Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Randomized Waitlist Controlled Trial

Corine Hg Horsch, Jaap Lancee, Fiemke Griffioen-Both, Sandor Spruit, Siska Fitrianie, Mark A Neerincx, Robbert Jan Beun, Willem-Paul Brinkman, Corine Hg Horsch, Jaap Lancee, Fiemke Griffioen-Both, Sandor Spruit, Siska Fitrianie, Mark A Neerincx, Robbert Jan Beun, Willem-Paul Brinkman

Abstract

Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia.

Objective: The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial.

Methods: We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant's progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition.

Results: The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=-0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up.

Conclusions: This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens.

Trial registration: Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4).

Keywords: cognitive behavioral therapy; eHealth; insomnia; smartphone app.

Conflict of interest statement

Conflicts of Interest: None declared.

©Corine HG Horsch, Jaap Lancee, Fiemke Griffioen-Both, Sandor Spruit, Siska Fitrianie, Mark A Neerincx, Robbert Jan Beun, Willem-Paul Brinkman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.04.2017.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trial (CONSORT) flow diagram of recruitment, reasons for exclusion, and experimental compliance. CBT-I: cognitive behavioral therapy for insomnia.
Figure 2
Figure 2
Sleepcare app treatment protocol.
Figure 3
Figure 3
Mock-up screenshots of the Sleepcare app translated from Dutch.
Figure 4
Figure 4
Completers sample: Insomnia Severity Index (ISI) scores and sleep efficiency of the Sleepcare mobile phone app group compared with the waitlist (WL) control group at baseline, posttest, and 3-month follow-up. Error bars represent standard error.

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