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Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial

Published online by Cambridge University Press:  23 August 2021

Christian S. Chan Open the ORCID record for Christian S. Chan [Opens in a new window] ,
Christy Y. F. Wong ,
Branda Y. M. Yu Open the ORCID record for Branda Y. M. Yu [Opens in a new window] ,
Victoria K. Y. Hui Open the ORCID record for Victoria K. Y. Hui [Opens in a new window] ,
Fiona Y. Y. Ho  and
Pim Cuijpers Open the ORCID record for Pim Cuijpers [Opens in a new window]
Christian S. Chan*
Affiliation:
The University of Hong Kong, Hong Kong
Christy Y. F. Wong
Affiliation:
The University of Hong Kong, Hong Kong
Branda Y. M. Yu
Affiliation:
The University of Hong Kong, Hong Kong
Victoria K. Y. Hui
Affiliation:
The University of Hong Kong, Hong Kong
Fiona Y. Y. Ho
Affiliation:
Chinese University of Hong Kong, Hong Kong
Pim Cuijpers
Affiliation:
Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
*
Author for correspondence: Christian S. Chan, E-mail: [email protected]
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Abstract

Background

Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia.

Methods

A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, proACT-S, or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up.

Results

Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's d = 0.86, 95% CI (−10.11 to −5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's d = 1.00, 95% CI (−5.93 to −3.53)], and anxiety [Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A): Cohen's d = 0.83, 95% CI (−3.75 to −1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's d = 0.91, 95% CI (−3.34 to −1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment.

Conclusion

proACT-S is an efficacious sleep-focused self-help treatment for major depression and insomnia.

Trial registration

ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. https://clinicaltrials.gov/ct2/show/NCT04228146

Keywords

Cognitive behavioral therapy for insomniainsomniamajor depressionsleep disturbancesmartphone intervention
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 5 , April 2023 , pp. 1799 - 1813
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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