Online insomnia treatment and the reduction of anxiety symptoms as a secondary outcome in a randomised controlled trial: The role of cognitive-behavioural factors

May 3, 2018The Australian and New Zealand journal of psychiatry

Online insomnia treatment and its link to reduced anxiety symptoms: The role of thinking and behavior patterns

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Abstract

A cognitive behavioral therapy-based online intervention for insomnia resulted in a greater reduction in anxiety symptoms, with a p-value of less than 0.001 at both posttest and 6-month follow-up.

The intervention significantly decreased anxiety symptoms compared to an attention-matched control.
Reduction in anxiety was notably moderated by participants' levels of sleep-threat monitoring.
Dysfunctional beliefs about sleep did not significantly influence the reduction of anxiety symptoms.
Higher levels of sleep-threat monitoring correlated with a greater reduction in anxiety from pretest to both posttest and follow-up.
These findings support cognitive models of insomnia by highlighting the relationship between sleep-related anxiety and insomnia treatment outcomes.

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OBJECTIVE: Insomnia and anxiety commonly co-occur, yet the mechanisms underlying this remain unclear. The current paper describes the impact of an Internet-based intervention for insomnia on anxiety, and explores the influence of two cognitive-behavioural constructs - dysfunctional beliefs about sleep and sleep-threat monitoring.

METHODS: A large-scale, 9-week, two-arm randomised controlled trial ( N = 1149) of community-dwelling Australian adults with insomnia and elevated yet subclinical depression symptoms was conducted, comparing a cognitive behavioural therapy-based online intervention for insomnia (Sleep Healthy Using The Internet) with an attention-matched online control intervention (HealthWatch). Symptoms of anxiety were assessed at pretest, posttest, and 6-month follow-up. Dysfunctional beliefs about sleep and sleep threat monitoring were assessed only at pretest.

RESULTS: Sleep Healthy Using The Internet led to a greater reduction in anxiety symptoms at both posttest ( t = -6.77, p < 0.001) and at 6-month follow-up ( t = -4.27, p < 0.001) than HealthWatch. At posttest and follow-up, this effect was found to moderated by sleep-threat monitoring ( t = -2.39, p < 0.05 and t = -2.98, p < 0.01 respectively) but not by dysfunctional beliefs about sleep at either posttest or follow-up ( t = -0.61, p = 0.55 and t = 0.22, p = 0.83 respectively). Participants in the Sleep Healthy Using The Internet condition with higher levels of sleep-threat monitoring showed a greater reduction in anxiety than those with lower levels from pretest to posttest, ( t = -6.77, p < 0.001) and through to 6-month follow-up ( t = -4.27, p < 0.001). This result remained after controlling for baseline anxiety levels. 724.27 700.67 713.69 694.77 717.53 683.79 724.27 700.67

CONCLUSION: The findings suggest that online cognitive behavioral therapy interventions for insomnia are beneficial for reducing anxiety regardless of people's beliefs about their sleep and insomnia, and this is particularly the case for those with high sleep-threat monitoring. This study also provides further evidence for cognitive models of insomnia.

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Online insomnia treatment and the reduction of anxiety symptoms as a secondary outcome in a randomised controlled trial: The role of cognitive-behavioural factors

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