The primary outcome of the study, whether the eCBTI program is sufficient in preventing transition from short-term to chronic insomnia [corrected], is measured by the Insomnia Severity Index. Secondary outcome measurements include the Dysfunctional Beliefs and Attitudes about Sleep Scale, Ford Insomnia Response to Stress Test, Sleep Hygiene and Practices Scale, Pre-sleep Arousal Scale and Epworth Sleepiness Scale. Additionally, the Hospital Anxiety and Depression Scale and the Short-Form 12-Item Health Survey will be used for measurement of mood symptoms and quality of life. ETHICS AND DISSEMINATION Ethical approval for the study has been obtained from the Ethics Committee of Southern Medical University (reference number: NFEC-2017-131). The results of the investigation will be published in scientific papers. The data from the investigation will be made available online if necessary. TRIAL REGISTRATION NCT03302455 (clinicaltrials.gov). Date of registration: October 5, 2017.
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Affiliation(s)
- Yuan Yang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xian Luo
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Dhirendra Paudel
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jihui Zhang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Shirley Xin Li
- Department of Psychology, University of Hong Kong, Hong Kong, China
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China
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Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work. Nutrients 2019; 11:nu11061382. [PMID: 31248175 PMCID: PMC6627504 DOI: 10.3390/nu11061382] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023] Open
Abstract
A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.
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15
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van Rijn B, Chryssafidou E, Falconer CJ, Stiles WB. Digital images as meaning bridges: Case study of assimilation using avatar software in counselling with a 14‐year‐old boy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2019. [DOI: 10.1002/capr.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Biljana van Rijn
- Faculty of Research Strategy and Innovation Metanoia Institute London UK
| | - Evi Chryssafidou
- Faculty of Research Strategy and Innovation Metanoia Institute London UK
| | | | - William B. Stiles
- Miami University and Appalachian State University Glendale Springs North Carolina
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16
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Thomas MSC, Ansari D, Knowland VCP. Annual Research Review: Educational neuroscience: progress and prospects. J Child Psychol Psychiatry 2019; 60:477-492. [PMID: 30345518 PMCID: PMC6487963 DOI: 10.1111/jcpp.12973] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 01/01/2023]
Abstract
Educational neuroscience is an interdisciplinary research field that seeks to translate research findings on neural mechanisms of learning to educational practice and policy and to understand the effects of education on the brain. Neuroscience and education can interact directly, by virtue of considering the brain as a biological organ that needs to be in the optimal condition to learn ('brain health'); or indirectly, as neuroscience shapes psychological theory and psychology influences education. In this article, we trace the origins of educational neuroscience, its main areas of research activity and the principal challenges it faces as a translational field. We consider how a pure psychology approach that ignores neuroscience is at risk of being misleading for educators. We address the major criticisms of the field comprising, respectively, a priori arguments against the relevance of neuroscience to education, reservations with the current practical operation of the field, and doubts about the viability of neuroscience methods for diagnosing disorders or predicting individual differences. We consider future prospects of the field and ethical issues it raises. Finally, we discuss the challenge of responding to the (welcome) desire of education policymakers to include neuroscience evidence in their policymaking, while ensuring recommendations do not exceed the limitations of current basic science.
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Affiliation(s)
- Michael S. C. Thomas
- Centre for Educational NeuroscienceDepartment of Psychological ScienceBirkbeckUniversity of LondonLondonUK
| | - Daniel Ansari
- Department of Psychology & Faculty of Education Western UniversityLondonONCanada
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Cheng P, Luik AI, Fellman-Couture C, Peterson E, Joseph CL, Tallent G, Tran KM, Ahmedani BK, Roehrs T, Roth T, Drake CL. Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial. Psychol Med 2019; 49:491-500. [PMID: 29792241 PMCID: PMC7050476 DOI: 10.1017/s0033291718001113] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Insomnia and depression are highly comorbid and mutually exacerbate clinical trajectories and outcomes. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces both insomnia and depression severity, and can be delivered digitally. This could substantially increase the accessibility to CBT-I, which could reduce the health disparities related to insomnia; however, the efficacy of digital CBT-I (dCBT-I) across a range of demographic groups has not yet been adequately examined. This randomized placebo-controlled trial examined the efficacy of dCBT-I in reducing both insomnia and depression across a wide range of demographic groups. METHODS Of 1358 individuals with insomnia randomized, a final sample of 358 were retained in the dCBT-I condition and 300 in the online sleep education condition. Severity of insomnia and depression was examined as a dependent variable. Race, socioeconomic status (SES; household income and education), gender, and age were also tested as independent moderators of treatment effects. RESULTS The dCBT-I condition yielded greater reductions in both insomnia and depression severity than sleep education, with significantly higher rates of remission following treatment. Demographic variables (i.e. income, race, sex, age, education) were not significant moderators of the treatment effects, suggesting that dCBT-I is comparably efficacious across a wide range of demographic groups. Furthermore, while differences in attrition were found based on SES, attrition did not differ between white and black participants. CONCLUSIONS Results provide evidence that the wide dissemination of dCBT-I may effectively target both insomnia and comorbid depression across a wide spectrum of the population.
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Affiliation(s)
- Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Annemarie I. Luik
- Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Edward Peterson
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Gabriel Tallent
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Brian K. Ahmedani
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Timothy Roehrs
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
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18
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van der Zweerde T, van Straten A, Effting M, Kyle SD, Lancee J. Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms. Psychol Med 2019; 49:501-509. [PMID: 29747706 PMCID: PMC6331685 DOI: 10.1017/s0033291718001149] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/02/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Insomnia is effectively treated with online Cognitive Behavioral Therapy for Insomnia (CBT-I). Previous research has suggested the effects might not be limited to sleep and insomnia severity, but also apply to depressive symptoms. Results, however, are mixed. METHODS In this randomized controlled trial we investigated the effects of guided online CBT-I on depression and insomnia in people suffering from symptoms of both. Participants (n = 104) with clinical insomnia and at least subclinical depression levels were randomized to (1) guided online CBT-I and sleep diary monitoring (i-Sleep) or (2) control group (sleep diary monitoring only). The primary outcome was the severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS). Secondary outcomes were insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety, and perseverative thinking. RESULTS At post-test, participants in the i-Sleep condition reported significantly less depressive symptoms (PHQ-WS) compared with participants in the sleep-diary condition (d = 0.76). Large significant effects were also observed for insomnia severity (d = 2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety, and perseverative thinking. Effects were maintained at 3 and 6 month follow-up. We did not find significant post-test effects on fatigue or total sleep time. CONCLUSIONS Findings indicate that guided online CBT-I is not only effective for insomnia complaints but also for depressive symptoms. The effects are large and comparable with those of depression therapy. CLINICAL TRIAL REGISTRATION NUMBER NTR6049 (Netherlands Trial Register).
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Affiliation(s)
- T. van der Zweerde
- Department of Clinical Psychology & EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - A. van Straten
- Department of Clinical Psychology & EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - M. Effting
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - S. D. Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - J. Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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Sakkas GK, Giannaki CD, Karatzaferi C, Manconi M. Sleep Abnormalities in Multiple Sclerosis. Curr Treat Options Neurol 2019; 21:4. [DOI: 10.1007/s11940-019-0544-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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20
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Espie CA, Emsley R, Kyle SD, Gordon C, Drake CL, Siriwardena AN, Cape J, Ong JC, Sheaves B, Foster R, Freeman D, Costa-Font J, Marsden A, Luik AI. Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:21-30. [PMID: 30264137 PMCID: PMC6583463 DOI: 10.1001/jamapsychiatry.2018.2745] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/04/2018] [Indexed: 12/21/2022]
Abstract
Importance Digital cognitive behavioral therapy (dCBT) is a scalable and effective intervention for treating insomnia. Most people with insomnia, however, seek help because of the daytime consequences of poor sleep, which adversely affects quality of life. Objectives To investigate the effect of dCBT for insomnia on functional health, psychological well-being, and sleep-related quality of life and to determine whether a reduction in insomnia symptoms was a mediating factor. Design, Setting, and Participants This online, 2-arm, parallel-group randomized trial comparing dCBT for insomnia with sleep hygiene education (SHE) evaluated 1711 participants with self-reported symptoms of insomnia. Participants were recruited between December 1, 2015, and December 1, 2016, and dCBT was delivered using web and/or mobile channels plus treatment as usual; SHE comprised a website and a downloadable booklet plus treatment as usual. Online assessments took place at 0 (baseline), 4 (midtreatment), 8 (posttreatment), and 24 (follow-up) weeks. Programs were completed within 12 weeks after inclusion. Main Outcomes and Measures Primary outcomes were scores on self-reported measures of functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale; range, 10-50; higher scores indicate better health); psychological well-being (Warwick-Edinburgh Mental Well-being Scale; range, 14-70; higher scores indicate greater well-being); and sleep-related quality of life (Glasgow Sleep Impact Index; range, 1-100; higher scores indicate greater impairment). Secondary outcomes comprised mood, fatigue, sleepiness, cognitive failures, work productivity, and relationship satisfaction. Insomnia was assessed with the Sleep Condition Indicator (range: 0-32; higher scores indicate better sleep). Results Of the 1711 participants included in the intention-to-treat analysis, 1329 (77.7%) were female, mean (SD) age was 48.0 (13.8) years, and 1558 (91.1%) were white. Use of dCBT was associated with a small improvement in functional health compared with SHE (adjusted difference [95% CI] at week 4, 0.90 [0.40-1.40]; week 8, 1.76 [1.24-2.28]; week 24, 1.76 [1.22-2.30]) and psychological well-being (adjusted difference [95% CI] at week 4, 1.04 [0.28-1.80]; week 8, 2.68 [1.89-3.47]; week 24, 2.95 [2.13-3.76]), and with a large improvement in sleep-related quality of life (at week 4, -8.76 [-11.83 to -5.69]; week 8, -17.60 [-20.81 to -14.39]; week 24, -18.72 [-22.04 to -15.41]) (all P < .01). A large improvement in insomnia mediated these outcomes (range mediated, 45.5%-84.0%). Conclusions and Relevance Use of dCBT is effective in improving functional health, psychological well-being, and sleep-related quality of life in people reporting insomnia symptoms. A reduction in insomnia symptoms mediates these improvements. These results confirm that dCBT improves both daytime and nighttime aspects of insomnia, strengthening existing recommendations of CBT as the treatment of choice for insomnia. Trial Registration isrctn.org identifier: ISRCTN60530898.
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Affiliation(s)
- Colin A. Espie
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Big Health Ltd, London, United Kingdom
| | - Richard Emsley
- Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Simon D. Kyle
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
- CIRUS Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Christopher L. Drake
- Department of Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan
| | | | - John Cape
- Big Health Ltd, London, United Kingdom
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Jason C. Ong
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bryony Sheaves
- Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Russell Foster
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Daniel Freeman
- Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joan Costa-Font
- Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom
| | - Antonia Marsden
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Annemarie I. Luik
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Big Health Ltd, London, United Kingdom
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21
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Zhou Y, Greenwald BD. Update on Insomnia after Mild Traumatic Brain Injury. Brain Sci 2018; 8:brainsci8120223. [PMID: 30551607 PMCID: PMC6315624 DOI: 10.3390/brainsci8120223] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/08/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022] Open
Abstract
Sleep disturbance after traumatic brain injury (TBI) has received growing interest in recent years, garnering many publications. Insomnia is highly prevalent within the mild traumatic brain injury (mTBI) population and is a subtle, frequently persistent complaint that often goes undiagnosed. For individuals with mTBI, problems with sleep can compromise the recovery process and impede social reintegration. This article updates the evidence on etiology, epidemiology, prognosis, consequences, differential diagnosis, and treatment of insomnia in the context of mild TBI. This article aims to increase awareness about insomnia following mTBI in the hopes that it may improve diagnosis, evaluation, and treatment of sleeping disturbance in this population while revealing areas for future research.
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Affiliation(s)
- Yi Zhou
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA.
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22
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Alhazzani AA, Alshahrani A, Alqahtani M, Alamri R, Alqahtani R, Alqahtani M, Alahmarii M. Insomnia among non-depressed multiple sclerosis patients: a cross-sectional study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:17. [PMID: 29962828 PMCID: PMC6002438 DOI: 10.1186/s41983-018-0016-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 01/21/2023] Open
Abstract
Background Insomnia is a common problem that affects approximately 50% of patients with multiple sclerosis (MS), who suffer from sleep disturbances. In general, persons with insomnia are at a higher risk of developing depression. This study was conducted to assess insomnia among non-depressed MS patients in Saudi Arabia. Methods Based on the Patient Health Questionnaire-9 (PHQ-9), those who scored 4 or less for depression out of 598 MS patients were selected (n = 112). A cross-sectional study was conducted to interview 112 non-depressed MS patients in order to assess insomnia among them. A data collection sheet has been designed by the researchers. It comprised socio-demographic variables (e.g., gender, age, area of residence, and marital status) and clinical variables (disease duration, age at disease onset, previous diagnosis of depression, and used antidepressant drugs). Insomnia was assessed by the Insomnia Severity Index (ISI), while severity of illness was assessed using the Patient Determined Disease Steps (PDDS). Results A total of 72 patients (64.3%) were females, and 62 (55.4%) were married. Their mean age was 32.6 years (SD = 8.9), ranging from 15 to 56 years. As for educational level, 64 (57.1%) had a Bachelor degree. The mean age at disease onset was 26 years (SD = 8.9). The mean duration of illness was 1.9 years. Symptoms of insomnia were present among 14 patients (12.5%). No statistical significance was found between the mean PDSS of insomnia and non-insomnia patients. Significant differences were present between insomnia and non-insomnia patients as regards their education level (P = 0.005) and use of antidepressant drugs (P = 0.008). Conclusions Prevalence of insomnia among non-depressed MS patients is low. Insomnia is associated with educational and use of antidepressants. Further research is needed to assess severity of different types of insomnia among depressed and non-depressed MS patients.
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Affiliation(s)
- A A Alhazzani
- 1Neurology Section, Department of Medicine, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,4College of Medicine, King Khalid University, PO Box 4557, Abha, 61412 Saudi Arabia.,5Neurology Section, Department of Medicine, King Khalid University, P.O. Box 641, Abha, Saudi Arabia
| | - A Alshahrani
- 2Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M Alqahtani
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - R Alamri
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - R Alqahtani
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - M Alqahtani
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - M Alahmarii
- 3Neurology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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23
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Ichikawa D, Kashiyama M, Ueno T. Tamper-Resistant Mobile Health Using Blockchain Technology. JMIR Mhealth Uhealth 2017; 5:e111. [PMID: 28747296 PMCID: PMC5550736 DOI: 10.2196/mhealth.7938] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/04/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022] Open
Abstract
Background Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials. Objective The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network. Methods We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults. Results Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network. Conclusions Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization.
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Affiliation(s)
| | | | - Taro Ueno
- Sustainable Medicine, Inc., Tokyo, Japan.,Institute of Neuropsychiatry, Seiwa Hospital, Tokyo, Japan.,Graduate School of Science, Department of Biomolecular, Science Toho University, Chiba, Japan
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24
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Kyle SD, Hurry MED, Emsley R, Luik AI, Omlin X, Spiegelhalder K, Espie CA, Sexton CE. Effects of digital Cognitive Behavioural Therapy for Insomnia on cognitive function: study protocol for a randomised controlled trial. Trials 2017; 18:281. [PMID: 28623947 PMCID: PMC5474001 DOI: 10.1186/s13063-017-2012-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/23/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The daytime effects of insomnia pose a significant burden to patients and drive treatment seeking. In addition to subjective deficits, meta-analytic data show that patients experience reliable objective impairments across several cognitive domains. While Cognitive Behavioural Therapy for Insomnia (CBT-I) is an effective and scalable treatment, we know little about its impact upon cognitive function. Trials of CBT-I have typically used proxy measures for cognitive functioning, such as fatigue or work performance scales, and no study has assessed self-reported impairment in cognitive function as a primary outcome. Moreover, only a small number of studies have assessed objective cognitive performance, pre-to-post CBT-I, with mixed results. This study specifically aims to (1) investigate the impact of CBT-I on cognitive functioning, assessed through both self-reported impairment and objective performance measures, and (2) examine whether change in sleep mediates this impact. METHODS/DESIGN We propose a randomised controlled trial of 404 community participants meeting criteria for Insomnia Disorder. In the DISCO trial (D efining the I mpact of improved S leep on CO gnitive function (DISCO)) participants will be randomised to digital automated CBT-I delivered by a web and/or mobile platform (in addition to treatment as usual (TAU)) or to a wait-list control (in addition to TAU). Online assessments will take place at 0 (baseline), 10 (post-treatment), and 24 (follow-up) weeks. At week 25, all participants allocated to the wait-list group will be offered digital CBT-I, at which point the controlled element of the trial will be complete. The primary outcome is self-reported cognitive impairment at post-treatment (10 weeks). Secondary outcomes include objective cognitive performance, insomnia severity, sleepiness, fatigue, and self-reported cognitive failures and emotional distress. All main analyses will be carried out on completion of follow-up assessments and will be based on the intention-to-treat principle. Further analyses will determine to what extent observed changes in self-reported cognitive impairment and objective cognitive performance are mediated by changes in sleep. The trial is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) based at Oxford University Hospitals NHS Trust and University of Oxford, and by the NIHR Oxford Health BRC. DISCUSSION This study will be the first large-scale examination of the impact of digital CBT-I on self-reported cognitive impairment and objective cognitive performance. TRIAL REGISTRATION ISRCTN, ID: ISRCTN89237370 . Registered on 17 October 2016.
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Affiliation(s)
- Simon D. Kyle
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
| | - Madeleine E. D. Hurry
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
- Oxford Nuffield Department of Clinical Neurosciences, Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Annemarie I. Luik
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
- Big Health Ltd., London, UK
| | - Ximena Omlin
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A. Espie
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, Oxford, OX1 3RE UK
- Big Health Ltd., London, UK
| | - Claire E. Sexton
- Oxford Nuffield Department of Clinical Neurosciences, Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford, UK
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Luik AI, Kyle SD, Espie CA. Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review. CURRENT SLEEP MEDICINE REPORTS 2017; 3:48-56. [PMID: 28553574 PMCID: PMC5427093 DOI: 10.1007/s40675-017-0065-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Over the past decade, digital solutions have been developed to support the dissemination of Cognitive Behavioral Therapy (CBT). In this paper, we review the evidence for and implications of digital CBT (dCBT) for insomnia. RECENT FINDINGS We propose three categories of dCBT, which differ in the amount of clinician time needed, level of automatization, costs, and scalability: dCBT as support, guided dCBT, and fully automated dCBT. Consistent evidence has been published on the effectiveness of dCBT to address insomnia disorder, in a variety of populations, with effects extending into well-being. Important gaps in the literature are identified around moderators and mediators of dCBT, cost-effectiveness, and the implementation of dCBT. SUMMARY The evidence base for dCBT is rapidly developing and already suggests that dCBT for insomnia is effective. However, further science and digital innovation is required to realize the full potential of dCBT and address important clinical questions.
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Affiliation(s)
- Annemarie I. Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, OMPI G, South Parks Road, Oxford, OX1 3RE UK
- Big Health Ltd, London, UK
| | - Simon D. Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, OMPI G, South Parks Road, Oxford, OX1 3RE UK
| | - Colin A. Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, OMPI G, South Parks Road, Oxford, OX1 3RE UK
- Big Health Ltd, London, UK
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Romero K, Goparaju B, Russo K, Westover MB, Bianchi MT. Alternative remedies for insomnia: a proposed method for personalized therapeutic trials. Nat Sci Sleep 2017; 9:97-108. [PMID: 28360539 PMCID: PMC5364017 DOI: 10.2147/nss.s128095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Insomnia is a common symptom, with chronic insomnia being diagnosed in 5-10% of adults. Although many insomnia patients use prescription therapy for insomnia, the health benefits remain uncertain and adverse risks remain a concern. While similar effectiveness and risk concerns exist for herbal remedies, many individuals turn to such alternatives to prescriptions for insomnia. Like prescription hypnotics, herbal remedies that have undergone clinical testing often show subjective sleep improvements that exceed objective measures, which may relate to interindividual heterogeneity and/or placebo effects. Response heterogeneity can undermine traditional randomized trial approaches, which in some fields has prompted a shift toward stratified trials based on genotype or phenotype, or the so-called n-of-1 method of testing placebo versus active drug in within-person alternating blocks. We reviewed six independent compendiums of herbal agents to assemble a group of over 70 reported to benefit sleep. To bridge the gap between the unfeasible expectation of formal evidence in this space and the reality of common self-medication by those with insomnia, we propose a method for guided self-testing that overcomes certain operational barriers related to inter- and intraindividual sources of phenotypic variability. Patient-chosen outcomes drive a general statistical model that allows personalized self-assessment that can augment the open-label nature of routine practice. The potential advantages of this method include flexibility to implement for other (nonherbal) insomnia interventions.
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Affiliation(s)
- Kate Romero
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Balaji Goparaju
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Kathryn Russo
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Matt T Bianchi
- Neurology Department, Massachusetts General Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
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Ye YY, Chen NK, Chen J, Liu J, Lin L, Liu YZ, Lang Y, Li XJ, Yang XJ, Jiang XJ. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open 2016; 6:e010707. [PMID: 27903557 PMCID: PMC5168528 DOI: 10.1136/bmjopen-2015-010707] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of internet-based cognitive-behavioural therapy for insomnia (ICBT-i) in adults. DESIGN A meta-analysis of ICBT-i. DATA SOURCES Systematic searches of randomised controlled trials of ICBT-i were performed in the PubMed, EMBASE, PsycINFO and Cochrane Library databases up to 19 June 2016. REVIEW METHOD 2 reviewers independently performed study selection, quality assessment and data extraction. Outcomes of interest included sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of nocturnal awakenings (NWAK), and Insomnia Severity Index (ISI). RevMan 5.2 and Stata 13.0 meta-analysis software were used to perform statistical analysis. RESULTS 14 records for 15 studies (1013 experimental group participants, 591 waiting list group participants) were included. The meta-analysis indicated that, at the post-test time point, SOL decreased by 18.41 min (95% CI 13.60 to 23.21), TST increased by 22.30 min (95% CI 16.38 to 28.23), SE increased by 9.58% (95% CI 7.30% to 11.85%), WASO decreased by 22.31 min (95% CI 13.50 to 31.11), NWAK decreased by 0.52 (95% CI 0.28 to 0.76), and ISI decreased by 5.88 points (95% CI 4.29 to 7.46). Additionally SOL, TST, SE, and WASO exhibited statistically significant improvements at follow-up versus before treatment. CONCLUSIONS ICBT-i is an effective treatment for adults with insomnia. This conclusion should be verified in further studies.
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Affiliation(s)
- Yuan-yuan Ye
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ni-ka Chen
- Department of Neurology, PLA 187 Hospital, Haikou, China
| | - Jia Chen
- Department of Neurology, PLA 123 Hospital, Bengbu, China
| | - Juan Liu
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ling Lin
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ya-zhen Liu
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ying Lang
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xun-jun Li
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xin-ju Yang
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiao-jiang Jiang
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
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