Abstract
BackgroundTreatment involvement, including involvement with written material as well as homework assignments, has previously been associated with better outcomes in cognitive behavioral therapy, but there is a lack of knowledge on which specific aspects of involvement that are the most promising for use as predictors of treatment effects.MethodsThe objective of this study was to use a battery of weekly self-rated questions regarding different aspects of participant involvement during 8 weeks of either guided internet cognitive behavioral therapy for insomnia (ICBT-i, n = 73), or an active internet-delivered control treatment also including homework (ICBT-ctrl, n = 75), to predict reductions in insomnia severity after treatment. The markers of involvement were single questions on amount of time spent on treatment, amount of text read, amount of subjective knowledge gained and index scores of homework quantity (based on ratings of how many times specific techniques were used) and homework quality (based on ratings of the understanding, used as intended, and helpfulness of each specific technique).ResultsWhile none of the markers predicted reductions in insomnia severity for participants in the ICBT-ctrl group, text read, subjective knowledge gain, and homework quality predicted larger reductions in insomnia severity for participants in ICBT-i. Amount of subjective knowledge gained was a particularly useful marker in the ICBT-i group, since weekly ratings from the first half of treatment sufficed to explain a rather large proportion of variance in insomnia severity post treatment (14%).ConclusionsThe results strengthen subjective knowledge gain as a candidate for use as a predictor of treatment effects in ICBT-i.
Highlights
Introduction and facts about sleepCognitive behavioral therapy (CBT) for insomnia and sleep hygiene Education on sleep medication and tapering Sleep restriction and stimulus control Stress management Managing fatigue Handling negative thoughts about sleep Planning aheadPsychoeducation on sleep Psychoeducation on insomnia and setting treatment goals, Sleep hygiene I Sleep hygiene II Applied relaxation Stress management Mindfulness Treatment evaluation and maintenancePlease see the Supplemental Materials for a complete list of all techniques plement for describing quantity per available technique by dividing the homework quantity sum of Internet Cognitive Behavioral Therapy for insomnia (ICBT-i) with 29 and the homework quantity sum of ICBT-ctrl with 8. 5
Participants in ICBT-i rated spending on average almost 40 h on their treatment compared to around 20 h on average rated by participants in ICBT-ctrl
In ICBT-i, using all weekly measurements, the amount of text read could explain 7% of the variance in insomnia severity post-treatment when controlling for pre-treatment insomnia severity, the amount of subjective knowledge gained could explain 11%, and self-rated homework quality could explain 12% of the variance in outcome
Summary
Introduction and facts about sleepCBT for insomnia and sleep hygiene Education on sleep medication and tapering (given only to participants with sleep medication) Sleep restriction and stimulus control Stress management Managing fatigue Handling negative thoughts about sleep Planning aheadPsychoeducation on sleep Psychoeducation on insomnia and setting treatment goals, Sleep hygiene I (light, sound, temperature) Sleep hygiene II (exercise, food, alcohol, nicotine, caffeine) Applied relaxation Stress management Mindfulness Treatment evaluation and maintenancePlease see the Supplemental Materials for a complete list of all techniques plement for describing quantity per available technique by dividing the homework quantity sum of ICBT-i with 29 and the homework quantity sum of ICBT-ctrl with 8. 5. Methods The objective of this study was to use a battery of weekly self-rated questions regarding different aspects of participant involvement during 8 weeks of either guided internet cognitive behavioral therapy for insomnia (ICBT-i, n = 73), or an active internet-delivered control treatment including homework (ICBT-ctrl, n = 75), to predict reductions in insomnia severity after treatment. The markers of involvement were single questions on amount of time spent on treatment, amount of text read, amount of subjective knowledge gained and index scores of homework quantity (based on ratings of how many times specific techniques were used) and homework quality (based on ratings of the understanding, used as intended, and helpfulness of each specific technique). Conclusions The results strengthen subjective knowledge gain as a candidate for use as a predictor of treatment effects in ICBT-i
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