Digital Cognitive Behavioral Therapy More Effective in Different Insomnia Chronotypes

Patrick Faaland

Digital cognitive behavioral therapy for insomnia had different efficacy results based on the chronotype of the insomnia.

A team, led by Patrick Faaland, Department of Mental Health, Norwegian University of Science and Technology, compared data on the effects of digital cognitive behavioral therapy for insomnia with patient education in a large-scale, community-based sample of Norwegian adults with self-reported insomnia.

CBT for Insomnia

Cognitive behavioral therapy for insomnia is considered first-line treatment for patients with chronic insomnia. However, about 30-60% of patients treated with this do not demonstrate clinically significant benefits over and above those attained with a comparator intervention, including patient education on sleep.

In the study, the investigators examined data from 1721 patients in a community-based randomized controlled trial testing digital cognitive behavioral therapy for insomnia between February 2016 and July 2018.

The investigators conducted a range of baseline assessments on eligible participants, including sleep diary self-ratings.

The program used, called the Sleep Healthy Using the Internet (SHUTi), is a fully automated and interactive web-based tool that incorporates primary strategies and techniques from cognitive behavioral therapy for insomnia.

SHUTi is individually adapted, with objective learning sets and performance requirements. The tool provides feedback on intervention achievements and targets.

Comparing Results

To compare results from patients with insomnia with patient education, the investigators used a linear mixed modelling analyses to identify whether chronotype moderated the benefits of digital cognitive behavioral therapy for insomnia on self-reported levels of insomnia, severity, fatigue, and psychological distress.

The investigators also used baseline self-rating on the reduced version of the Horne–Östberg Morningness–Eveningness Questionnaire to categorize patients as either morning type (n = 345; 20%), intermediate type (n = 843; 49%), or evening type (n = 524; 30%).

They also assessed Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale before and after the 9 week intervention.

The Value of Digital Cognitive Behavioral Therapy

Digital cognitive behavioral therapy for insomnia was the better option to patient education on all ratings for patients with self-reported morning or intermediate chronotypes (P ≤ 0.05).

However, for individuals with the self-reported evening chronotype, digital cognitive behavioral therapy was superior to patient education for Insomnia Severity Index and Chalder Fatigue Questionnaire, but not for Hospital Anxiety and Depression Scale (P = 0.139).

There was also significant differences in the treatment effects between the different chronotypes on the Insomnia Severity Index (P = 0.023). The estimated differences between evening and morning type was -1.70 (95% CI, -2.96 to -0.45; P = 0.009) and the estimated difference between evening and intermediate type was -1.53 (95% CI, -3.04 to -0.03;P = 0.536).

“We conclude that self-reported chronotype moderates the effects of digital cognitive behavioral therapy for insomnia on insomnia severity, but not on psychological distress or fatigue,” the authors wrote.

The study, “Digital cognitive behavior therapy for insomnia (dCBT-I): Chronotype moderation on intervention outcomes,” was published online in the Journal of Sleep Research.