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Rowan AB, Magnante AT, Urh N, Figueroa L. Cognitive Behavioral Therapy for Insomnia Self-Management Mobile Apps: A Review of Efficacy and Quality. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09992-y. [PMID: 38281307 DOI: 10.1007/s10880-023-09992-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for insomnia, yet multiple barriers limit utilization. Digital CBT-I may present a solution, though related reviews have focused on Internet-based delivery rather than app use. The high utilization of health apps and prevalence of sleep apps indicate the need to equip clinicians with app-specific research. Toward this end, we reviewed efficacy and quality data on self-management CBT-I smartphone apps, revealing efficacy research on eleven apps, five of which were publicly available. While preliminary, these efficacy studies showed consistent positive findings. When examining quantitative quality indicators for the five publicly available apps, two had consistent data. Overall, two apps, CBTi Coach and Insomnia Coach, had positive, empirical findings across all efficacy and quality assessment approaches. We provide recommendations to guide clinician decision making regarding CBT-I self-management apps based on the literature and publicly available methods of app evaluations.
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Affiliation(s)
- Anderson B Rowan
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA.
| | - Anna T Magnante
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicole Urh
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA
| | - Lynette Figueroa
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA
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2
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Singh A, Schooley B, Patel N. Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study. JMIR Mhealth Uhealth 2023; 11:e43105. [PMID: 38096007 PMCID: PMC10727483 DOI: 10.2196/43105] [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: 09/29/2022] [Revised: 06/19/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. OBJECTIVE The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. METHODS A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. RESULTS A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19-related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. CONCLUSIONS Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement.
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Affiliation(s)
- Akanksha Singh
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Benjamin Schooley
- IT & Cybersecurity, Department of Electrical and Computer Engineering, Brigham Young University, Provo, UT, United States
| | - Nitin Patel
- Hackensack Meridian Health, Hackensack, NJ, United States
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3
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Alavi SMA, Irani RD, Fattahi P, Pakseresht S. Effects of brief cognitive behavioral therapy on mental health in substance-related disorder: a randomized controlled trial. BMC Psychiatry 2023; 23:924. [PMID: 38066514 PMCID: PMC10709952 DOI: 10.1186/s12888-023-05413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND & OBJECTIVES Population and aging are major contributing factors influencing the increase in substance use disorder (SUD), which in itself affects mental health, particularly anxiety and depression. Cognitive behavioral therapy (CBT) and pharmacotherapy co-treatment are considered the gold standard for the treatment of SUD. Thus, the present study has been carried out to investigate the efficacy of brief CBT on the general health of opioid users. METHODS A randomized controlled trial (RCT) was conducted with forty opioid users whose addiction was dully confirmed by a psychiatrist at the drop-in center of the Ahvaz Jundishapur University of Medical Sciences. The patients were then randomly divided into two equal groups (n = 20). The control group was treated solely using methadone maintenance therapy (MMT); however, the intervention group underwent four sessions of CBT in addition to MMT. The general health questionnaire (GHQ) consisting of 28 items (Goldberg, 1979) was applied to both groups at the beginning and end of the study. The collected data was analyzed using IBM SPSS ver. 26, and data analysis was carried out using chi-square, t-test, Mann-Whitney, and Poisson regression model. P < 0.05 was statistically significant for all the aforementioned tests. RESULTS The mean age for the control and intervention groups were 37.95 ± 7.64 and 43.85 ± 9.92, respectively (p = 0.042). There was no statistically significant difference in terms of gender and levels of education (p = 0.311 and p = 0.540). Both groups differed statistically regarding marital status and occupation (p = 0.025 and 0.002). There was no significant statistical difference in all subclasses and the total scores of GHQ-28 for both groups, except for anxiety and insomnia in the intervention group (p = 0.038). After applying a Likert scale with a 23-point cut-off score, there was no statistically significant difference in terms of psychosis after intervention in the intervention group (p = 0.077). CONCLUSION The results of the current study show that brief CBT is effective on psychiatric health, especially anxiety and sleep disorders, whereas brief CBT fails to affect the patient's depression, somatic symptoms, and social dysfunction. TRIAL REGISTRATION The Iranian Registry of Clinical Trials (IRCT) approved the study design (IRCT registration number: IRCT20190929044917N1, registration date: 13/01/2020).
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Affiliation(s)
- Seyed Mohammad Amin Alavi
- Faculty of medicine, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd, Ahvaz, 6135715794, Khuzestan, Iran.
| | | | - Payam Fattahi
- Medical Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sirus Pakseresht
- Department of Psychiatry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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4
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Goodhines PA, Rathod K. Substance use and sleep health in young adults: Implications for integrated treatment and harm reduction. Sleep Med Rev 2023; 70:101811. [PMID: 37423096 DOI: 10.1016/j.smrv.2023.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
In their systematic review and meta-analysis, Meneo and colleagues document distinct substance-sleep effects reported by young adults (ages 18-30) across multidimensional sleep health and different substances used in the naturalistic environment, including alarming rates of self-medication for sleep aid. Key innovations of Meneo et al.'s review include (a) a multidimensional approach to defining sleep health and (b) robust inclusion of various substances commonly used in young adults. Although future research will be essential to clarifying transdiagnostic risk mechanisms, interplay of co-used substances, and the role of expectancies in risk processes, the developing literature reviewed herein may inform much-needed clinical recommendations. This work by Meneo et al should prompt an emphasis on approaching young adult substance use and self-medication through a harm reduction lens, highlighting recommendations for integrated behavioral sleep treatment tailored to stage of change using motivational interviewing.
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5
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Todd Arnedt J, Conroy DA, Stewart H, Yeagley E, Bowyer G, Bohnert KM, Ilgen MA. Cognitive behavioral therapy for insomnia to reduce cannabis use: Results from a pilot randomized controlled trial. Drug Alcohol Depend 2023; 246:109835. [PMID: 36940598 DOI: 10.1016/j.drugalcdep.2023.109835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Individuals with regular cannabis use demonstrate adverse health outcomes, yet infrequently seek treatment. Insomnia, a common co-occurring complaint, could be targeted to reduce cannabis use and improve functioning in these individuals. In an intervention development study, we refined and tested the preliminary efficacy of a telemedicine-delivered CBT for insomnia tailored to individuals with regular cannabis use for sleep (CBTi-CB-TM). METHODS In this single-blind randomized trial, fifty-seven adults (43 women, mean age 37.6 ± 12.8 years) with chronic insomnia and cannabis use for sleep ≥3 times/week received CBTi-CB-TM (n = 30) or sleep hygiene education (SHE-TM, n = 27). Participants completed self-reported assessments of insomnia (Insomnia Severity Index [ISI]) and cannabis use (Timeline Followback [TLFB] and daily diary data) at pre-treatment, post-treatment, and 8-week follow-up. RESULTS ISI scores improved significantly more in the CBTi-CB-TM compared to SHE-TM condition (β = -2.83, se=0.84, P = 0.004, d=0.81). At 8-week follow-up, 18/30 (60.0 %) CBTi-CB-TM compared to 4/27 (14.8 %) SHE-TM participants were in remission from insomnia (X2 =12.8, P = 0.0003). The TLFB showed a small reduction in past 30-day cannabis use for both conditions (β = -0.10, se=0.05, P = 0.026); CBTi-CB-TM participants demonstrated greater post-treatment reductions in the % of days cannabis was used within 2 h of bedtime (-29.1 ± 7.9 % fewer days vs. 2.6 ± 8.0 % more days, P = 0.008). CONCLUSIONS CBTi-CB-TM is feasible, acceptable, and demonstrated preliminary efficacy for improving sleep and cannabis-related outcomes among non-treatment-seeking individuals with regular cannabis use for sleep. Although sample characteristics limit generalizability, these findings support the need for adequately powered randomized controlled trials with longer follow-up periods.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Haylie Stewart
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Emily Yeagley
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Gabrielle Bowyer
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road Room B601, East Lansing, MI 48824, USA
| | - Mark A Ilgen
- The Addiction Center, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA; Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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McGee-Vincent P, Mackintosh MA, Jamison AL, Juhasz K, Becket-Davenport C, Bosch J, Avery TJ, Glamb L, Hampole S. Training Staff Across the Veterans Affairs Health Care System to Use Mobile Mental Health Apps: A National Quality Improvement Project. JMIR Ment Health 2023; 10:e41773. [PMID: 36633895 PMCID: PMC9880807 DOI: 10.2196/41773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The National Center for PTSD, within the Department of Veterans Affairs (VA), has developed a suite of free, publicly available, evidence-informed apps that can reach an increasing number of veterans and bridge gaps in care by providing resources to those who are not engaged in mental health treatment. To expand the reach of these apps, staff across VA service lines learned about these apps, their features and limitations, and how to introduce them to veterans. OBJECTIVE This study aimed to develop, disseminate, and evaluate a training for multidisciplinary staff as part of a national quality improvement project to increase the reach of mobile mental health apps as a resource for veterans. METHODS Sites from all of VA's 18 geographic regions enrolled in this project. At each site, a minimum of 25 VA staff members who had direct contact with veterans, including staff from the mental health service line and all other service lines, were recruited to participate. Training included a 3-hour multidisciplinary core module, and a 1-hour clinical integration module designed specifically for mental health clinicians. Owing to the COVID-19 pandemic, the trainings were adapted to a live, web-based format. Pre- and posttraining surveys assessed program reach (ie, participants enrolled per site), satisfaction, and effectiveness of the training as measured by changes in knowledge, basic skills, and behavioral intentions to use apps with veterans. RESULTS A total of 1110 participants representing 34 disciplines at 19 VA sites completed the training. Overall, 67% (743/1109) of participants were mental health staff members. Sites averaged 58.4 participants (SD 36.49, median [IQR] 51). Most (961/1024, 93.85%) participants were satisfied with the training and reported that they (941/1018, 92.44%) would recommend it to others. App knowledge scores significantly increased from pretraining (mean 80.8% correct, SD 15.77%) to posttraining (mean 91.1% correct, SD 9.57%; P<.001). At posttraining, participants also reported greater confidence in their ability to show veterans how to download (z=-13.86; P<.001) and use VA mental health apps (z=-15.13; P<.001). There was near universal endorsement by staff for their intentions to recommend apps to veterans as well as their ability to think of at least one specific veteran to whom they could recommend an app. Staff also reported a strong motivation to encourage other VA staff to share apps with veterans. CONCLUSIONS The training far exceeded the initial goals for staff recruitment and training for all three metrics. Overall, 33% (366/1109) of participants came from service lines outside of mental health, indicating the feasibility of introducing these mental health resources during medical appointments and in other contexts.
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Affiliation(s)
- Pearl McGee-Vincent
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Office of Mental Health and Suicide Prevention, Veterans Health Administration, Menlo Park, CA, United States
| | - Margaret-Anne Mackintosh
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Andrea L Jamison
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Katherine Juhasz
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,National Training Division, Education Service, Veterans Benefits Administration, Washington, DC, United States
| | - Colleen Becket-Davenport
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Jeane Bosch
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Timothy J Avery
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Peninsula Vet Center, Readjustment Counselling Services, US Department of Veterans Affairs, Menlo Park, CA, United States
| | - Lauren Glamb
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, United States
| | - Shilpa Hampole
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
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7
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Geagea L, Ghanimé PM, El Hayek S, Kobeissy F, Tamim H, Elbejjani M, Talih F. Assessing cognitive behavioral therapy for insomnia in individuals with cannabis use disorder utilizing actigraphy and serum biomarkers: A pilot study. Sleep Med 2022; 100:434-441. [PMID: 36244318 DOI: 10.1016/j.sleep.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/BACKGROUND This pilot study aims to assess the effect of Cognitive Behavioral Therapy for insomnia (CBTi) in individuals with cannabis use disorder and insomnia. It also aims to investigate the effect of CBTi on levels of serum inflammatory markers in relation to insomnia symptoms. METHODS/PATIENTS Individuals with cannabis use disorder and insomnia symptoms were recruited over 18 months. Data collected included demographics, self-reported sleep parameters, and cannabis use. Blood samples were drawn to measure IL-2, IL-6, CRP, and cortisol. Participants completed the Insomnia Severity Index questionnaire (ISI) and the Patient Health Questionnaire-4 (PHQ-4), and they were provided with an actigraphy (wrist) device for 1 week before CBTi and a subsequent week after completing the 4 CBTi sessions. RESULTS Nineteen participants were enrolled in the study. The mean ISI score decreased from moderately severe insomnia at baseline to no clinically significant insomnia after CBTi with a sustained decrease at 3- and 6-months follow-up. Actigraphy showed a significant decrease in sleep onset latency (SOL) after CBTi. Three months after CBTi, 80% of participants reported a decrease in their cannabis use. There was also a significant and sustained decrease in mean PHQ-4 scores after CBTi. Although only trending towards significance, the levels of three out of four biomarkers (IL-2, IL-6, CRP) were decreased 6 months after CBTi. CONCLUSIONS CBTi is effective as a short- and long-term treatment of insomnia and comorbid anxiety/depression in individuals who regularly use cannabis. A potential added benefit is a reduction in cannabis consumption and inflammatory serum biomarkers.
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Affiliation(s)
- Luna Geagea
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Pia Maria Ghanimé
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, United States
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute and Department of Internal Medicine, American University of Beirut, Lebanon
| | - Martine Elbejjani
- Clinical Research Institute and Department of Internal Medicine, American University of Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
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Berey BL, Aston ER, Kearns NT, McGeary JE, Borsari B, Metrik J. Prospective associations between sleep disturbances and cannabis use among Veterans: A behavioral economic approach. Addict Behav 2022; 134:107424. [PMID: 35863267 DOI: 10.1016/j.addbeh.2022.107424] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/20/2022] [Accepted: 07/05/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Veterans often use cannabis for sleep despite limited evidence of its efficacy. Moreover, how sleep disturbances impact cannabis use longitudinally is unclear. We applied a behavioral economic framework to examine whether sleep disturbances and cannabis demand (i.e., relative value) were related risk-factors for future cannabis use and problems. METHODS Veterans deployed post-9/11/2001 who reported past 6-month cannabis use at baseline (n = 126) completed surveys on their sleep disturbances, demand via the Marijuana Purchase Task (MPT), and cannabis use. Mediation analyses using Hayes' PROCESS Macro and zero-inflated negative binomial models tested indirect effects of baseline sleep disturbances on 12-month cannabis use frequency, quantity, and problems via 6-month cannabis demand (i.e., intensity, Omax, Pmax, and breakpoint). RESULTS Only Omax (i.e., maximum expenditure for cannabis) was a significant mediator for 12-month cannabis use quantity and problems when examined concurrently with other demand indices after controlling for covariates. Intensity (i.e., purchase at zero cost) was a significant mediator for 12-month cannabis use frequency when examined concurrently with other demand indices in models controlling for lifetime cannabis use, but not past 30-day use at baseline. CONCLUSION Cannabis demand, specifically intensity and Omax, may help to identify Veterans with sleep disturbances who are at increased risk for escalating their cannabis use. Subsequent research should assess the extent that sleep disturbances impact cannabis demand in the context of withdrawal, which will inform novel prevention and intervention strategies geared toward reducing negative cannabis-related outcomes among Veterans.
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Affiliation(s)
- Benjamin L Berey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States
| | - Elizabeth R Aston
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States
| | - Nathan T Kearns
- U.S. Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, United States
| | - John E McGeary
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States; Department of Psychiatry and Human Behavior, Brown University, United States; Providence VA Medical Center, Providence, RI, United States
| | - Brian Borsari
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, United States; Mental Health Service, San Francisco VA Health Care System, United States
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States; Department of Psychiatry and Human Behavior, Brown University, United States; Providence VA Medical Center, Providence, RI, United States.
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Aji M, Glozier N, Bartlett DJ, Grunstein RR, Calvo RA, Marshall NS, White DP, Gordon C. The Effectiveness of Digital Insomnia Treatment with Adjunctive Wearable Technology: A Pilot Randomized Controlled Trial. Behav Sleep Med 2022; 20:570-583. [PMID: 34415819 DOI: 10.1080/15402002.2021.1967157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This pilot trial aimed to provide evidence for whether the integration of a wearable device with digital behavioral therapy for insomnia (dBTi) improves treatment outcomes and engagement. PARTICIPANTS AND METHODS One hundred and twenty-eight participants with insomnia symptoms were randomized to a 3-week dBTi program (SleepFix®) with a wearable device enabling sleep data synchronization (dBTi+wearable group; n = 62) or dBTi alone (n = 66). Participants completed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI) parameters: wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST) at baseline and weeks 1, 2, 3, and primary endpoint of week 6 and follow-up at 12 weeks. Engagement was measured by the number of daily sleep diaries logged in the app. RESULTS There was no difference in ISI change scores between the groups from pre- to post-treatment (Cohen's d= 0.7, p= .061). The dBTi+wearable group showed greater improvements in WASO (d= 0.8, p = .005) and TST (d= 0.3, p= .049) compared to the dBTi group. Significantly greater engagement (sleep diary entries) was observed in the dBTi+wearable group (mean = 22.4, SD = 10.0) compared to the dBTi group (mean = 14.1, SD = 14.2) (p = .010). CONCLUSIONS This pilot trial found that integration of wearable device with a digital insomnia therapy enhanced user engagement and led to improvements in sleep parameters compared to dBTi alone. These findings suggest that adjunctive wearable technologies may improve digital insomnia therapy effectiveness.
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Affiliation(s)
- Melissa Aji
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,CRC for Alertness, Safety and Productivity, Melbourne, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CRC for Alertness, Safety and Productivity, Melbourne, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Charles Perkins Centre-RPA Clinic, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - David P White
- CRC for Alertness, Safety and Productivity, Melbourne, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Christopher Gordon
- CRC for Alertness, Safety and Productivity, Melbourne, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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10
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Huhn AS, Ellis JD, Dunn KE, Sholler DJ, Tabaschek P, Burns R, Strain EC. Patient-reported sleep outcomes in randomized-controlled trials in persons with substance use disorders: A systematic review. Drug Alcohol Depend 2022; 237:109508. [PMID: 35660223 DOI: 10.1016/j.drugalcdep.2022.109508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sleep disturbances and disorders are a common and sometimes recalcitrant problem in persons recovering from substance use disorders (SUDs). As such, several randomized-controlled trials (RCTs) have been conducted to address sleep disturbances in a variety of SUD subpopulations and clinical scenarios. The goal of this systematic review was to collate patient-reported sleep outcomes used in past SUD-related RCTs to provide guidance for future sleep research in persons with SUDs. METHODS This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on May 7th, 2020 (CRD42020182004). Studies were included if they were peer-reviewed manuscripts describing RCTs in an SUD population. RESULTS The initial search yielded 13,403 candidate articles, and 76 met a priori criteria and were included in this review. Thirty-five (46.1%) assessed sleep as a primary outcome (i.e., sleep improvement was the primary goal of the research) and 41 (53.9%) assessed sleep as a secondary outcome (i.e., sleep improvement was an important outcome, but not the primary outcome). The most commonly used measures included the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and sleep diaries. However, multiple additional sleep assessments were also used, including visual analogue and Likert scales. CONCLUSIONS The field of addiction medicine would benefit from a streamlined approach in assessing patient-reported sleep in RCTs, including commonly used and validated assessments of sleep quality, inserting daily or repeated measures into RCTs, and including questionnaires that assess clinically relevant insomnia or other sleep disorders.
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Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Dennis J Sholler
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Paula Tabaschek
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Rachel Burns
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
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11
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Kuhn E, Miller KE, Puran D, Wielgosz J, YorkWilliams SL, Owen JE, Jaworski BK, Hallenbeck HW, McCaslin SE, Taylor KL. A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility, Acceptability, and Potential Efficacy. Behav Ther 2022; 53:440-457. [PMID: 35473648 DOI: 10.1016/j.beth.2021.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022]
Abstract
Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28-55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = -0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = -1.1, p = .001), sleep onset latency (d = -0.6, p = .021), global sleep quality (d = -0.9, p = .002), and depression symptoms (d = -0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.
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Affiliation(s)
- Eric Kuhn
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University, School of Medicine.
| | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Deloras Puran
- National Center for PTSD, VA Palo Alto Health Care System
| | - Joseph Wielgosz
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University, School of Medicine; Sierra Pacific Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System
| | - Sophie L YorkWilliams
- National Center for PTSD, VA Palo Alto Health Care System; University of Colorado Boulder
| | - Jason E Owen
- National Center for PTSD, VA Palo Alto Health Care System
| | | | - Haijing Wu Hallenbeck
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University School of Medicine
| | - Shannon E McCaslin
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University School of Medicine
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12
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Pakpour AH, Fazeli S, Zeidi IM, Alimoradi Z, Georgsson M, Brostrom A, Potenza MN. Effectiveness of a mobile app-based educational intervention to treat internet gaming disorder among Iranian adolescents: study protocol for a randomized controlled trial. Trials 2022; 23:229. [PMID: 35313935 PMCID: PMC8935262 DOI: 10.1186/s13063-022-06131-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of video games, a hobby for many teenagers in their leisure time, has brought with it a new potential for concerns. Internet gaming disorder (IGD) is a mental condition classified as a disorder due to addictive behaviors. It may include use of video games, both online and offline. Consequences of IGD may include introversion, social anxiety, mood swings, loneliness, sleep problems, behavioral problems, depression, low self-esteem, and increased violence. In order to design an app-based intervention for adolescents, a transtheoretical model (TTM) has been used. This widely used model in the field of behavioral change is also practical for health education programs. In addition, cognitive-behavioral therapy (CBT) has been used to make people more aware of their behaviors, feelings and thoughts and how to achieve behavioral change. The present study seeks to determine the effectiveness of this app-based intervention in in the treatment of IGD among adolescents. Method In this single-blinded, randomized, controlled trial, 206 high-school adolescents aged 13 to 18 years in Qazvin city will be recruited. Eligible adolescents will be randomly assigned into intervention and control groups. Eight consecutive sessions delivered over 2 months and based on the TTM and CBT will be delivered through the `app (named HAPPYTEEN) to the intervention group. The control group will receive a sleep hygiene intervention (8 consecutive sessions for 2 months) via the app. Data collection tools include the Internet Gaming Disorder Scale, Insomnia Severity Index, Depression, Anxiety, and Stress Scales, Stages of Change Questionnaire, Decision Balance, and Self-Efficacy. The study measures will be completed at baseline, post intervention, and 1 month and 3 months after the intervention. Discussion The results of this intervention could be used as adjunct therapy for adolescents with IGD. Trial registration Clinical Trial Registration Center of Iran (IRCT) IRCT20181226042140N1. Registered on June 9, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06131-0.
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13
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Reilly ED, Robinson SA, Petrakis BA, Gardner MM, Wiener RS, Castaneda-Sceppa C, Quigley KS. Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial. JMIR Form Res 2021; 5:e29573. [PMID: 34889746 PMCID: PMC8704109 DOI: 10.2196/29573] [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: 04/12/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354
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Affiliation(s)
- Erin Dawna Reilly
- Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, United States.,Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephanie A Robinson
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | | | - Renda Soylemez Wiener
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | | | - Karen S Quigley
- Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Northeastern University, Boston, MA, United States
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14
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Aji M, Glozier N, Bartlett D, Peters D, Calvo RA, Zheng Y, Grunstein R, Gordon C. A feasibility study of a mobile app to treat insomnia. Transl Behav Med 2021; 11:604-612. [PMID: 32227087 DOI: 10.1093/tbm/ibaa019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Insomnia is a major public health concern. Sleep restriction therapy (SRT) is an effective behavioral treatment but its delivery is impeded by a shortage of trained clinicians. We developed a mobile app delivering SRT to individuals with insomnia. This feasibility study employed a mixed-methods design to examine the engagement, acceptability, and potential efficacy of the mobile app. Fifteen participants diagnosed with insomnia disorder used the mobile app synchronized with a wearable device for 3 weeks. Those who persisted with the study (n = 12) found the mobile app to be highly acceptable and engaging, logging on average 19 nightly sleep diary entries across the 21 day period. Significant improvements were observed for sleep measures (insomnia severity and sleep efficiency) and daytime symptoms (fatigue and sleepiness). The results suggest that a mobile app delivering SRT to individuals with insomnia is engaging, acceptable, and potentially efficacious. Further, a full-scale effectiveness study is warranted.
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Affiliation(s)
- Melissa Aji
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Nick Glozier
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Delwyn Bartlett
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Dorian Peters
- School of Electrical and Information Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College, London, UK
| | - Yizhong Zheng
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Ronald Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Susan Wakil School of Nursing, University of Sydney, Sydney, NSW, Australia
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15
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McGee-Vincent P, Juhasz K, Jamison AL, Avery TJ, Owen JE, Jaworski BK, Blonigen DM. Mobile Mental Health Apps from the National Center for PTSD: Digital Self-Management Tools for Co-Occurring Disorders. J Dual Diagn 2021; 17:181-192. [PMID: 34152258 DOI: 10.1080/15504263.2021.1939919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mobile mental health apps can help bridge gaps in access to care for those with substance use disorders and dual diagnoses. The authors describe a portfolio of free, publicly available mobile mental health apps developed by the National Center for PTSD. The authors also demonstrate how this suite of primarily non-substance use disorder-specific mobile mental health apps may support the active ingredients of substance use disorder treatment or be used for self-management of substance use disorder and related issues. The potential advantages of these apps, as well as limitations and considerations for future app development, are discussed.
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Affiliation(s)
- Pearl McGee-Vincent
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Katherine Juhasz
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Andrea L Jamison
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Timothy J Avery
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jason E Owen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Beth K Jaworski
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Daniel M Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Menlo Park, California, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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16
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Short NA, Zvolensky MJ, Schmidt NB. A pilot randomized clinical trial of Brief Behavioral Treatment for Insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 2021; 131:108537. [PMID: 34148759 DOI: 10.1016/j.jsat.2021.108537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/17/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Insomnia symptoms may be an important etiological factor for substance use disorders; however, whether improving sleep leads to reductions in problematic substance use among at-risk populations remains unclear. METHOD As such, the current pilot study used a randomized controlled design to test the effects of Brief Behavioral Treatment for Insomnia (BBTI) against a waitlist control among a sample of trauma-exposed young adults with elevated insomnia symptoms who regularly use cannabis (N = 56). RESULTS Intent-to-treat multilevel modeling analyses indicated that BBTI may be more efficacious than waitlist control in reducing self-reported insomnia symptoms, with large effects three months post-treatment (d = 1.34). Further, our initial evidence suggested that BBTI resulted in reductions in cannabis-related problems with medium to large effects at three months post-treatment (d = 0.75). The current pilot analyses indicated BBTI also reduced cravings to use cannabis to reduce negative emotions in response to trauma cues with a large effect size. CONCLUSION This pilot study suggests BBTI may be efficacious not only in improving insomnia symptoms among cannabis users but also in reducing cannabis-related problems and cravings over three months. Future research should replicate these results in a larger, fully powered sample with improved follow-up rates designed to test temporal mediation using multimethod assessments of insomnia symptoms and problematic cannabis use. Overall, BBTI may be a promising intervention for trauma-exposed cannabis users to improve sleep and reduce cannabis-related problems.
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Affiliation(s)
- Nicole A Short
- Department of Psychology, Florida State University, Tallahassee, FL, USA; Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; MD Anderson Cancer Center, Houston, TX, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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17
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Turna J, MacKillop J. Cannabis use among military veterans: A great deal to gain or lose? Clin Psychol Rev 2021; 84:101958. [PMID: 33486280 DOI: 10.1016/j.cpr.2021.101958] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
Policy changes have resulted in dramatic increases in access to cannabis for medical purposes. Veterans are disproportionately affected by conditions for which medical cannabis is often pursued, making an evidence-based perspective on risks versus benefits of high priority. The current review sought to examine the state of the evidence on the correlates and consequences of cannabis use among veterans. Using a comprehensive search strategy, 501 articles were identified and 86 studies met criteria for inclusion. The literature was predominated by cross-sectional studies (67%) of male veterans (71.4%-100% male) from the United States (93.0%). Three overarching themes emerged, comprising cannabis associations with other substance use, mental health, and physical health outcomes. The balance of the evidence associated cannabis use with negative health outcomes, with consistent positive associations with other substance use, psychiatric disorders, and self-harm/suicidality. Few studies examined the therapeutic effects of cannabis, thus limiting the potential to evaluate evidence of efficacy. Priority areas for future research are studies using designs that can examine the directionality of links between cannabis and health in veterans more conclusively, and studies directly examining therapeutic efficacy of cannabis-based therapies in veterans. Methodologically rigorous design will be essential to inform clinical recommendations and practices guidelines in an era of burgeoning access to cannabis.
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Affiliation(s)
- Jasmine Turna
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Homewood Research Institute, 150 Delhi St. Riverslea Building, Guelph, ON N1E 6K9, Canada.
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18
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Aji M, Gordon C, Stratton E, Calvo RA, Bartlett D, Grunstein R, Glozier N. Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review. J Med Internet Res 2021; 23:e24607. [PMID: 33595441 PMCID: PMC7929739 DOI: 10.2196/24607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/12/2020] [Accepted: 01/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation.
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Affiliation(s)
- Melissa Aji
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Glebe, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Elizabeth Stratton
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Delwyn Bartlett
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Glebe, Australia
| | - Ronald Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Glebe, Australia.,Charles Perkins Centre - RPA Clinic, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nick Glozier
- Brain and Mind Center, The University of Sydney, Camperdown, Australia
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19
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Shams F, Wong JSH, Nikoo M, Outadi A, Moazen-Zadeh E, Kamel MM, Song MJ, Jang KL, Krausz RM. Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review. J Med Internet Res 2021; 23:e20557. [PMID: 33475520 PMCID: PMC7861997 DOI: 10.2196/20557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/10/2020] [Accepted: 12/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. OBJECTIVE We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: "How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?" METHODS A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. RESULTS A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. CONCLUSIONS Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.
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Affiliation(s)
- Farhud Shams
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ava Outadi
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Mostafa M Kamel
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Tanta University, Tanta, Egypt
| | - Michael Jae Song
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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20
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Macatee RJ, Albanese BJ, Okey SA, Afshar K, Carr M, Rosenthal MZ, Schmidt NB, Cougle JR. Impact of a computerized intervention for high distress intolerance on cannabis use outcomes: A randomized controlled trial. J Subst Abuse Treat 2020; 121:108194. [PMID: 33357604 DOI: 10.1016/j.jsat.2020.108194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/02/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prevalence of regular cannabis use and cannabis use disorder (CUD) have increased in the past two decades, but treatment-seeking is low and extant brief interventions do not target causal risk factors implicated in etiological models of addiction. Elevated distress intolerance (DI) is one risk factor that has been empirically linked with greater CUD severity and maintenance in regular users, but, to our knowledge, research has never targeted it in a brief intervention among cannabis users with CUD or at high risk. The current RCT evaluated the impact of a DI intervention (i.e., Distress Tolerance Intervention [DTI]) compared to a healthy habits control intervention (i.e., Healthy Video Control [HVC]) on DI and cannabis use outcomes. METHOD We randomized cannabis users with high DI (N = 60) to the DTI or HVC condition and they received two computerized intervention sessions. We assessed relief cannabis craving at pre- and post-treatment; and we assessed DI, cannabis use coping motives, use-related problems, and use frequency at pre- and post-treatment as well as one- and four-month follow-ups. We assessed CUD symptoms via interviews at pre-treatment and four-month follow-up. RESULTS Significant, durable reductions in DI and all cannabis use outcomes occurred in both conditions. Compared to the HVC condition, the DTI led to greater reductions in use frequency during the treatment period. Reductions in self-reported DI were correlated with reductions in coping motives and CUD symptoms. CONCLUSION The DTI's impact on all outcomes was largely comparable to the control condition, though it may have utility as an adjunctive intervention.
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Affiliation(s)
| | | | - Sarah A Okey
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Kaveh Afshar
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - Meghan Carr
- Department of Psychology, Auburn University, Auburn, AL, USA
| | - M Zachary Rosenthal
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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21
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Chung K, Kim S, Lee E, Park JY. Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study. JMIR Mhealth Uhealth 2020; 8:e17755. [PMID: 32831177 PMCID: PMC7477668 DOI: 10.2196/17755] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.
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Affiliation(s)
- Kyungmi Chung
- Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Seoyoung Kim
- Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Eun Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jin Young Park
- Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
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22
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Perez-Pozuelo I, Zhai B, Palotti J, Mall R, Aupetit M, Garcia-Gomez JM, Taheri S, Guan Y, Fernandez-Luque L. The future of sleep health: a data-driven revolution in sleep science and medicine. NPJ Digit Med 2020; 3:42. [PMID: 32219183 PMCID: PMC7089984 DOI: 10.1038/s41746-020-0244-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 01/04/2023] Open
Abstract
In recent years, there has been a significant expansion in the development and use of multi-modal sensors and technologies to monitor physical activity, sleep and circadian rhythms. These developments make accurate sleep monitoring at scale a possibility for the first time. Vast amounts of multi-sensor data are being generated with potential applications ranging from large-scale epidemiological research linking sleep patterns to disease, to wellness applications, including the sleep coaching of individuals with chronic conditions. However, in order to realise the full potential of these technologies for individuals, medicine and research, several significant challenges must be overcome. There are important outstanding questions regarding performance evaluation, as well as data storage, curation, processing, integration, modelling and interpretation. Here, we leverage expertise across neuroscience, clinical medicine, bioengineering, electrical engineering, epidemiology, computer science, mHealth and human-computer interaction to discuss the digitisation of sleep from a inter-disciplinary perspective. We introduce the state-of-the-art in sleep-monitoring technologies, and discuss the opportunities and challenges from data acquisition to the eventual application of insights in clinical and consumer settings. Further, we explore the strengths and limitations of current and emerging sensing methods with a particular focus on novel data-driven technologies, such as Artificial Intelligence.
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Affiliation(s)
- Ignacio Perez-Pozuelo
- Department of Medicine, University of Cambridge, Cambridge, UK
- The Alan Turing Institute, London, UK
| | - Bing Zhai
- Open Lab, University of Newcastle, Newcastle, UK
| | - Joao Palotti
- Qatar Computing Research Institute, HBKU, Doha, Qatar
- CSAIL, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | | | - Juan M. Garcia-Gomez
- BDSLab, Instituto Universitario de Tecnologias de la Informacion y Comunicaciones-ITACA, Universitat Politecnica de Valencia, Valencia, Spain
| | - Shahrad Taheri
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine - Qatar, Qatar Foundation, Doha, Qatar
| | - Yu Guan
- Open Lab, University of Newcastle, Newcastle, UK
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23
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Miller KE, Kuhn E, Owen JE, Taylor K, Yu JS, Weiss BJ, Crowley JJ, Trockel M. Clinician Perceptions Related to the Use of the CBT-I Coach Mobile App. Behav Sleep Med 2019; 17:481-491. [PMID: 29120247 DOI: 10.1080/15402002.2017.1403326] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Clinicians' perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice, the compatibility to clinicians' needs, the complexity, the innovation's trialability, and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians. Participants and Methods: Clinicians (N = 108) were surveyed about their use, feedback, and perceptions of CBT-I Coach a year after the app became available. Results: Overall perceptions of CBT-I Coach were favorable. Fifty percent of clinicians reported using CBT-I Coach, with 98% intending to continue use. The app was perceived to increase sleep diary completion and homework compliance. Clinicians viewed the app as providing accessibility to helpful tools and improving patient engagement. Of those not using the app, 83% endorsed intention to use it. Reasons for nonuse were lack of patient access to smart phones, not being aware of the app, not having time to learn it, and inability to directly access app data. Those who reported using CBT-I Coach had more favorable perceptions across all constructs (p < .01 - p < .001), except relative advantage, compared to nonusers. Users perceived it as less complex and more compatible with their practice than nonusers. Conclusions: Continued efforts are needed to increase adoption and enhance use of CBT-I Coach, as well as study if reported benefits can be evidenced more directly.
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Affiliation(s)
- Katherine E Miller
- a National Center for PTSD , Dissemination and Training Division , Menlo Park , California , USA.,b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Eric Kuhn
- a National Center for PTSD , Dissemination and Training Division , Menlo Park , California , USA.,b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Jason E Owen
- a National Center for PTSD , Dissemination and Training Division , Menlo Park , California , USA
| | - Katherine Taylor
- a National Center for PTSD , Dissemination and Training Division , Menlo Park , California , USA
| | - Jessica S Yu
- c VA Palo Alto Healthcare System , Palo Alto , California , USA
| | - Brandon J Weiss
- d Alliant International University , California School of Professional Psychology , San Francisco , California , USA
| | - Jill J Crowley
- a National Center for PTSD , Dissemination and Training Division , Menlo Park , California , USA
| | - Mickey Trockel
- b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
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Aledavood T, Torous J, Triana Hoyos AM, Naslund JA, Onnela JP, Keshavan M. Smartphone-Based Tracking of Sleep in Depression, Anxiety, and Psychotic Disorders. Curr Psychiatry Rep 2019; 21:49. [PMID: 31161412 PMCID: PMC6546650 DOI: 10.1007/s11920-019-1043-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Sleep is an important feature in mental illness. Smartphones can be used to assess and monitor sleep, yet there is little prior application of this approach in depressive, anxiety, or psychotic disorders. We review uses of smartphones and wearable devices for sleep research in patients with these conditions. RECENT FINDINGS To date, most studies consist of pilot evaluations demonstrating feasibility and acceptability of monitoring sleep using smartphones and wearable devices among individuals with psychiatric disorders. Promising findings show early associations between behaviors and sleep parameters and agreement between clinic-based assessments, active smartphone data capture, and passively collected data. Few studies report improvement in sleep or mental health outcomes. Success of smartphone-based sleep assessments and interventions requires emphasis on promoting long-term adherence, exploring possibilities of adaptive and personalized systems to predict risk/relapse, and determining impact of sleep monitoring on improving patients' quality of life and clinically meaningful outcomes.
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Affiliation(s)
- Talayeh Aledavood
- Department of Psychiatry, University of Helsinki, P.O. Box 22, Välskärinkatu 12 A, FI-00014, Helsinki, Finland.
- Department of Computer Science, Aalto University, Espoo, Finland.
| | - John Torous
- Division of Digital Psychiatry Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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25
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Cognitive Behavioral Therapy for Insomnia in Patients with Medical and Psychiatric Comorbidities. Sleep Med Clin 2019; 14:167-175. [DOI: 10.1016/j.jsmc.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Insomnia is commonly reported by military populations, especially those with comorbid mental and physical health conditions. Co-occurring conditions result in an altered presentation of insomnia symptoms, and complicate provision of cognitive-behavioral therapy for insomnia (CBT-I), requiring supplementary assessment or modifications to traditional techniques. CBT-I has consistently demonstrated positive outcomes for active-duty service members and veterans, even in the context of significant comorbidities such as post-traumatic stress disorder, depression, sleep apnea, and chronic pain. Despite its promise, studies of CBT-I in some populations, including women and individuals with substance use disorders, remain relatively understudied in active-duty and veteran populations.
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27
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Consumer Technology for Sleep-Disordered Breathing: a Review of the Landscape. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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29
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Chakravorty S, Vandrey RG, He S, Stein MD. Sleep Management Among Patients with Substance Use Disorders. Med Clin North Am 2018; 102:733-743. [PMID: 29933826 PMCID: PMC6289280 DOI: 10.1016/j.mcna.2018.02.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sleep and substance use disorders commonly co-occur. Insomnia is commonly associated with use and withdrawal from substances. Circadian rhythm abnormalities are being increasingly linked with psychoactive substance use. Other sleep disorders, such as sleep-related breathing disorder, should be considered in the differential diagnosis of insomnia, especially in those with opioid use or alcohol use disorder. Insomnia that is brief or occurs in the context of active substance use is best treated by promoting abstinence. A referral to a sleep medicine clinic should be considered for those with chronic insomnia or when another intrinsic sleep disorder is suspected.
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Affiliation(s)
- Subhajit Chakravorty
- Department of Psychiatry, Perelman School of Medicine, Corporal Michael J. Crescenz VA Medical Center, MIRECC, 2nd Floor, Postal Code 116, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
| | - Ryan G Vandrey
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Sean He
- Post-baccalaureate studies program, College of Liberal Arts and Professional Studies, University of Pennsylvania, 3440 Market Street Suite 100, Philadelphia, PA 19104, USA; Department of R & D, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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30
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Owen JE, Kuhn E, Jaworski BK, McGee-Vincent P, Juhasz K, Hoffman JE, Rosen C. VA mobile apps for PTSD and related problems: public health resources for veterans and those who care for them. Mhealth 2018; 4:28. [PMID: 30148141 PMCID: PMC6087876 DOI: 10.21037/mhealth.2018.05.07] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/18/2018] [Indexed: 11/06/2022] Open
Abstract
Many public health agencies, including the U.S. Department of Veterans Affairs (VA), have identified the use of mobile technologies as an essential part of a larger strategy to address major public health challenges. The VA's National Center for PTSD (NCPTSD), in collaboration with VA's Office of Mental Health and Suicide Prevention and the Defense Health Agency inside the U.S. Department of Defense (DoD), has been involved in the development, evaluation, and testing of 15 mobile apps designed specifically to address the needs and concerns of veterans and others experiencing symptoms of posttraumatic stress disorder (PTSD). These applications include seven treatment-companion apps (designed to be used with a provider, in conjunction with an evidence-based therapy) and eight self-management apps (designed to be used independently or as an adjunct or extender of traditional care). There is growing evidence for the efficacy of several of these apps for reducing PTSD and other symptoms, and studies of providers demonstrate that the apps are engaging, easy-to-use, and provide a relative advantage to traditional care without apps. While publicly available apps do not collect or share personal data, VA has created research-enabled versions of many of its mental health apps to enable ongoing product enhancement and continuous measurement of the value of these tools to veterans and frontline providers. VA and DoD are also collaborating on provider-based implementation networks to enable clinicians to optimize implementation of mobile technologies in care. Although there are many challenges to developing and integrating mHealth into care, including cost, privacy, and the need for additional research, mobile mental health technologies are likely here to stay and have the potential to reach large numbers of those with unmet mental health needs, including PTSD-related concerns.
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Affiliation(s)
- Jason E. Owen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Beth K. Jaworski
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Pearl McGee-Vincent
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Katherine Juhasz
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Julia E. Hoffman
- Office of Mental Health Services, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Craig Rosen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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31
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Tam-Seto L, Wood VM, Linden B, Stuart H. A scoping review of mental health mobile apps for use by the military community. Mhealth 2018; 4:57. [PMID: 30701175 PMCID: PMC6327160 DOI: 10.21037/mhealth.2018.12.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/14/2018] [Indexed: 01/27/2023] Open
Abstract
Advancements in technology have opened doors to new directions in mental health care, including the emergence of mobile health applications. Such apps are helping to make mental health care more accessible to those who face barriers to care, such as military personnel. We conducted a scoping review to map the existing literature on mental health-related apps intended for use by military personnel/veterans. As a result, we identified several themes from the literature. We also discuss how apps are being developed and tested for use by the military community and provide suggestions for future research directions.
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Affiliation(s)
- Linna Tam-Seto
- Health Services and Policy Research Institute, Queen's University, Kingston, ON, Canada
| | - Valerie M Wood
- Health Services and Policy Research Institute, Queen's University, Kingston, ON, Canada
| | - Brooke Linden
- Health Services and Policy Research Institute, Queen's University, Kingston, ON, Canada
| | - Heather Stuart
- Health Services and Policy Research Institute, Queen's University, Kingston, ON, Canada
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32
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Shin JC, Kim J, Grigsby-Toussaint D. Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review. JMIR Mhealth Uhealth 2017; 5:e131. [PMID: 28882808 PMCID: PMC5608984 DOI: 10.2196/mhealth.7244] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/18/2017] [Accepted: 06/17/2017] [Indexed: 01/04/2023] Open
Abstract
Background Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. Objective A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. Methods Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. Results An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). Conclusions We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research.
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Affiliation(s)
- Jong Cheol Shin
- Department of Kinesiology and Community Health, University of Illinois-Urbana Champaign, Champaign, IL, United States
| | - Julia Kim
- Division of Nutritional Sciences, University of Illinois-Urbana Champaign, Urbana, IL, United States
| | - Diana Grigsby-Toussaint
- Department of Kinesiology and Community Health, University of Illinois-Urbana Champaign, Champaign, IL, United States.,Division of Nutritional Sciences, University of Illinois-Urbana Champaign, Urbana, IL, United States
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33
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Kang SG, Kang JM, Cho SJ, Ko KP, Lee YJ, Lee HJ, Kim L, Winkelman JW. Cognitive Behavioral Therapy Using a Mobile Application Synchronizable With Wearable Devices for Insomnia Treatment: A Pilot Study. J Clin Sleep Med 2017; 13:633-640. [PMID: 28162145 DOI: 10.5664/jcsm.6564] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/22/2016] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVES The use of telemedicine with a mobile application (MA) and a wearable device (WD) for the management of sleep disorders has recently received considerable attention. We designed an MA synchronizable with a WD for insomnia treatment. Our pilot study determined the efficacy of simplified group cognitive behavioral therapy for insomnia (CBT-I) delivered using our MA and assessed participant adherence to and satisfaction with the device. METHODS The efficacy of the CBT-I using MA (CBT-I-MA) was assessed by comparing sleep variables (sleep efficiency [SE], Insomnia Severity Index [ISI], and Pittsburgh Sleep Quality Inventory [PSQI] scores) before and after a 4-week treatment protocol in 19 patients with insomnia disorder patients. SE was assessed using a sleep diary, actigraphy, and the PSQI. RESULTS The intervention significantly improved all three measures of SE (P < .05), and the response rate to treatment was high (94.7%). Total ISI and PSQI scores and sleep latency, as measured by the sleep diary, improved significantly. Participants showed relatively good adherence to our MA, and sleep diary entries were made on 24.3 ± 3.8 of 28 days. Moreover, 94.7% of the participants reported that our MA was effective for treating insomnia. CONCLUSIONS Our pilot study suggested the clinical usefulness of a CBT-I-MA. We expect that our findings will lead to further development and replication studies of CBT-I-MA.
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Affiliation(s)
- Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University, School of Medicine, Incheon, Republic of Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University, School of Medicine, Incheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University, School of Medicine, Incheon, Republic of Korea
| | - Kwang-Pil Ko
- Department of Preventive Medicine, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Leen Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Smail D, Elison S, Dubrow-Marshall L, Thompson C. A Mixed-Methods Study Using a Nonclinical Sample to Measure Feasibility of Ostrich Community: A Web-Based Cognitive Behavioral Therapy Program for Individuals With Debt and Associated Stress. JMIR Ment Health 2017; 4:e12. [PMID: 28396305 PMCID: PMC5404141 DOI: 10.2196/mental.6809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/21/2016] [Accepted: 01/29/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are increasing concerns about the health and well-being of individuals facing financial troubles. For instance, in the United Kingdom, the relationship between debt and mental health difficulties is becoming more evident due to the economic downturn and welfare reform. Access to debt counseling services is limited and individuals may be reluctant to access services due to stigma. In addition, most of these services may not be appropriately resourced to address the psychological impact of debt. This study describes outcomes from an Internet-based cognitive behavioral therapy (ICBT) program, Ostrich Community (OC), which was developed to provide support to those struggling with debt and associated psychological distress. OBJECTIVE The aim of this feasibility study was to assess the suitability and acceptability of the OC program in a nonclinical sample and examine mental health and well-being outcomes from using the program. METHODS A total of 15 participants (who were not suffering from severe financial difficulty) were assisted in working through the 8-week ICBT program. Participants rated usability and satisfaction with the program, and after completion 7 participants took part in a semistructured interview to provide further feedback. Before the first session and after the final session all participants completed questionnaires to measure well-being and levels of depression, stress, and anxiety and pre- and postscores were compared. RESULTS Satisfaction was high and themes emerging from the interviews indicate that the program has the potential to promote effective financial behaviors and improve financial and global psychosocial well-being. When postcompletion scores were compared with those taken before the program, significant improvements were identified on psychometric measures of well-being, stress, and anxiety. CONCLUSIONS The OC program is the first ICBT program that targets poor mental health associated with financial difficulty. This feasibility study indicates that OC may be an effective intervention for increasing financial resilience, supporting individuals to become financially independent, and promoting positive financial and global well-being. Further work with individuals suffering from debt and associated emotional difficulties will help to examine clinical effectiveness more closely.
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Affiliation(s)
- Dawn Smail
- Ostrich Community, Manchester, United Kingdom
| | | | | | - Catherine Thompson
- School of Health Sciences, University of Salford, Salford, United Kingdom
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Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana. Int J Telemed Appl 2016; 2016:2515420. [PMID: 28070186 PMCID: PMC5192299 DOI: 10.1155/2016/2515420] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/14/2016] [Indexed: 01/12/2023] Open
Abstract
Mobile phone applications may enhance the delivery of critical health services and the accuracy of health service data. Yet, the opinions and experiences of frontline health workers on using mobile apps to track pregnant and recently delivered women are underreported. This evaluation qualitatively assessed the feasibility, usability, and acceptability of a mobile Client Data App for maternal, neonatal, and child client data management by community health nurses (CHNs) in rural Ghana. The mobile app enabled CHNs to enter, summarize, and query client data. It also sent visit reminders for clients and provided a mechanism to report level of care to district officers. Fourteen interviews and two focus groups with CHNs, midwives, and district health officers were conducted, coded, and thematically analyzed. Results indicated that the app was easily integrated into care, improved CHN productivity, and was acceptable due to its capacity to facilitate client follow-up, data reporting, and decision-making. However, the feasibility and usability of the app were hindered by high client volumes, staff shortages, and software and device challenges. Successful integration of mobile client data apps for frontline health workers in rural and resource-poor settings requires real-time monitoring, program investments, and targeted changes in human resources.
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Metrik J, Jackson K, Bassett SS, Zvolensky MJ, Seal K, Borsari B. The mediating roles of coping, sleep, and anxiety motives in cannabis use and problems among returning veterans with PTSD and MDD. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:743-754. [PMID: 27786514 DOI: 10.1037/adb0000210] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Veterans with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), the 2 most prevalent mental health disorders in the Iraq and Afghanistan veterans, are at increased risk for cannabis use and problems including cannabis use disorder (CUD). The present study examined the relationship of PTSD and MDD with cannabis use frequency, cannabis problems, and CUD as well as the role of 3 coping-oriented cannabis use motives (coping with negative affect, situational anxiety, and sleep) that might underlie this relationship. Participants were veterans (N = 301) deployed post-9/11/2001 recruited from a Veterans Health Administration facility in the Northeast United States based on self-reported lifetime cannabis use. There were strong unique associations between PTSD and MDD and cannabis use frequency, cannabis problems, and CUD. Mediation analyses revealed the 3 motives accounted, in part, for the relationship between PTSD and MDD with 3 outcomes in all cases but for PTSD with cannabis problems. When modeled concurrently, sleep motives, but not situational anxiety or coping with negative affect motives, significantly mediated the association between PTSD and MDD with use. Together with coping motives, sleep motives also fully mediated the effects of PTSD and MDD on CUD and in part the effect of MDD on cannabis problems. Findings indicate the important role of certain motives for better understanding the relation between PTSD and MDD with cannabis use and misuse. Future work is needed to explore the clinical utility in targeting specific cannabis use motives in the context of clinical care for mental health and CUD. (PsycINFO Database Record
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Affiliation(s)
| | - Kristina Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health
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Koffel E, Kuhn E, Petsoulis N, Erbes CR, Anders S, Hoffman JE, Ruzek JI, Polusny MA. A randomized controlled pilot study of CBT-I Coach: Feasibility, acceptability, and potential impact of a mobile phone application for patients in cognitive behavioral therapy for insomnia. Health Informatics J 2016; 24:3-13. [PMID: 27354394 DOI: 10.1177/1460458216656472] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been growing interest in utilizing mobile phone applications (apps) to enhance traditional psychotherapy. Previous research has suggested that apps may facilitate patients' completion of cognitive behavioral therapy for insomnia (CBT-I) tasks and potentially increase adherence. This randomized clinical trial pilot study ( n = 18) sought to examine the feasibility, acceptability, and potential impact on adherence and sleep outcomes related to CBT-I Coach use. All participants were engaged in CBT-I, with one group receiving the app as a supplement and one non-app group. We found that patients consistently used the app as intended, particularly the sleep diary and reminder functions. They reported that it was highly acceptable to use. Importantly, the app did not compromise or undermine benefits of cognitive behavioral therapy for insomnia and patients in both groups had significantly improved sleep outcomes following treatment.
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Affiliation(s)
- Erin Koffel
- Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA
| | - Eric Kuhn
- National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA
| | | | - Christopher R Erbes
- Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA
| | | | - Julia E Hoffman
- National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA
| | - Josef I Ruzek
- National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA
| | - Melissa A Polusny
- Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA
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#Wasted: the intersection of substance use behaviors and social media in adolescents and young adults. Curr Opin Psychol 2016. [DOI: 10.1016/j.copsyc.2015.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kuhn E, Weiss BJ, Taylor KL, Hoffman JE, Ramsey KM, Manber R, Gehrman P, Crowley JJ, Ruzek JI, Trockel M. CBT-I Coach: A Description and Clinician Perceptions of a Mobile App for Cognitive Behavioral Therapy for Insomnia. J Clin Sleep Med 2016; 12:597-606. [PMID: 26888586 DOI: 10.5664/jcsm.5700] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 11/25/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). METHODS VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. RESULTS Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p < 0.05) and perceptions of relative advantage to existing CBT-I practices (β = 0.286, p < 0.01), compatibility with their own needs and values (β = 0.307, p < 0.01), and expectations about the complexity of the app (β = 0.245, p < 0.05). Two years after CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. CONCLUSIONS Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value.
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Affiliation(s)
- Eric Kuhn
- VA Palo Alto Health Care System, Palo Alto, CA.,Stanford University, Stanford, CA
| | - Brandon J Weiss
- VA Palo Alto Health Care System, Palo Alto, CA.,Stanford University, Stanford, CA
| | | | | | | | | | - Philip Gehrman
- Philadelphia VA Medical Center, Philadelphia, PA.,University of Pennsylvania, Philadelphia, PA
| | | | - Josef I Ruzek
- VA Palo Alto Health Care System, Palo Alto, CA.,Stanford University, Stanford, CA
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