Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review

Current Sleep Medicine Reports, May 2017

Purpose of Review Over the past decade, digital solutions have been developed to support the dissemination of Cognitive Behavioral Therapy (CBT). In this paper, we review the evidence for and implications of digital CBT (dCBT) for insomnia. Recent Findings We propose three categories of dCBT, which differ in the amount of clinician time needed, level of automatization, costs, and scalability: dCBT as support, guided dCBT, and fully automated dCBT. Consistent evidence has been published on the effectiveness of dCBT to address insomnia disorder, in a variety of populations, with effects extending into well-being. Important gaps in the literature are identified around moderators and mediators of dCBT, cost-effectiveness, and the implementation of dCBT. Summary The evidence base for dCBT is rapidly developing and already suggests that dCBT for insomnia is effective. However, further science and digital innovation is required to realize the full potential of dCBT and address important clinical questions.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs40675-017-0065-4.pdf

Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review

Curr Sleep Medicine Rep Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review Annemarie I. Luik 0 1 Simon D. Kyle 0 1 Colin A. Espie 0 1 0 Big Health Ltd , London , UK 1 Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford , OMPI G, South Parks Road, Oxford OX1 3RE , UK 2 Colin A. Espie Purpose of Review Over the past decade, digital solutions have been developed to support the dissemination of Cognitive Behavioral Therapy (CBT). In this paper, we review the evidence for and implications of digital CBT (dCBT) for insomnia. Recent Findings We propose three categories of dCBT, which differ in the amount of clinician time needed, level of automatization, costs, and scalability: dCBT as support, guided dCBT, and fully automated dCBT. Consistent evidence has been published on the effectiveness of dCBT to address insomnia disorder, in a variety of populations, with effects extending into well-being. Important gaps in the literature are identified around moderators and mediators of dCBT, costeffectiveness, and the implementation of dCBT. Summary The evidence base for dCBT is rapidly developing and already suggests that dCBT for insomnia is effective. However, further science and digital innovation is required to realize the full potential of dCBT and address important clinical questions. Insomnia; Cognitive Behavioral Therapy; Digital CBT Introduction The ubiquitous nature of web and smartphone technology has changed our lives in every way imaginable, including offering new approaches to the evaluation and treatment of many disorders. Over the past decade, digital solutions, for example via web and mobile devices, have been developed to support the dissemination of Cognitive Behavioral Therapy (CBT). These are of particular interest to the insomnia field because CBT has emerged as the recommended first-line therapy for insomnia [ 1 ]. Correspondingly, perhaps the 5-year period ending in December 2016 saw a substantial increase in published papers, with approximately one paper featuring digital CBT (dCBT) for insomnia published per month, whereas less than a handful of articles were published prior to 2012. Undoubtedly, therefore, the evidence base has substantially increased. However, CBT for insomnia, in whichever form, still faces a lot of challenges such as costs and scalability [ 2, 3 ]. Similar to the dissemination of conventional CBT, the dissemination of dCBT remains limited. What Is BDigital CBT^ for Insomnia? CBT has traditionally been a face-to-face talking therapy, delivered in a direct one-to-one relationship between patient and therapist. It also has been demonstrated that CBT can be provided successfully as a group therapy [ 4 ], in large workshops [ 5 ], as a self-help bibliotherapy [ 6 ], or by telephone [ 7 ]. These methods reflect attempts at Bscaling^ CBT to meet the population need. However, they are by no stretch sufficient if our ambition is to make CBT as ubiquitous as pharmacotherapy. It is in fact a perfectly reasonable ambition to provide CBT to the tens of millions of people who might benefit, considering that CBT’s evidence base is stronger than that of pharmacotherapy—the problem is that providing CBT to a large population is not even remotely feasible using traditional methods of dissemination. Potentially, technology can bridge that feasibility gap, with digital solutions offering the possibility of true scalability. Although several terms have been used to describe technological advances, for example internet CBT (iCBT), computerized CBT (cCBT), electronic CBT (eCBT), or online CBT (oCBT), we have suggested that the field recognizes and evolves towards the term Bdigital CBT (dCBT)^ to reflect the contemporary spectrum of digital technology, rather than one specific, and most likely historical aspect (e.g. computer or internet) that will soon enough be lost in the mists of time [ 3 ]. There can be little doubt that the pace of change in this digital age will afford unrelenting opportunity for the dissemination of dCBT. The corollary to this, however, is that all forms of dCBT will be perpetually out of date unless they remain at the forefront of digital innovation. Consequently, it will not be the provenance, content, validation, or outcome data associated with any particular dCBT program that determines its longevity but its level of execution. For clinicians and patients wherever they may be to have ready and sustained access to high quality, engaging, and effective CBT, we need both clinical excellence and creative genius, as illustrated in Fig. 1. Supportive to Fully Automated dCBT For convenience, to present a model of how CBT may be offered using technology, and to summarize progress in the field to date, we will use the term dCBT for all interventions, but the reader should note that the literature to date comprises everything from optimized web sites through t (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs40675-017-0065-4.pdf

Annemarie I. Luik, Simon D. Kyle, Colin A. Espie. Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review, Current Sleep Medicine Reports, 2017, pp. 48-56, Volume 3, Issue 2, DOI: 10.1007/s40675-017-0065-4