Unguided online Cognitive Behavioral Therapy for insomnia in General Practice: a mixed method study

Abstract Background Sleep contributes to physical, cognitive and emotional restoration. Sleep problems may eventually cause physical and mental dysfunctions. Insomnia symptoms are the most common, leading to insufficient sleep. Unguided online interventions for insomnia merit further study, because of their potential for care avoiders and their potential cost-efficiency in General Practice settings. The research question is which factors contribute to its' effectiveness and intention to use. Methods A mixed method approach was implemented with patients with insomnia symptoms of a General Practice in Amsterdam. Semi- structured in-depth interviews were administered after completion of an online CBTI of five sessions (N = 7 females; age from 30 to 54) A questionnaire was administered (N = 118; female: 68%; [Mean age = 24.5, sd = 7.8]) Severity of insomnia was measured with the ISI. Regression analysis was deployed in a prediction model to predict intention to use unguided online CBTI based on the Technology Acceptance Model. Results The interviews revealed that the level of knowledge, duration of the intervention and severity of symptoms contributed to the effectiveness of online CBTI. Additionally, therapeutic support is needed to convert knowledge into action. Unguided CBTI is more suitable for individuals with onset or milder insomnia symptoms. Results of the questionnaire indicated that the severity of symptoms predicted the intention to use. F(8, 110) = 14.36, p = .000; β = 0.20, t(113) = 3.01, p = 0.003. Conclusions These findings indicate a healthcare challenge: online unguided CBTI is perhaps more suitable for individuals with onset or milder symptoms, however they are less inclined to use such an intervention. Therefore, their awareness of potential CBTI treatments should be increased. Furthermore, the level of knowledge and capability to transfer that knowledge into action should be considered in order to determine the amount of support an individual needs. Key messages Unguided online CBTI has potential for insomnia patients in a General Practice setting; awareness of this should especially increase amongst those with less severe symptoms. Online CBTI for insomnia should also take into account, the level of knowledge and capability to transfer that knowledge into action to determine its content and communication.