The Program Development Of A Digital Brief Therapy For Insomnia And The Study Of Its Adherence And Efficacy For Patients With Acute Insomnia Disorder

Objectives:Insomnia disorder represents a prevalent mental health issue that has a profound impact on the mental well-being of the Chinese population.Brief therapy for insomnia(BTI)has been identified as an effective treatment for insomnia.While offline implementation of this therapy faces several limitations,such as therapist shortages,lack of timeliness and high costs,which preclude many acute insomnia patients from receiving the necessary care.Concurrently,digital medicine has experienced tremendous growth in recent years and has emerged as a focal point of research in numerous fields.To address the limitations of offline treatment,this study represents the first attempt to integrate BTI with digital technology,resulting in the creation of digital brief therapy for insomnia(dBTI).This study seeks to evaluate the clinical effectiveness of dBTI,explore its implementation in various age groups of acute insomnia patients,investigate the factors that influence overall compliance,and examine the relationship between treatment efficacy and compliance.This study aims to provide a more convenient and effective digital solution for the treatment of acute insomnia patients.Methods:(1)Based on the MINA framework of WeChat Mini Program,the five treatment modules of BTI(Sleep hygiene education,Sleep restriction,Stimulus control,Relaxation training,and Cognitive therapy)were restructured to develop the first dBTI program.(2)A total of 194 acute insomnia patients who met the criteria were included for dBTI intervention and underwent online evaluations at baseline and after intervention.The participants were stratified by age group into<35 years old(N=87)and≥35 years old(N=107)and categorized into three adherence groups,namely poor completion rate group(N=62),good completion rate group(N=57),and excellent completion rate group(N=75).The main efficacy indicators were the Insomnia Severity Index(ISI),the Pre-sleep Arousal Scale(PSAS),and the Hospital Anxiety and Depression Scale(HADS).(3)Statistical analyses included descriptive statistics,t-tests,chi-square tests,analysis of variance,multiple logistic regression analysis,repeated measures analysis of variance,and non-binary propensity score matching.Data analysis was performed using SPSS 26.0 and R 4.2.2.Results:(1)The first dBTI program has been designed,which includes five treatment modules:sleep restriction,stimulus control,relaxation training,cognitive therapy,and three functions:baseline evaluation,treatment,and post-treatment evaluation.(2)Among the participants included in the study,68%completed more than half of the treatment tasks.(3)Regarding age stratification:There was no significant difference in task completion between the<35 years old and≥35 years old groups(P>0.05).Significant group effects were observed between the two age groups in terms of PSAS somatic arousal scores(F=5.48,P=0.021),PSAS cognitive arousal scores(F=5.48,P=0.021),HADS anxiety scores(F=11.62,P=0.001),and HADS depression scores(F=10.36,P=0.002).Time effects were significant in ISI scores(F=120.60,P<0.001),PSAS cognitive arousal scores(F=16.17,P<0.001),HADS anxiety scores(F=15.08,P<0.001),and HADS depression scores(F=34.09,P<0.001).There was no statistically significant time×group interaction effect in any of the score measurements(all P>0.05).(4)Adherence Influencing Factors:Male patients were more likely to have a completion rate of "good" compared to female patients(OR:2.196;P=0.044).Patients with a sleep latency of 31-60 minutes showed better compliance compared to those with a sleep latency>60 minutes(OR:0.343,P=0.027 for completion rate difference vs.completion rate optimal;OR:0.195,P=0.003 for completion rate good vs.completion rate optimal).Furthermore,patients with a lower score on the PSAS somatic arousal sub-scale had a higher tendency to achieve a good completion rate compared to those with a higher score(OR:3.267;P=0.005).(5)The relationship between efficacy and adherence:The scores on the PSAS somatic arousal sub-scale for the group with poor completion rate group increased from 17.5 points at baseline to 21.4 points,while the scores for the good completion rate group increased slightly from 17.2 to 17.7 points,and those for the excellent completion rate group decreased from 16.5 to 12.2 points.The group effect(F=4.438,P=0.016)and the time×group interaction effect(F=3.200,P=0.049)were significant.Similarly,the scores on the PSAS cognitive arousal sub-scale for the poor completion rate group increased from 21.6 points at baseline to 22.4 points,while those for the good completion rate group decreased from 24.4 to 18.1 points,and those for the excellent completion rate group decreased from 22.2 to 16.8 points.The time effect(F=11.925,P=0.001)and the time×group interaction effect(F=4.590,P=0.013)were significant.The time effect was also significant for the ISI score,as well as for the anxiety and depression sub-scales of the HADS(all P<0.05).Conclusions:This study presents a convenient and effective digital treatment approach for patients with acute insomnia.