The Anxiolytic Effects of Cognitive Behavior Therapy for Insomnia: Preliminary Results from a Web-delivered Protocol

Abstract

Though the efficacy of cognitive behavior therapy for insomnia (CBTI) is well-established, the paucity of credentialed providers hinders widespread access. Further, the impact of alternatives such as web-delivered CBTI has not been adequately tested on common insomnia comorbidities such as anxiety. Therefore, we assessed the impact of an empirically validated web-delivered CBTI intervention on insomnia and comorbid anxiety symptoms. A sample of 22 adults (49.8±13.5 yo; 62.5% female) with DSM-5 based insomnia were randomized to either an active CBTI treatment group (n = 13) or an information-control (IC) group (n = 9). Participants in the CBTI group underwent a standard CBTI program delivered online by a 'virtual' therapist, whereas the IC group received weekly 'sleep tips' and general sleep hygiene education via electronic mail. All participants self-reported sleep parameters, including sleep onset latency (SOL), insomnia symptoms per the Insomnia Severity Index (ISI), and anxiety symptoms per the Beck Anxiety Inventory (BAI) at both baseline as well as follow- up assessment one week post-treatment. There were no significant differences between the CBTI and IC groups on baseline measures. The CBTI group showed significantly larger reductions in BAI scores (t = 2.6; p < .05; Cohen's d = .8) and ISI scores (t = 2.1; p < .05; Cohen's d = .9) at follow-up than did the IC group. Further, changes in SOL from baseline (62.3±44.0 minutes) to follow-up (22.3±14.4 minutes) in the CBTI group were also significantly greater (t = 2.3; p < .05; Cohen's d = .9) than in the IC group (baseline: 55.0±44.2 minutes; follow-up: 50.±60.2 minutes). This study offers preliminary evidence that a web-delivered CBTI protocol with minimal patient contact can improve comorbid anxiety symptoms among individuals with insomnia.

Keywords: Anxiety; CBTI; Insomnia; Randomized Clinical Trial.

Conflict of interest statement

Conflicts of Interest The software and web development for this study was supported by Big Health Limited. Drs. Espie and Bostock receive a salary from Big Health Limited and hold shares in the company, but did not have access to the data analyzed in the present study. Dr. Espie has also participated in speaking engagements and has served as a consultant for Boots Pharmaceuticals and Novartis; received free use of actigraphs by Philips Respironics. Dr. Drake has served as consultant for Teva; has received research support from Merck and Teva; and has served on speakers bureaus for Jazz, Purdue, and Teva. Drs. Pillai, Cheng, and Bazan did not indicate any financial conflicts of interests. Mr. Anderson did not indicate any financial conflicts of interests. Dr. Roth has served as consultant for Abbott, Accadia, AstraZeneca, Aventis, AVER, Bayer, BMS, Cypress, Ferrer, Glaxo Smith Kline, Impax, Intec, Jazz, Johnson and Johnson, Merck, Neurocrine, Novartis, Proctor and Gamble, Pfizer, Purdue, Shire, Somaxon, Transcept; has received research support from Cephalon, Merck, and Transcept; and has served on speakers bureau for Purdue.

Figures

Figure 1

Consort chart depicting flow of participants through the study.