Does adjunctive digital CBT for insomnia improve clinical outcomes in an improving access to psychological therapies service?

Richard Stott; John Pimm; Richard Emsley; Christopher B Miller; Colin A Espie

doi:10.1016/j.brat.2021.103922

Does adjunctive digital CBT for insomnia improve clinical outcomes in an improving access to psychological therapies service?

Behav Res Ther. 2021 Sep:144:103922. doi: 10.1016/j.brat.2021.103922. Epub 2021 Jul 1.

Authors

Richard Stott¹, John Pimm², Richard Emsley³, Christopher B Miller⁴, Colin A Espie⁵

Affiliations

¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Big Health Ltd, San Francisco, USA, London, UK. Electronic address: richard.stott@kcl.ac.uk.
² Oxford Health NHS Foundation Trust, Oxford, UK. Electronic address: john.pimm@oxfordhealth.nhs.uk.
³ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: richard.emsley@kcl.ac.uk.
⁴ Big Health Ltd, San Francisco, USA, London, UK; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. Electronic address: chris.miller@bighealth.com.
⁵ Big Health Ltd, San Francisco, USA, London, UK; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. Electronic address: colin.espie@ndcn.ox.ac.uk.

PMID: 34246110
DOI: 10.1016/j.brat.2021.103922

Abstract

Background: Insomnia has a bidirectional relationship with broader mental health functioning, including anxiety and depression. Yet, poor sleep has historically been neglected as a specific treatment target in mental health programmes (Freeman, Sheaves, Waite, Harvey, & Harrison, 2020).

Method: All patients over a 12-month period entering the Improving Access to Psychological Therapies (IAPT) service endorsing a 'poor sleep' questionnaire item at assessment, were offered a self-guided digital sleep intervention, Sleepio, in addition to routine care. Sleepio is based on the principles of Cognitive Behavioural Therapy for Insomnia (CBT-I). Propensity score matching established a non-Sleepio control group matched on demographic and baseline clinical measures.

Results: Patients who signed up to Sleepio (n = 510) achieved significantly better outcomes on core clinical metrics (PHQ-9, GAD-7, WSAS) than controls. IAPT recovery rates¹ (on PHQ-9 and GAD-7) were 64.7%, versus 58% in the control group. Duration of clinical contact time was marginally elevated overall in the Sleepio group but by less than 1 h CONCLUSIONS: Significant clinical benefit was associated with the introduction of an evidence-based digital sleep intervention alongside other mental health interventions for depression and anxiety. Widespread deployment was achieved with immediate availability, minimal additional clinical time or staff training. This approach provides a feasible and highly scalable model for improving mental health outcomes in clinical services.

Keywords: Adjunctive treatment; Cognitive behavioural therapy (CBT); Digital health; Dissemination; Insomnia; Sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety Disorders / therapy
Cognitive Behavioral Therapy*
Cost-Benefit Analysis
Humans
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome