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Cited by 97Sleep and related disordersCOVID-19 and Mental HealthDigital Mental Health Interventions

Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic

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Cheng, Philip, Casement, Melynda D, Kalmbach, David A, Castelan, Andrea Cuamatzi, Drake, Christopher L·2021·Sleep
DOI 10.1093/sleep/zsaa258PMC PMC7798633
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Abstract

Study Objectives: Stressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic. Methods: COVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016–2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic. Results: Insomnia symptoms were significantly associated with COVID-19 related disruptions, and those who previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition. Conclusions: Those who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic. Clinical Trial Registration: NCT02988375

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  • In a randomized trial by Cheng and colleagues, the digital CBT-i group had significantly fewer insomnia symptoms, stress, cognitive intrusions, and depression than the education-only control during the pandemic.

    “The digital CBT-i group had significantly less insomnia symptoms, stress, cognitive intrusions and depression [12].”

    From Overview of sleep management during COVID-19. (2022) · cites this paper as [12]

    The Results sections on insomnia, stress, and health during COVID-19 report significantly lower insomnia symptoms, COVID-related cognitive intrusions, and depressive symptoms in the prior dCBT-I group than in the sleep-education control. COVID-specific stress was also significantly lower, but general stress showed only a trend (p = 0.055), so the claim overstates the significance of the general-stress finding. (LLM, conf=0.90)

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  • For specific management of COVID-19 sleep dysfunction, five CBT studies were available: two controlled insomnia trials, one worry/secondary insomnia study, one case study, and one small online child study.

    “As to specific management of sleep dysfunction during COVID-19, five studies of cognitive behavioral therapy (CBT) were available – two controlled trials of insomnia [11,12], one focused on worry and secondary insomnia [13], one case study [14] and a small online study in children [15].”

    From Overview of sleep management during COVID-19. (2022) · cites this paper as [12]

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Research works printed but not linked: 61

  1. [4]Rajkumar RP. COVID-19 and mental health: a review of the existing literature. Asian J Psychiatr. 2020; 52: 102066. 32302935 PMC7151415
  2. [5]Cellini N, et al Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020; 29(4): e13074. 32410272 PMC7235482
  3. [12]Germain A, et al Sleep in PTSD: conceptual model and novel directions in brain-based research and interventions. Curr Opin Psychol. 2017; 14: 84– 89. 28813325
  4. [13]Manber R, et al Insomnia and depression: a multifaceted interplay. Curr Psychiatry Rep. 2009; 11(6): 437– 442. 19909664
  5. [14]Vargas I, et al Insomnia and depression: clinical associations and possible mechanistic links. Curr Opin Psychol. 2020; 34: 95– 99. 31846870 PMC12172691
  6. [16]Hertenstein E, et al Insomnia as a predictor of mental disorders: a systematic review and meta-analysis. Sleep Med Rev. 2019; 43: 96– 105. 30537570
  7. [17]Pigeon WR, et al Insomnia as a precipitating factor in new onset mental illness: a systematic review of recent findings. Curr Psychiatry Rep. 2017; 19(8): 44. 28616860
  8. [18]Li L, et al Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2016; 16(1): 375. 27816065 PMC5097837
  9. [19]Soehner AM, et al Prevalence and clinical correlates of co-occurring insomnia and hypersomnia symptoms in depression. J Affect Disord. 2014; 167: 93– 97. 24953480 PMC4291280
  10. [20]O’Brien EM, et al Severe insomnia is associated with more severe presentation and greater functional deficits in depression. J Psychiatr Res. 2011; 45(8): 1101– 1105. 21306733
  11. [22]Brownlow JA, et al Influence of sleep disturbance on global functioning after posttraumatic stress disorder treatment. J Trauma Stress. 2016; 29(6): 515– 521. 27859588
  12. [23]Mason EC, et al Insomnia before and after treatment for anxiety and depression. J Affect Disord. 2014; 168: 415– 421. 25108278
  13. [24]Pigeon WR, et al Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. J Psychosom Res. 2013; 75(6): 546– 550. 24290044
  14. [25]Schnurr PP, et al Residual symptoms following prolonged exposure and present-centered therapy for PTSD in female veterans and soldiers. Depress Anxiety. 2019; 36(2): 162– 169. 30576030
  15. [26]Larsen SE, et al Residual symptoms following empirically supported treatment for PTSD. Psychol Trauma. 2019; 11(2): 207– 215. 29963892
  16. [27]Xiao L, et al Comparison of residual depressive symptoms and functional impairment between fully and partially remitted patients with major depressive disorder: a multicenter study. Psychiatry Res. 2018; 261: 547– 553. 29407721
  17. [30]Kalmbach DA, et al Sleep system sensitization: evidence for changing roles of etiological factors in insomnia. Sleep Med. 2016; 21: 63– 69. 27448474 PMC4963610
  18. [31]Morin CM, et al Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med. 2003; 65(2): 259– 267. 12651993
  19. [32]Palagini L, et al Lack of resilience is related to stress-related sleep reactivity, hyperarousal, and emotion dysregulation in insomnia disorder. J Clin Sleep Med. 2018; 14(5): 759– 766. 29734989 PMC5940426
  20. [33]Ebert DD, et al It is time to invest in the prevention of depression. JAMA Netw Open. 2018; 1(2): e180335. 30646081
  21. [34]Germain A, et al Sleep and resilience—a call for prevention and intervention. Sleep. 2016; 39(5): 963– 965. 27091522 PMC4835317
  22. [35]Taylor DJ, et al Insomnia as a health risk factor. Behav Sleep Med. 2003; 1(4): 227– 247. 15600216
  23. [36]Dolsen MR, et al Insomnia as a transdiagnostic process in psychiatric disorders. Curr Psychiatry Rep. 2014; 16(9): 471. 25030972 PMC4185311
  24. [37]Qaseem A, et al; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016; 165(2): 125– 133. 27136449
  25. [39]Cheng P, et al Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial. Psychol Med. 2019; 49(3): 491– 500. 29792241 PMC7050476
  26. [40]Pillai V, et al. The anxiolytic effects of cognitive behavior therapy for insomnia: preliminary results from a web-delivered protocol. J Sleep Med Disord. 2015; 2(2): 1017. 32195356 PMC7081886
  27. [41]Cheng P, et al Depression prevention in digital cognitive behavioral therapy for insomnia: Is rumination a mediator? J Affect Disord. 2020; 273: 434– 441. 32560938
  28. [43]Espie CA, et al Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: a randomized clinical trial. JAMA Psychiatry. 2019; 76(1): 21– 30. 30264137 PMC6583463
  29. [44]Cheng P, et al Depression prevention via digital CBT for insomnia: a randomized controlled trial. Sleep. 2019; 42(10). doi: 10.1093/sleep/zsz150. PMC6783888 31535688 · DOI
  30. [45]Cheng P, et al Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial. Psychol Med. 2018; 49(3): 491– 500. 29792241 PMC7050476
  31. [48]Espie CA, et al The daytime impact of DSM-5 insomnia disorder: comparative analysis of insomnia subtypes from the Great British Sleep Survey. J Clin Psychiatry. 2012; 73(12): e1478– 84. 23290331
  32. [49]Gray MJ, et al Psychometric properties of the life events checklist. Assessment. 2004; 11(4): 330– 341. 15486169
  33. [51]Elo A-L, et al Validity of a single-item measure of stress symptoms. Scand J Work Environ Health. 2003; 444– 451. 14712852
  34. [52]Salminen S, et al Is a single item stress measure independently associated with subsequent severe injury: a prospective cohort study of 16,385 forest industry employees. BMC Public Health. 2014; 14(1): 543. 24884543 PMC4047775
  35. [53]Weiss DS, et al The impact of event scale-revised. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma and PTSD. New York: Guilford Press; 1997: 399– 411.
  36. [54]Rush AJ, et al The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003; 54(5): 573– 583. doi: 10.1016/S0006-3223(02)01866-8 12946886 · DOI · Paper page
  37. [56]Zhao Q, et al BETS: the dangers of selection bias in early analyses of the coronavirus disease (COVID-19) pandemic. ArXiv Prepr ArXiv200407743. 2020.
  38. [57]Sullivan SG. The need for robust epidemiological evidence during a pandemic. Clin Infect Dis. 2020. PMC7454378 32544943
  39. [58]Kalmbach DA, et al Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education. Sleep Med. 2019; 55: 124– 134. 30785053 PMC6503531
  40. [61]Batterham PJ, et al Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression. BJPsych Open. 2017; 3(5): 228– 235. doi: 10.1192/bjpo.bp.117.005231. 28959453 PMC5611538 · DOI
  41. [62]Nano M-M, et al Measures of cardiovascular autonomic activity in insomnia disorder: A systematic review. PLoS One. 2017; 12(10): e0186716. doi: 10.1371/journal.pone.0186716. 29059210 PMC5653329 · DOI
  42. [63]Dodds KL, et al Heart rate variability in insomnia patients: A critical review of the literature. Sleep Med Rev. 2017; 33: 88– 100. doi: 10.1016/j.smrv.2016.06.004. 28187954 · DOI
  43. [64]Carter JR, et al Assessment of sympathetic neural activity in chronic insomnia: evidence for elevated cardiovascular risk. Sleep. 2018; 41(6). doi: 10.1093/sleep/zsy048. PMC5995193 29522186 · DOI
  44. [65]Jarrin DC, et al Cardiovascular autonomic dysfunction in insomnia patients with objective short sleep duration. J Sleep Res. 2018; 27(3): e12663. doi: 10.1111/jsr.12663. 29493063 PMC5992004 · DOI
  45. [68]Kuisk LA, et al Presleep cognitive hyperarousal and affect as factors in objective and subjective insomnia. Percept Mot Skills. 1989; 69(3-2): 1219– 1225. doi: 10.1177/00315125890693-228. 2622737 · DOI
  46. [69]Bonnet MH, et al Hyperarousal and insomnia: State of the science. Sleep Med Rev. 2010; 14(1): 9– 15. doi: 10.1016/j.smrv.2009.05.002. 19640748 · DOI · Paper page
  47. [70]Kalmbach DA, et al Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep. 2018; 10: 193– 201. doi: 10.2147/NSS.S138823. 30046255 PMC6054324 · DOI
  48. [72]Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015; 147(4): 1179– 1192. doi: 10.1378/chest.14-1617. 25846534 PMC4388122 · DOI
  49. [73]Riemann D, et al The neurobiology, investigation, and treatment of chronic insomnia. Lancet Neurol. 2015; 14(5): 547– 558. doi: 10.1016/S1474-4422(15)00021-6. 25895933 · DOI
  50. [74]Irwin MR, et al Cognitive behavioral therapy and Tai Chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial. Biol Psychiatry. 2015; 78(10): 721– 729. doi: 10.1016/j.biopsych.2015.01.010. 25748580 PMC4524803 · DOI · Paper page
  51. [75]Marques DR, et al Neurobiological correlates of psychological treatments for insomnia. Eur Psychol. 2016; 21(3): 195- 205. doi: 10.1027/1016-9040/a000264. · DOI
  52. [76]Casement MD, et al Neural reward processing mediates the relationship between insomnia symptoms and depression in adolescence. Sleep. 2016; 39(2): 439– 447. doi: 10.5665/sleep.5460. 26350468 PMC4712408 · DOI
  53. [78]Ancoli-Israel S, et al Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999; 22(Suppl 2): S347– S353. 10394606
  54. [79]Sarsour K, et al The association between insomnia severity and healthcare and productivity costs in a health plan sample. Sleep. 2011; 34(4): 443- 450. doi: 10.1093/sleep/34.4.443. 21461322 PMC3065254 · DOI
  55. [80]Stoller MK. Economic effects of insomnia. Clin Ther Int Peer-Rev J Drug Ther. 1994; 16(5): 873– 897. 7859246
  56. [81]McCrae Christina S, et al Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med. 2014; 10(2): 127- 135. doi: 10.5664/jcsm.3436. 24532995 PMC3899314 · DOI
  57. [82]Snedecor SJ, et al Cost-effectiveness of Eszopiclone for the treatment of adults with primary chronic insomnia. Sleep. 2009; 32(6): 817- 824. doi: 10.1093/sleep/32.6.817. 19544759 PMC2690570 · DOI
  58. [83]Jhaveri M, et al Will insomnia treatments produce overall cost savings to commercial managed-care plans? a predictive analysis in the United States. Curr Med Res Opin. 2007; 23(6): 1431- 1443. doi: 10.1185/030079907X199619. 17559740 · DOI
  59. [84]Asche CV, et al The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder. Curr Med Res Opin. 2010; 26(8): 1843- 1853. doi: 10.1185/03007995.2010.488037. 20515321 · DOI
  60. [85]Bramoweth AD, et al Chronic insomnia and health care utilization in young adults. Behav Sleep Med. 2012; 10(2): 106- 121. doi: 10.1080/15402002.2011.587067. 22468929 · DOI
  61. [86]Ho FY-Y, et al Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials. Sleep Med Rev. 2015; 19: 17- 28. doi: 10.1016/j.smrv.2014.06.010. 25104471 · DOI

Cited by

Sorted by citations

Authors
Cheng, P., Casement, M. D., Kalmbach, D. A., Castelan, A. C., & Drake, C. L.
Affiliations
  • Henry Ford Health (US)
  • University of Oregon (US)
Corresponding author
Cheng, Philip
ORCID
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
2020-11-29
Volume
44
Issue
4
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/zsaa258
PMC
PMC7798633
OpenAlex
W3109523581
Cited by
97
References
22
Citations by year
2026: 2 · 2025: 12 · 2024: 13 · 2023: 23 · 2022: 27 · 2021: 20
FWCI
16.93
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • SLEEP (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
digital cognitive behavioral therapy for insomnia, insomnia, health resilience, COVID-19 pandemic, stress, depression, sleep education, mental health, global health
MeSH terms
COVID-19, SARS-CoV-2, Adult, Depression, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Pandemics

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