TY - JOUR
T1 - Does adjunctive digital CBT for insomnia improve clinical outcomes in an improving access to psychological therapies service?
AU - Stott, Richard
AU - Pimm, John
AU - Emsley, Richard
AU - Miller, Christopher B
AU - Espie, Colin A
N1 - Funding Information:
This study was funded by an Innovate UK grant and Big Health Ltd (Sleepio). It was supported by the NIHR Oxford Health Biomedical Research Centre , and the Oxford Academic Health Science Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. We are grateful to all the staff at Healthy Minds Buckinghamshire, including Reena Thomas, Arnya Gumbs and Kate Smart who helped with clinical implementation.
Funding Information:
The IAPT programme in England assesses approximately one million people each year and offers evidence-based psychological interventions, primarily for diagnoses of anxiety and depression (Clark, 2018). These services utilise a stepped-care model whereby most patients begin with a low-intensity intervention, such as a psychoeducation group, or computer-based CBT package, supported by a Psychological Wellbeing Practitioner (PWP). A subset of patients for whom low-intensity interventions are not indicated, or who do not benefit from this step, can be ?stepped up?, typically to individual treatment involving weekly sessions with a psychological therapist trained to use specific evidence-based models of treatment for the identified disorder.One IAPT service, in Buckinghamshire, UK, offered Sleepio as a scalable and fully automated approach to all patients with possible sleep problems, as an adjunctive intervention option alongside treatment as usual. This was possible in the context of an Innovate UK award to explore different approaches to commissioning and disseminating digital therapeutics in the Thames Valley region during 2018?2019, and which is reported elsewhere (Williams, Stott, Bromwich et al., 2020). The Buckinghamshire IAPT service routinely treats in excess of 5000 patients per year for anxiety and depression. Therefore we report here a large, observational, service-led audit study investigating the routine incorporation of Sleepio into a clinical mental health setting. We hypothesized that the introduction of Sleepio as an adjunctive treatment element would boost mental health outcomes, whilst not taking up significant additional clinical time.This study was funded by an Innovate UK grant and Big Health Ltd (Sleepio). It was supported by the NIHR Oxford Health Biomedical Research Centre, and the Oxford Academic Health Science Network. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. We are grateful to all the staff at Healthy Minds Buckinghamshire, including Reena Thomas, Arnya Gumbs and Kate Smart who helped with clinical implementation.
Publisher Copyright:
© 2021 The Authors
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Background: Insomnia has a bidirectional relationship with broader mental health functioning, including anxiety and depression. Yet, poor sleep has historically been neglected as a specific treatment target in mental health programmes (Freeman, Sheaves, Waite, Harvey, & Harrison, 2020). Method: All patients over a 12-month period entering the Improving Access to Psychological Therapies (IAPT) service endorsing a ‘poor sleep’ questionnaire item at assessment, were offered a self-guided digital sleep intervention, Sleepio, in addition to routine care. Sleepio is based on the principles of Cognitive Behavioural Therapy for Insomnia (CBT-I). Propensity score matching established a non-Sleepio control group matched on demographic and baseline clinical measures. Results: Patients who signed up to Sleepio (n = 510) achieved significantly better outcomes on core clinical metrics (PHQ-9, GAD-7, WSAS) than controls. IAPT recovery rates (on PHQ-9 and GAD-7) were 64.7%, versus 58% in the control group. Duration of clinical contact time was marginally elevated overall in the Sleepio group but by less than 1 h Conclusions: Significant clinical benefit was associated with the introduction of an evidence-based digital sleep intervention alongside other mental health interventions for depression and anxiety. Widespread deployment was achieved with immediate availability, minimal additional clinical time or staff training. This approach provides a feasible and highly scalable model for improving mental health outcomes in clinical services.
AB - Background: Insomnia has a bidirectional relationship with broader mental health functioning, including anxiety and depression. Yet, poor sleep has historically been neglected as a specific treatment target in mental health programmes (Freeman, Sheaves, Waite, Harvey, & Harrison, 2020). Method: All patients over a 12-month period entering the Improving Access to Psychological Therapies (IAPT) service endorsing a ‘poor sleep’ questionnaire item at assessment, were offered a self-guided digital sleep intervention, Sleepio, in addition to routine care. Sleepio is based on the principles of Cognitive Behavioural Therapy for Insomnia (CBT-I). Propensity score matching established a non-Sleepio control group matched on demographic and baseline clinical measures. Results: Patients who signed up to Sleepio (n = 510) achieved significantly better outcomes on core clinical metrics (PHQ-9, GAD-7, WSAS) than controls. IAPT recovery rates (on PHQ-9 and GAD-7) were 64.7%, versus 58% in the control group. Duration of clinical contact time was marginally elevated overall in the Sleepio group but by less than 1 h Conclusions: Significant clinical benefit was associated with the introduction of an evidence-based digital sleep intervention alongside other mental health interventions for depression and anxiety. Widespread deployment was achieved with immediate availability, minimal additional clinical time or staff training. This approach provides a feasible and highly scalable model for improving mental health outcomes in clinical services.
UR - http://www.scopus.com/inward/record.url?scp=85110251224&partnerID=8YFLogxK
U2 - 10.1016/j.brat.2021.103922
DO - 10.1016/j.brat.2021.103922
M3 - Article
C2 - 34246110
SN - 0005-7967
VL - 144
SP - 103922
JO - Behaviour Research and Therapy
JF - Behaviour Research and Therapy
M1 - 103922
ER -
