title: Weekly brief phone support in self-help cognitive behavioral therapy for insomnia disorder: Relevance to adherence and efficacy.
abstract: Self-help cognitive-behavioral therapy for insomnia (CBT-I) is an acceptable, low-intensity treatment in a stepped care model for insomnia. We tested the application of self-help CBT-I in a Chinese population. 312 participants with self-report of insomnia associated with distress or daytime impairment 3 or more nights per week for at least 3 months were randomized to self-help CBT-I with telephone support (SHS), self-help CBT-I (SH) and waiting-list (WL). The program was Internet-based with treatment materials delivered once per week, and lasted for 6 consecutive weeks, while the telephone support was limited to 15 min weekly. Mixed-effects analyses found significant group by time interaction in sleep and sleep-related cognitions at immediate and 4-week posttreatment. Post-hoc pairwise comparison with WL revealed that both SHS and SH had significantly higher sleep efficiency at immediate (p = .004 and p = .03, respectively) and 4-week posttreatment (p = .002 and p = .02, respectively) and lower insomnia and dysfunctional beliefs scores. The SHS group had additional improvements in sleep onset latency and sleep quality. Benefits with self-help CBT-I were maintained at 12-week posttreatment, but attrition rate was about 35%. Internet-based self-help CBT-I was effective and acceptable for treating insomnia in the Chinese population. A brief telephone support further enhanced the efficacy.
authors.affiliation: Department of Psychology, The University of Hong Kong, Hong Kong.
authors.forename: Fiona Yan-Yee
authors.initials: FY
authors.lastname: Ho
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong. Electronic address: kfchung@hkucc.hku.hk.
authors.forename: Ka-Fai
authors.initials: KF
authors.lastname: Chung
authors.affiliation: School of Chinese Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Wing-Fai
authors.initials: WF
authors.lastname: Yeung
authors.affiliation: Department of Psychology, Temple University, United States.
authors.forename: Tommy Ho-Yee
authors.initials: TH
authors.lastname: Ng
authors.affiliation: Dr. Sammy Cheng Psychological Services, Hong Kong.
authors.forename: Sammy Kin-Wing
authors.initials: SK
authors.lastname: Cheng
mesh_terms: D000328:Adult; D017668:Age of Onset; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008499:Medical Records; D010349:Patient Compliance; D017060:Patient Satisfaction; D012648:Self Care / Q000379:methods*; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome
keywords: Cognitive behavioral therapy; Insomnia; Internet; Psychological treatment; Randomized controlled trial; Self-help; Sleep