Abstract
Behavioral treatments for insomnia require a personalized, time-varying approach whereby treatment is adapted over time in response to the changing needs and evolving condition of the patient. Mobile technologies allow for this treatment adjustment performed in real-time, called Just-in-Time Adaptive Intervention (JITAI). The purpose of this pilot study was to evaluate the effects of a JITAI approach on insomnia treatment response and remission. A cross-platform mobile health (mHealth) solution was developed for the purpose of delivering the JITAI. This solution consists of 1) a smartphone application; 2) a Web-based clinician portal that allows therapists to monitor patients and provide personalized treatment recommendations, assess adherence and progress; and 3) a secure communication system between the patient and clinician. Twenty-two military veterans with chronic insomnia received a 4-week behavioral insomnia treatment through the JITAI mHealth solution. All completed the Insomnia Severity Index (ISI) a baseline and 2 weeks post-treatment. Rates of treatment response and remission with the new mHealth JITAI solution were compared with rates previously reported in military veterans with chronic insomnia who completed a traditional 4-week in-person behavioral treatment. Treatment response was defined as a reduction of 8 points or more on the ISI. Remission was defined as meeting the definition for response and a final ISI score lower than 7. The rates of treatment response (84.21%) and remission (68.42%) were slightly higher in the mHealth JITAI group compared to the in-person condition (76.47% and 52.94%, respectively). Response and remission rates were not different between the delivery methods (χ2= 0.34, p>0.05 and χ2< 0.91, p>0.05 for response and remission, respectively). mHealth JITAI solution is a promising insomnia treatment delivery mode. Results suggest that mHealth JITAI is non-inferior to an in-person brief behavioral treatment. mHealth JITAI is scalable and has a high potential for cost-effectiveness.
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