Cognitive Mechanisms of Sleep Outcomes in a Randomized Clinical Trial of Internet-Based Cognitive Behavioral Therapy for Insomnia

Publication date: Available online 20 December 2017
Source:Sleep Medicine
Author(s): Philip I. Chow, Karen Ingersoll, Frances P. Thorndike, Holly R. Lord, Linda Gonder-Frederick, Charles M. Morin, Lee M. Ritterband
ObjectiveIn a randomized clinical trial, to investigate the role of sleep-related cognitive variables in the long-term efficacy of an online, fully automated cognitive behavioral therapy intervention for insomnia (Sleep Healthy Using the Internet [SHUTi]).Method303 participants (Mage=43.3; SD=11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline, post intervention (9 weeks after baseline), 6- and 12-months after the intervention period. Cognitive variables were self-reported internal and chance sleep locus of control, dysfunctional beliefs and attitudes about sleep, sleep specific self-efficacy, and insomnia knowledge. Primary outcomes were self-reported online ratings of insomnia severity (Insomnia Severity Index), as well as sleep onset latency and wake after sleep onset from online sleep diaries, collected 12-months after the intervention period.ResultsThose who received SHUTi had, at post-assessment, higher levels of insomnia knowledge (95% CI=.10-.16) and internal sleep locus of control (95% CI=.04-.55), and lower dysfunctional beliefs and attitudes about sleep (95% CI=1.52-2.39) and sleep locus of control attributed to chance (95% CI=.15-.71). Insomnia knowledge, chance sleep locus of control, and dysfunctional beliefs and attitudes about sleep mediated the relationship between condition and at least one post 12-month sleep outcome. Within the SHUTi condition, changes in each cognitive variable (with the exception of internal sleep locus of control) predicted improvement in at least one sleep outcome one year later.ConclusionOnline CBT-I may reduce the enormous public health burden of insomnia by changing underlying cognitive variables that lead to long-term changes in sleep outcomes.



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