Effects of app-based cognitive behavioral therapy for insomnia (CBT-I) in college students

Abstract

Insomnia among adolescents and young adults is common in Hong Kong, with approximately 10.7 to 18.5% of adolescents meeting the criteria of clinical insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recommended as the first line treatment for insomnia. Digitally delivered CBT-I has been shown to be comparable to the face-to-face modality in improving insomnia. Yet, the high dropout rate associated with the digital approach remained as a concern. This study aimed to 1) examine the efficacy of app-based CBT-I with or without support to the waitlist control (WL) group in adolescents; 2) to evaluate the mediating effect of dysfunctional beliefs about sleep between CBT-I and insomnia outcome; 3) to compare the treatment adherence and dropout rate between app-based CBT-I with and without support. This was an assessor-blind, randomized controlled trial in which participants were randomized to receiving either app-based CBT-I with support or app-based CBT-I only. A waitlist control group was included and extracted from a previous insomnia study (ClinicalTrials.gov Reference no.: NCT03522701) for the comparison of the treatment effects. The app-based CBT-I with six weekly sessions was delivered to participants in both treatment groups. Participants in the support group additionally received weekly SMS text message with feedback based on their completed sleep diary. Assessments were conducted at baseline and one-week after treatment. Treatment effects were assessed using linear mixed models. One hundred and thirty-five participants were included in the analysis (mean age= 20.3± 2.27 years; female= 59.3%). At post treatment, both treatment groups reported a significant reduction in insomnia symptoms (Support: d= -.91; App only: d= -1.32) without a significant group difference. There was a significant mediating effect of dysfunctional beliefs about sleep between intervention and insomnia outcome. Moreover, the Support group (19.5%) yielded a slightly lower dropout rate (during intervention) compared to the App only group (21.9%). To conclude, app-based CBT-I was effective for improving insomnia in youth.