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Published on: April 26, 2024
Changes in sleep effort mediate insomnia severity in older adults following online cognitive behavioural therapy
Yvonne Kutzer1, Lisa Whitehead1, Eimear Quigley1,2
1Edith Cowan University, Perth, Western Australia, Australia.
Background:
To examine treatment mechanisms of digitally delivered cognitive behavioural therapy for insomnia (CBT-I), this study assessed the mediating effects of dysfunctional beliefs, hyperarousal, locus of control, self-efficacy, sleep effort, and safety behaviours on self-reported insomnia severity in older adults before and following the completion of a self-guided, online CBT-I program.
Methods:
The baseline and follow-up measurements were completed by 62 older adults (55 female, 89%). This was a two-condition within-participant design. Mediation analysis using a parallel mediation model was conducted using the MEMORE macro for repeated measure designs.
Results:
Out of all the included mediator variables, only a reduction in sleep effort scores (0.88; SE 0.51; 95% CI 0.001-2.00) significantly mediated changes in insomnia severity scores following the intervention. Insomnia severity scores significantly reduced following the intervention (Mpre = 9.84, SD = 5.89, Mpost = 6.87, SD = 4.90); t(61) = 5.19, P = <0.001; d = 0.55 95% CI 0.38-0.93.
Conclusions:
Sleep in older adults improved following digitally delivered CBT-I, and these changes were influenced by a reduction in sleep control efforts exerted by participants. These findings highlight possible treatment pathways of CBT-I. Further investigation of CBT-I as a strategy to prevent sleep problems is warranted.
Trial Registration:
Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451.
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