A Pilot Randomized Controlled Trial of a Tailored Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Persons with Inflammatory Rheumatic Diseases
Sleep disturbances are reported in up to 80% of persons with inflammatory arthritis (IA) and are poorly addressed. Cognitive-behavioral therapy for insomnia (CBTi) is the first-line insomnia treatment in the general population, but access is limited. Internet-delivered CBT for insomnia (ICBTi) overcomes accessibility barriers. A randomized waitlist-controlled pilot trial was conducted to determine the acceptability and preliminary efficacy of ICBTi for individuals with inflammatory arthritis and insomnia symptoms. Participants with IA and symptoms of insomnia were recruited through social media and patient-partner organizations and randomly assigned to the ICBTi treatment group (n= 24; 6 modules over 8 weeks) or the waitlist-control group (n= 26). Participants completed surveys at baseline, 8 weeks (post-treatment), and 3 months later. Treatment group participants completed questions about treatment perceptions. The Insomnia Severity Index (ISI) (maximum score of 28) assessed insomnia symptoms at each time point. Paired sample t-tests were used to analyze changes in ISI scores over time for each group. The sample included 50 participants with IA and insomnia symptoms (Table 1). Post treatment completion, most participants in the treatment group rated the ICBTi modules as moderately or extremely useful (84%) and were moderately or extremely satisfied (89%) with the program. Seventy-three percent of treatment group participants self-reported moderate or extreme improvements in sleep. However, only 52% of the treatment group completed the entire program. Feedback included wanting more relevance to arthritis and chronic pain, and a guide alongside the intervention. The mean baseline ISI score was 16.7 in the treatment group and 14.9 in the control group. Twenty treatment groups and 24 control group participants completed the 8-week survey. The mean (95% CI) change in ISI scores pre- to post-treatment in the treatment group was −4.95 (−6.77, −3.13), p<.001, and −0.94 (−.38, 2.26) in the control group, a non-significant difference. Eighteen treatment group and 21 control group participants completed the 3-month survey. The mean (95% CI) change in ISI scores from pre-treatment to the 3-month follow-up was −5.28 (−7.62, −2.93, p<.001) in the treatment group and −0.83 (−1.53, 3.20) in the control group, a non-significant difference. Table 1 Characteristics of the Sample The Internet-delivered CBTi program was acceptable and perceived as useful by most participants but could benefit from further adaptation to arthritis-specific needs. The results suggest efficacy of ICBTi among individuals with arthritis. A larger randomized-controlled trial with a larger, more diverse sample is needed to determine the effectiveness of using ICBTi to help people manage the double-burden of insomnia and arthritis. Supported by a CIORA grant