Background: Sleep hygiene is important for maintaining good sleep and reducing insomnia.
Objective: This study examined the long-term efficacy of a theory-based app (including cognitive behavioral therapy [CBT], theory of planned behavior [TPB], health action process approach [HAPA], and control theory [CT]) on sleep hygiene among insomnia patients.
Methods: The study was a 2-arm single-blind parallel-group randomized controlled trial (RCT). Insomnia patients were randomly assigned to a treatment group that used an app for 6 weeks (ie, CBT for insomnia [CBT-I], n=156) or a control group that received only patient education (PE, n=156) through the app. Outcomes were assessed at baseline and 1 month, 3 months, and 6 months postintervention. Primary outcomes were sleep hygiene, insomnia, and sleep quality. Secondary outcomes included attitudes toward sleep hygiene behavior, perceived behavioral control, behavioral intention, action and coping planning, self-monitoring, behavioral automaticity, and anxiety and depression. Linear mixed models were used to evaluate the magnitude of changes in outcomes between the two groups and across time.
Results: Sleep hygiene was improved in the CBT-I group compared with the PE group (P=.02 at 1 month, P=.04 at 3 months, and P=.02 at 6 months) as were sleep quality and severity of insomnia. Mediation analyses suggested that perceived behavioral control on sleep hygiene as specified by TPB along with self-regulatory processes from HAPA and CT mediated the effect of the intervention on outcomes.
Conclusions: Health care providers might consider using a CBT-I app to improve sleep among insomnia patients.
Trial Registration: ClinicalTrials.gov NCT03605732; https://clinicaltrials.gov/ct2/show/NCT03605732. Copyright © 2020 Nilofar Rajabi Majd, Anders Broström, Martin Ulander, Chung-Ying Lin, Mark D Griffiths, Vida Imani, Daniel Kwasi Ahorsu, Maurice M Ohayon, Amir H Pakpour.
|Journal||Journal of Medical Internet Research|
|Publication status||Published - Apr 2020|
CitationMajd, N. R., Broström, A., Ulander, M., Lin, C.-Y., Griffiths, M. D., Imani, V., . . . Pakpour, A. H. (2020). Efficacy of a theory-based cognitive behavioral technique app-based intervention for patients with insomnia: Randomized controlled trial. Journal of Medical Internet Research, 22(4). Retrieved from https://doi.org/10.2196/15841
- App-based intervention
- Cognitive behavioral therapy
- Sleep hygiene
- Theory of planned behavior