Efficacy of repeated self-guided digital cognitive behavioral therapy for chronic insomnia: A pilot open-label study...

This study aimed to assess whether a second course of digital cognitive behavioral therapy for insomnia (dCBT-I) could benefit patients with chronic insomnia who had suboptimal responses to the initial fully self-guided dCBT-I.

Building on a previous randomized controlled trial (RCT), participants with an Insomnia Severity Index (ISI) score ≥8 at 6 months after completing the initial digital CBT-I therapy were invited to enroll in the second phase of the study. Among the 20 eligible participants, 9 received a second round of digital dCBT-I therapy, 6 participated in follow-up only. Primary outcomes included changes in ISI scores and ISI remission rates (defined as ISI <8). Secondary outcomes included sleep attitudes and beliefs, as well as mental health questionnaire scores.

Among patients who did not achieve full remission after the first course of digital CBT-I, 44.4% and 62.5% of participants experienced a reduction in their ISI scores to <8 following the second course of treatment and at the 3-month follow-up, respectively. Following the second treatment, ISI scores showed a trend of continued decrease, but no statistically significant difference was observed compared to the baseline before the second treatment (p > 0.05). Sleep-related attitudes and beliefs, as measured by the DBAS-16 scale, also significantly improved after the second round of treatment (p < 0.05). At the 3-month follow-up, the second treatment group showed a greater improvement in ISI scores (3.00(1.25, 5.00)) compared to the follow-up only group (-1.50(-3.25, 0.50)) (p < 0.05).

The present study suggests that a second course of digital CBT-I may benefit chronic insomnia patients who initially fail to achieve ISI remission after the first round of self-guided digital CBT-I. However, larger randomized controlled trials are needed to definitively assess its effectiveness.