Low-intensity cognitive-behavioural therapy for insomnia as the entry of the stepped-care model : evaluation with a randomised controlled trial

Abstract

Introduction: Cognitive behavioural therapy for insomnia (CBTI), the first-line treatment for chronic insomnia, is applied under the stepped-care model for better resource allocation. At the entry, apart from self-help CBTI, the large-group workshop is an emerging potential. To identify an effective and suitable entry in the local community, a randomised controlled trial was conducted to compare the CBTI workshop (CBTIw) and online CBTI (sCBTI) with the active control, sleep hygiene education workshop (SHEw), in terms of alleviation in insomnia severity and mood symptoms, improvement in the quality of life, treatment compliance, and credibility. Methodology: A total of 210 local dwellers with insomnia for one month or more were recruited online and in public areas. They were block-randomised into CBTIw, sCBTI, and SHEw in an equal proportion. Both CBTIw and SHEw received a single-session four-hour workshop delivered by a psychiatric nurse in a university while sCBTI reviewed on a webpage. Follow-ups took place 8 and 16 weeks after the baseline. Measurements included the Insomnia Severity Index (primary outcome measure), the Hospital Anxiety and Depression Scale, the Short-Form Six-Dimension Health Survey, the Treatment Credibility Rating Scale, and compliance. Interaction effects were analysed by linear mixed modelling. Results: All the groups showed significant, comparable, and lasting effects on improving sleep, mood, and quality of life. Treatment compliance was suboptimal but similar between the arms. Treatment credibility reduced in sCBTI but heightened in CBTIw (p = 0.037). Discussion/Conclusion: With comparable effects, additional factors, including participant compliance, credibility, and preference for the delivery mode, should be considered when applying low-intensity interventions in the community. The difference in treatment credibility can be related to the perception of the formats. CBTI workshops fit the participants who value face-to-face interaction, while online CBTI is suitable for those preferring self-progress. Comprehensive SHE is an alternative in resource-limited areas. Improving compliance is vital to maximise the effects of the interventions in the community. With the popularisation of telehealth, more entry treatments for insomnia are anticipated with added benefits to raise the accessibility, availability, convenience, and compliance.