Researchers Describe Development, Evaluation of Digital Brief Therapy for Insomnia

New research provided a framework and course design of a digital brief therapy for insomnia (dBTI).

BTI is a short-term—lasting between 1 and 2 weeks—cognitive therapy used in patients with insomnia that, prior to this study, has not been combined with modern technology. BTI’s main purpose 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 insomnia severity and alleviate symptoms in patients.

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

To attempt to solve this problem, the authors built a dBTI platform based on the WeChat mini program and evaluated its development, efficacy, and patient adherence. Their research was published in Methods.

WeChat is a popular social application in China with functions including text messages and video calls, and the WeChat mini program is built into the app. According to the study authors, the WeChat mini program has several advantages over other similar digital platforms in the development of dBTI. These advantages include convenience, lower development requirements and maintenance costs, wide audience and is easy to popularize further, and data access that improves 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.

At first use, patients completed a virtual self-assessment of their short-term insomnia disorders so 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, the patients reported the time they got into bed, how long it took to fall asleep, what time they woke up, how long it took to get out of bed, and the duration of any night awakening. They also rated the quality of their sleep on a 5-point scale.

Patients also recorded their daytime behavior, including if and how long they had exposure to sunlight, napped, or exercised. Daytime behavior also included any medicine use or consumption of alcohol, tea, or coffee.

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

At the end of the 1-week program, patients completed a post-assessment.

To evaluate the program’s adherence and efficacy, the study authors recruited 194 participants with acute insomnia.

Of this group, 75 (38.7%) participants—the high-adherence group—logged in for all 7 days and completed all lessons, and 14 participants never logged in. The low-adherence group who logged in between 0 and 3 days of the week accounted for 32% of all participants, 29.4% made up the medium-adherence group by logging in between 4 and 6 days.

A single-factor analysis showed that gender (P = .002), pre-sleep arousal scale (PSAS) somatic score (P = .012), and insomnia severity index (ISI) score (P = .030) were statistically associated with adherence to the dBTI program. Specifically, male gender and lower PSAS score were both linked to medium adherence.

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

“The possible reason for it is that participants scoring 8-14 in ISI suffered from less severity of insomnia and thus were not much highly motivated to receive treatment,” the authors explained. “Patients scoring 22-28 in ISI, on the other hand, suffered from more severe insomnia. Thereupon, their cognitive and physical functions were more impaired and they were diffident about the treatment efficacy.”

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

“Compared with off-line behavioral therapy, patients without the supervision of therapists need to have a strong will and self-discipline in order to complete all the courses,” the authors wrote. “Nevertheless, the feedback of our platform shows that, with only the daily reminder that comes with the system, the proportion of participants who have completed more than half of the course with medium to high adherence is 68%.”

The authors said further research is needed to determine whether dBTI specifically or treatment-seeking behavior in general is the factor alleviating symptoms of insomnia.

Reference

Liu X, Li Y, Yan R, et al. The platform development, adherence and efficacy to 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