Digital CBT Effective for Insomnia in Pregnant Women


Digital cognitive behavioral therapy for pregnant women is a safe and effective alternative to medications for the condition.

Jennifer Felder, PhD

Jennifer Felder, PhD

A digital cognitive behavioral therapy program improved symptoms of insomnia, depression, and anxiety in pregnant women better than traditional treatment.

What’s more, the program improved sleep efficiency and global sleep quality.

Jennifer Felder, PhD, an assistant professor of psychiatry at the University of California, San Francisco Weill Institute for Neurosciences, and colleagues compared the efficacy of digital cognitive behavioral therapy program of 6 weekly sessions of approximately 20 minutes, and traditional care.

The findings suggested the digital intervention was safe and efficient for pregnant women who suffered from insomnia and did not want to use medications.

The digital program, Sleepio, was accessed online or through a phone application. Sleepio content was based on cognitive behavioral therapy for insomnia manuals and included 5 main components: sleep restriction; stimulus control; cognitive therapy; relaxation techniques; and sleep hygiene and education. The interactive program was delivered by an animated digital therapist.

Women who were randomized to the digital intervention received automated reminders to complete each session and a daily sleep diary. Sleepio sent tailored, automated help based on the progress of each participant. Those in the intervention group had access to a moderated online community and a library of sleep information.

Standard care consisted of nonstudy treatments, including sleep, pain, and antidepressant medications; alternative therapy or herbal supplements; psychotherapy or counseling; and support groups. The women randomized to traditional treatment received a free voucher code to access Sleepio when the study ended.

The investigators recruited pregnant women from November 2016-March 2018. Women who were included had a self-reported pregnancy < 28 weeks’ gestation, > 18 years old, met the DSM-5 criteria for insomnia disorder (experienced symptoms for > 1 month. Participants had regular access to a web-enabled device.

Felder and the team randomly assigned each woman to receive digital cognitive behavioral therapy for insomnia or standard treatment. Overall, 105 women were in the digital group and 103 received traditional care.

The primary outcome of the study was the total score on the Insomnia Severity Index (ISI), a seven-item measure of insomnia that assessed difficulty with initiating or maintaining sleep; sleep satisfaction; impairment; distress; and the extent other have noticed symptoms during the previous 2 weeks. Scores < 7 indicated no clinically significant insomnia; 8-14 indicated subthreshold insomnia; 15-21 indicated moderate insomnia; and > indicated severe insomnia.

Sleep diaries helped measure sleep efficiency and duration, while depressive and anxiety symptom severity were also recorded.

Among the 105 women who received digital cognitive behavioral therapy, 68 (64.8%) completed all 6 sessions. The digital intervention group experienced statistically significant greater improvements in insomnia severity from baseline to postintervention compared with the control group (time-by-group interaction, difference = -.36; 95% CI, -.48 to -.23; P <.001).

ISI scores < 7 were significantly higher among those in the intervention group (30 women [44%]) vs those in the standard care group (21 women [22.3%]; P = .002).

Improvements to all secondary outcomes were statistically significant, except sleep duration (.03 vs .002; difference = .028 [95% CI, -.002 to .67] P = .07). Outcomes were significantly greater in the intervention group for depressive symptom severity (-.22 vs -.01; difference = -.21 [95% CI, -.3 to -.11]; P <.001) and anxiety symptom severity (-.19 vs -.002; difference = -.188 [95% CI, -.26 to -.10; P <.001).

The findings of the study added to previous research which suggested that cognitive behavioral therapy for insomnia was an effective nonpharmacological approach for treating the condition’s symptoms during pregnancy. Because pregnant women could be interested in such an intervention, the results showed great promise in the program.

The study, “Efficacy of Digital Cognitive Behavioral Therapy for the Treatment of Insomnia Symptoms Among Pregnant Women,” was published online in JAMA Psychiatry.

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