Researchers describe the development and evaluation of digital brief therapy for insomnia

Researchers have published a framework and course design for digital brief therapy for insomnia (dBTI).

New research has provided a course framework and design for a

digital brief therapy for insomnia (dBTI).

BTI is a short-term cognitive therapy (between 1 and 2 weeks) used in patients with insomnia that, prior to this study, has not been combined with modern technology. The primary goal of BTI is to adjust behaviors while the patient is awake in order to regulate sleep, including factors such as stimulus control and sleep restriction, and has been shown to rapidly reduce severity of insomnia and alleviates symptoms in patients.

With the major shift to online healthcare and telehealth during the COVID-19 pandemic, many patients with acute insomnia needed a virtual treatment option that could quickly improve their insomnia symptoms.

To try to solve this problem, the authors built a dBTI platform based on the WeChat mini-program and evaluated its development, efficiency and patient adherence. Their research has been published in Methods.

WeChat is a popular social app in China with functions such as text message and video call, and the WeChat mini program is built into the app. According to the authors of the study, the WeChat mini program has several advantages over other similar digital platforms in the development of dBTI. These benefits include convenience, reduced development requirements and maintenance costs, large audiences and easier popularization, and data access that enhances individual experience with the app.

The dBTI platform developed in this study was made accessible through the WeChat mini program and served as a daily log.

When first used, patients completed a virtual self-assessment of their short-term insomnia troubles so that the platform could determine the extent of their insomnia at baseline.

Throughout the week, patients completed daily modules and sleep diary entries. In these entries, patients indicated the time they went to bed, the time it took them to fall asleep, the time they woke up, the time it took them to getting out of bed and the duration of any nocturnal awakenings. They also rated the quality of their sleep on a 5-point scale.

Patients also recorded their daytime behavior, including whether and how long they were in the sun, took a nap or exercised. Daytime behavior also included any use of medication or consumption of alcohol, tea or coffee.

Using this data, the dBTI program automatically generated a sleep efficiency report to tailor sleep behavior, such as bedtime and wake-up time.

At the end of the week-long program, patients completed a post-assessment.

To assess adherence and effectiveness of the program, the study authors recruited 194 participants with acute insomnia.

Of this group, 75 (38.7%) participants (the high-adherence group) logged in during the 7 days and completed all lessons, and 14 participants never logged in. The low-adherence group that logged in between 0 and 3 weekdays made up 32% of all participants, 29.4% was the medium-adherence group that logged in between 4 and 6 days.

A single-factor analysis showed that gender (P = 0.002), somatic score on the Pre-Sleep Awakening Scale (PSAS) (P = 0.012), and the Insomnia Severity Index (ISI) score (P = 0.030) were statistically associated with adherence to the dBTI program. Specifically, male gender and a lower PSAS score were both related to average adherence.

The authors also found that participants with moderate insomnia had better adherence to the dBTI platform, compared to participants with minimal, mild, or severe insomnia.

“The possible reason for this is that participants scoring 8 to 14 in the ISI had less severe insomnia and therefore were not highly motivated to receive treatment,” the authors explained. “Patients with an ISI score of 22-28, on the other hand, suffered from more severe insomnia. As a result, their cognitive and physical functions were more impaired and they were suspicious of the effectiveness of the treatment.

They also noted that most online interventions have low adherence risk in real-world studies and clinical trials, including dBTI.

“Compared to offline behavior therapy, patients without the supervision of therapists must have strong willpower and self-discipline in order to complete all courses,” the authors wrote. “Nevertheless, feedback from our platform shows that with just the daily reminder that comes with the system, the proportion of participants who completed more than half of the course with medium to high adherence is 68%.

The authors said more research is needed to determine whether dBTI in particular or treatment-seeking behavior in general is the factor that alleviates symptoms of insomnia.

Reference

Liu X, Li Y, Yan R, et al. The platform development, uptake and effectiveness of a digital brief therapy for insomnia (dBTI) during the covid-19 pandemic. Methods. Published online May 5, 2022. doi:10.1016/j.ymeth.2022.04.016

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