Tailored Smartphone Application Helps Treat Insomnia


Worker productivity also increased from brief behavioral therapy for insomnia through a smartphone application.

Isa Okajima, PhD

Isa Okajima, PhD

Individuals with insomnia may benefit from a personalized version of therapy administered through their smartphones.

A team, led by Isa Okajima, PhD, Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, explored whether a brief behavioral therapy smartphone application for insomnia could improve insomnia-related symptoms and worker productivity.

According to the stepped-care model, there is a medium to large effect size for using cognitive behavioral therapy for insomnia (BBTI) delivered digitally. However, studies show follow automated cognitive behavioral therapy for insomnia applications without additional expert support have high dropout rates.

In the randomized clinical trial, the investigators examined 92 workers with insomnia using an application that provided tailored brief behavioral therapy for 2 weeks. The average of the participants was 42.7 years old.

The investigators examined the effects of using a fully automated and individually tailored brief behavior therapy for insomnia applications for 2 weeks on insomnia-related symptoms, social disabilities, and work productivity among workers within Japan.

The intent-to-treat prospective parallel-group randomized clinical trial included individuals at least 20 years old with Insomnia Severity Index (ISI). Scores of 8 or higher. Each participant was recruited through an internet advertisement and workplace flyers and were randomized to either a tailored or standard version of brief behavioral therapy for insomnia, self-monitoring with sleep diaries, or a waiting list control group.

Both the personalized and standard brief behavioral therapy for insomnia included sleep scheduling, relaxation, sleep hygiene, and sleep diaries conducted through their smartphone application.

A total of 24 participants were randomized to the tailored version, 23 individuals were put in the standard treatment group, 23 participants were assigned to self-monitoring, and 22 patients were assigned to the waiting list control group.

The study took place between September 2017 and February 2018.

At baseline, there were no significant differences among groups on any demographic characteristics or outcome measures, but the results of the intent-to-treat analysis showed an interaction effect for all outcome measures.

When compared to the waiting list control group, both brief behavior therapy for insomnia interventions were more effective for reduction of insomnia severity (tailored BBTI: Hedges g &thinsp;= &thinsp;—1.64; 95% CI, –2.32 to –0.96; P&thinsp; <&thinsp;.001; standard BBTI: g &thinsp;= &thinsp;—1.28; 95% CI, –1.93 to –0.63; P&thinsp; <&thinsp;.001) at the 3-month follow-up.

This was also found for social disabilities relating to social life (tailored BBTI: g &thinsp;= &thinsp;—1.33; 95% CI, –1.97 to –0.68; P &thinsp;<&thinsp;.001; standard BBTI: g &thinsp;= &thinsp;—0.84; 95% CI, –1.46 to –0.22]; P &thinsp;= &thinsp;.009) and dysfunctional beliefs (tailored BBTI: g &thinsp;= &thinsp;—1.17; 95% CI, –1.80 to –0.54; P&thinsp; <&thinsp;.001; standard BBTI: g &thinsp;= &thinsp;—0.84 [95% CI, –1.46 to –0.23]; P &thinsp;= &thinsp;.02) at the 3-month follow-up.

The tailored therapy quickly reduced insomnia severity (1-month follow-up: g&thinsp; = &thinsp;—0.85; 95% CI, –1.46 to –0.24) and was only more effective for improvement of work performance (g&thinsp; = &thinsp;—1.09; 95% CI, –1.71 to –0.46; P &thinsp;= &thinsp;.005), social disabilities related to family life (g&thinsp; = &thinsp;—0.89; 95% CI, –1.51 to –0.28; P =&thinsp; .005), and sleep reactivity (g &thinsp;= &thinsp;—1.09; 95% CI, –1.72 to –0.46; P&thinsp;=&thinsp;.007) compared with the waiting list control group at the 3-month follow-up.

The tailored therapy also led to improved worker productivity when compared to the standard brief behavioral therapy for insomnia (g &thinsp;= &thinsp;0.94; 95% CI, 0.33-1.55; P&thinsp;=&thinsp; .01) at the three-month follow-up. Okajima and colleagues concluded individually tailored brief behavioral therapy for insomnia delivered through a smartphone application can be an effective and inexpensive treatment for workers with insomnia.

“These findings suggest that an application for individually tailored BBTI is an inexpensive and effective treatment for insomnia,” the authors wrote. “In future research, it would be informative to investigate the reasons for dropout during the follow-up period.”

The study, “Effects of a Tailored Brief Behavioral Therapy Application on Insomnia Severity and Social Disabilities Among Workers With Insomnia in Japan,” was published online in JAMA Network Open.

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