Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 7, 2024
Date Accepted: Jan 16, 2025
Efficacy of a self-guided internet intervention with optional feedback on demand versus digital sleep hygiene psychoeducation for university students suffering from insomnia: A randomized controlled trial
ABSTRACT
Background:
Internet-based cognitive behavioral therapy for insomnia (iCBT-I) provides flexibility but requires significant time and includes potentially challenging components like sleep deprivation. This raises questions about its incremental effectiveness compared to less demanding minimal interventions like psychoeducation.
Objective:
This study aimed to assess the incremental efficacy of iCBT-I for university students with insomnia compared to a single session of digital sleep hygiene psychoeducation.
Methods:
In a randomized controlled trial, 90 students with insomnia (Insomnia Severity Index [ISI] ≥ 10) were randomly allocated to self-help based iCBT-I (n=45) or one session of digital psychoeducation (aCG, n=45). The self-help-based iCBT-I consisted of six sessions on psychoeducation, sleep restriction, and stimulus control including written feedback on demand by an eCoach. Assessments occurred at baseline (T1), 8 weeks post-treatment (T2), and 6-month follow-up (T3) via online self-assessment and diagnostic telephone interviews. The primary outcome was insomnia severity at T2. Analyses of covariance were conducted in an intention-to-treat sample. Secondary outcomes included diagnosis of insomnia and major depression, sleep quality, sleep efficiency, worrying, recovery experiences, recovery activities, presenteeism, procrastination, cognitive irritation, and recuperation in sleep.
Results:
There was no difference in insomnia severity at T2 between iCBT-I (M=11.27, SD=5.21) and aCG (M=12.36, SD=4.16; F(1, 989.03)=1.12, p=.29; d=-0.26, 95%-CI:-0.68—0.17). A significant difference emerged at T3 (iCBT-I: M=9.43, SD=5.36; aCG: M=12.44, SD=5.39; F(1, 426.15)=4.72, p=.03), favoring iCBT-I with a medium effect (d=-.57, 95%-CI:-1.07— -0.06). Secondary outcomes showed no significant effects. In total, 51.1% (n=23/45) of participants in iCBT-I completed all six sessions, and 68.9% (n=31/45) completed the four core sessions.
Conclusions:
In the short term, students might similarly benefit from low-intensity, easily accessible sleep hygiene psychoeducation or iCBT-I. However, it appears that iCBT-I offers superiority over psychoeducation in the long term. Clinical Trial: Registry's URL and the trial's registration number: https://drks.de/search/de/trial/DRKS00017737, DRKS00017737
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