Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Prognostic and Treatment-Predictive Factors

Understanding which factors predict the outcome of internet-based cognitive behavioral therapy for insomnia (iCBT-I) may help to tailor this intervention to the patient's needs. We have conducted a secondary analysis of a randomized, controlled trial comparing a multicomponent iCBT-I (MCT) and an online sleep restriction therapy (SRT) for 83 chronic insomnia patients. The difference in the Insomnia Severity Index from pre- to post-treatment and from pre-treatment to follow-up at 6 months after treatment was the dependent variable. Prognostic and treatment-predictive factors assessed at baseline were analyzed with multiple linear regression. The shorter duration of insomnia, female gender, high health-related quality of life, and the higher total number of clicks had prognostic value for a better outcome. Other factors were found to be prognostic for outcome at the follow-up assessment: treatment with benzodiazepines, sleep quality, and personal significance of sleep problems. A high level of dysfunctional beliefs and attitudes about sleep (DBAS) was a moderator for better effects in the MCT at post-treatment assessment. Various prognostic factors (e.g., duration of insomnia, gender, or quality of life) may influence the success of treatment. The DBAS scale may be recommended to select patients for MCT rather than SRT.

Automated summary

Understanding the factors that predict the outcome of internet-based cognitive behavioral therapy for insomnia (iCBT-I) can help tailor the intervention to each patient. A secondary analysis of a trial comparing multicomponent iCBT-I and online sleep restriction therapy for 83 chronic insomnia patients was conducted. Prognostic and treatment-predictive factors were analyzed, revealing that duration of insomnia, gender, health-related quality of life, and total number of clicks were predictive of better outcomes. The study also found that treatment with benzodiazepines, sleep quality, and personal significance of sleep problems were prognostic for outcomes at follow-up assessment.