Zarski Anna-Carlotta, Bernstein Karina, Baumeister Harald, Lehr Dirk, Wernicke Stella, Küchler Ann-Marie, Kählke Fanny, Spiegelhalder Kai, Ebert David Daniel
Division of eHealth in Clinical Psychology, Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany.
Psychology and Digital Mental Health Care, TUM School of Medicine and Health, Technical University Munich, Munich, Germany.
J Med Internet Res. 2025 May 8;27:e58024. doi: 10.2196/58024.
Internet-based cognitive behavioral therapy for insomnia (iCBT-I) provides flexibility but requires significant time and includes potentially challenging components such as sleep restriction therapy. This raises questions about its incremental effectiveness compared to less demanding minimal interventions such as sleep hygiene psychoeducation.
This study aimed to assess the incremental efficacy of self-guided iCBT-I with optional on-demand feedback for university students with insomnia compared to a single session of digital psychoeducation on sleep hygiene.
In a randomized controlled trial, 90 students with insomnia (Insomnia Severity Index ≥10) were randomly allocated to self-help-based iCBT-I (45/90, 50%) or one session of digital sleep hygiene psychoeducation with stimulus control instructions (active control group [aCG]: 45/90, 50%). The self-help-based iCBT-I consisted of 6 sessions on psychoeducation, sleep restriction, and stimulus control, including written feedback on demand from an eCoach. Assessments occurred at baseline (T1), 8 weeks after treatment (T2), and at a 6-month follow-up (T3) via web-based self-assessment and diagnostic telephone interviews. The primary outcome was insomnia severity at T2. Analyses of covariance were conducted in an intention-to-treat sample. Secondary outcomes included diagnoses of insomnia and major depression, sleep quality, sleep efficiency, worrying, recovery experiences, recovery activities, presenteeism, procrastination, cognitive irritation, and recuperation in sleep.
There was no difference in insomnia severity at T2 between the iCBT-I group (mean 11.27, SD 5.21) and aCG group (mean 12.36, SD 4.16; F=1.12; P=.29; d=-0.26; 95% CI 0.68 to 0.17). A significant difference emerged at T3 (iCBT-I: mean 9.43, SD 5.36; aCG: mean 12.44, SD 5.39; F=4.72; P=.03), favoring iCBT-I with a medium effect (d=-0.57; 95% CI 1.07 to -0.06). Most secondary outcomes revealed no significant differences between the groups. In total, 51% (23/45) of participants in the iCBT-I group completed all 6 sessions, and 69% (31/45) completed the 4 core sessions.
In the short term, students might benefit from low-intensity, easily accessible digital sleep hygiene psychoeducation or iCBT-I. However, it appears that iCBT-I offers superiority over sleep hygiene psychoeducation in the long term.
German Clinical Trials Register DRKS00017737; https://drks.de/search/de/trial/DRKS00017737.
基于互联网的失眠认知行为疗法（iCBT - I）具有灵活性，但需要大量时间，且包含睡眠限制疗法等潜在具有挑战性的组成部分。这引发了与要求较低的最小干预措施（如睡眠卫生心理教育）相比，其增量有效性的问题。
本研究旨在评估与单次数字睡眠卫生心理教育相比，针对失眠大学生的带有可选按需反馈的自我引导式iCBT - I的增量疗效。
在一项随机对照试验中，90名失眠学生（失眠严重程度指数≥10）被随机分配至基于自助的iCBT - I组（45/90，50%）或接受一次包含刺激控制指导的数字睡眠卫生心理教育（积极对照组[aCG]：45/90，50%）。基于自助的iCBT - I包括6次关于心理教育、睡眠限制和刺激控制的课程，包括来自电子教练的按需书面反馈。通过基于网络的自我评估和诊断性电话访谈在基线（T1）、治疗后8周（T2）和6个月随访（T3）时进行评估。主要结局是T2时的失眠严重程度。在意向性分析样本中进行协方差分析。次要结局包括失眠和重度抑郁症的诊断、睡眠质量、睡眠效率、担忧、恢复体验、恢复活动、出勤主义、拖延、认知烦躁和睡眠恢复。
iCBT - I组（均值11.27，标准差5.21）和aCG组（均值12.36，标准差4.16；F = 1.12；P = 0.29；d = -0.26；95%置信区间0.68至0.17）在T2时失眠严重程度无差异。在T3时出现显著差异（iCBT - I：均值9.43，标准差5.36；aCG：均值12.44，标准差5.39；F = 4.72；P = 0.03），iCBT - I组具有中等效应优势（d = -0.57；95%置信区间1.07至 -0.06）。大多数次要结局在两组之间无显著差异。总体而言，iCBT - I组中51%（23/45）的参与者完成了所有6次课程，69%（31/45）完成了4次核心课程。
短期内，学生可能从低强度、易于获取的数字睡眠卫生心理教育或iCBT - I中受益。然而，从长期来看，iCBT - I似乎比睡眠卫生心理教育更具优势。
德国临床试验注册中心DRKS00017737；https://drks.de/search/de/trial/DRKS00017737
