Authors (including presenting author) :
Amy Pui Ling Kwok,(1) Xiao Li,(2) Shirley Xin Li (2)
Affiliation :
1. Department of Clinical Psychology, Pamela Youde Nethersole Eastern Hospital
2. Department of Psychology, The University of Hong Kong
Introduction :
Insomnia is one of the most common health complaints in both general and clinical populations. It is often associated with substantial personal distress and daytime impairments, and if left untreated, may run a persistent course and lead to a constellation of negative outcomes. Although cognitive-behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment for adult insomnia, the accessibility and scalability of this intervention remained limited due to several constraints, such as limited trained therapists, long waiting time, and geographical limitations. As such, there is a need to explore alternative treatment modality (e.g. telehealth care) to address these barriers, especially in the context of ongoing pandemic.
Objectives :
1) To evaluate the effectiveness of telehealth-delivered CBT-I with telephone support, as compared to care-as-usual (CAU), in a sample of adult psychiatric outpatients in Hong Kong; 2) To examine whether improvement of insomnia is mediated by changes in sleep-related dysfunctional beliefs.
Methodology :
This study was a randomised controlled trial conducted in the hospitals of the New Territories East Cluster. Eligible participants aged 18 or above meeting DSM-5 diagnostic criteria of insomnia disorder were randomised to either treatment group or CAU group. The treatment involved providing five weekly 60-min online educational videos based on the key therapeutic elements of CBT-I (e.g. stimulus control, sleep restriction, cognitive restructuring), followed by a brief weekly telephone support session (15-min) with a therapist, over a 6-week period. All participants were assessed at baseline and post-treatment, and participants in the intervention group were additionally followed up at post-treatment 3-month. The primary outcome was Insomnia Severity Index (ISI).
Result & Outcome :
A total of 41 adults (mean age: 15±12.26, female: 90%) were recruited (Treatment: N = 20, CAU: N = 21). At post-treatment, the CBT-I group showed significant improvements in insomnia symptoms as measured by ISI (Cohen’s d = 0.681 , p = 0.004), less sleep-related dysfunctional belief as measured by Dysfunctional Beliefs and Attitudes about Sleep (DBAS) (Cohen’s d = 1.228, p = 0.006), and lower stress level as measured by Depression Anxiety stress Scale (DASS) - stress subscale (Cohen’s d = 0.627, p = 0.035) compared to the CAU group. These improvements were able to sustained at three-month follow-up. Moreover, the treatment group had a significant reduction in DASS total score and anxiety subscale score at three-month follow-up compared to baseline. The improvement of insomnia symptoms from baseline to post-treatment was mediated by a reduction in sleep-related dysfunctional belief.
The findings support that a brief telehealth-delivered CBT-I with telephone support programme may be a promising, efficient means of providing timely intervention to psychiatric outpatients.
Clinical trial registration: NCT04653155
