Reference: Cheng, P., Casement, M. D., Kalmbach, D. A., Castelan, A. C., & Drake, C. L. (2021). Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic. Sleep, 44(4), zsaa258.
Guest post by Lydia Martin
As the daily rollercoaster that started in 2020 continues, you may wonder “what could I have done to prepare for this?” You probably know someone who responded to the mayhem of the coronavirus (COVID-19) pandemic with a daily dose of resilience—maybe that someone was you! If not, you’re not alone. In addition to physical illness, the COVID-19 pandemic has posed numerous challenges to our mental health by uprooting our daily routines, altering our social habits, imposing financial burdens, and more. It’s no surprise that illnesses such as insomnia, depression, and post-traumatic stress have been on the rise in response to COVID-19.1-4
Insomnia has significant health consequences such as heightening an individual’s sensitivity to stress and intensifying the negative effects of other mental health problems. Medical research has long supported the use of cognitive behavioral therapy for insomnia (CBT-I) as a first line of treatment.5,6 Because CBT-I has additional mental health benefits beyond reducing insomnia, researchers Philipp Cheng and colleagues at the Sleep Disorders and Research Center in Detroit, MI sought to examine if participating in CBT-I treatment in the past would promote health resilience during the COVID-19 pandemic in individuals previously treated for insomnia.
How did they research that?
Back in 2016-2017, 658 individuals participated in a research study where they received sleep education or the digital CBT-I (dCBT-I).7 The sleep education group received 6 e-mails containing general information on healthy sleep based the NIH guide. Participants in the dCBT-I group received 6 sessions of therapy containing digital information and animations with content tailored to each participants’ responses. Digital CBT-I is known to provide similar benefits to traditional CBT-I but is more widely accessible and affordable.8,9 To see if these interventions help with resilience at the height of changes in daily life related to the COVID-19 pandemic, participants were invited to complete follow-up surveys investigating various mental and physical health domains. From the original study, 208 participants (over 100 from both groups) completed these surveys in April-May 2020 in Michigan—an area with significant COVID-19 cases at that time and 5 weeks into a state-wide stay-at-home order.
To measure each participant’s health resilience, the researchers administered 6 online surveys which are summarized below.
- Direct impact of COVID-19: Participants rated how closely they were affected by COVID-19 exposure, life-threatening COVID-19 related illness or injury, and human suffering related to COVID-19. Participants ranked survey items on a 6-point scale that ranged from direct, personal illness to not applicable.
- Impact of the pandemic on daily life: Participants responded to 11 unique prompts on a 4-point scale to rate the degree of change to their routines.
- Severity of insomnia: Participants completed a 7-item standardized questionnaire to rate their insomnia and the effect of COVID-19 pandemic on their sleep.
- Stress due to the COVID-19 pandemic and overall stress: Participants were asked to rate their recent stress levels plus respond to a 22-item questionnaire asking specifically about stress due to the COVID-19 pandemic. This questionnaire also helped determine if they were experiencing stress by repeating thoughts about the pandemic, intentionally avoiding reminders of the pandemic, or staying on high alert due to their experiences of the pandemic.
- Symptoms of depression: Participants completed a commonly used inventory regarding the presence and severity of depressive symptoms.
- Overall health: Lastly, participants were asked to rank their physical and mental health and their quality of life.
What did they discover?
Individuals who participated in dCBT-I during the 2016-2017 research study reported less insomnia, less stress, fewer symptoms of depression, and better overall health during the COVID-19 pandemic compared to individuals who only received sleep education. In fact, participating in dCBT-I years before the pandemic was associated with half the risk of developing insomnia or depression in response to the stressors of the COVID-19 pandemic!
Looking closer at these results, both groups reported a similar impact of the COVID-19 pandemic on their daily life; but individuals who received dCBT-I reported less impact on their sleep and lower severity of their insomnia. In addition to this protective effect on the resurgence of insomnia, participants’ overall stress and stress due to the pandemic were both lower after dCBT-I compared to traditional sleep education. Digital CBT-I also improved self-reports of physical health, improved overall health, and reduced the odds of moderate to severe depression by 57% compared to traditional sleep education.
What do these discoveries mean?
The uncertainty of the past few years has undoubtedly challenged our resilience. This study indicates that individuals with a history of insomnia were better prepared to face the uncertainties of living during a pandemic if they previously participated in dCBT-I treatment. This research is novel in providing evidence of long-lasting improvements in resilience associated with dCBT-I. Future investigations should aim to understand the mechanisms by which this improvement occurred and the effects on health resilience in individuals with other metal health conditions. Although this study didn’t investigate the use of dCBT-I for individuals without insomnia, if you are suffering from anxiety, depression, or insomnia then dCBT-I may promote your long-term health resilience! A health care provider can prescribe an FDA approved dCBT-I app similar to the one used in this study or help direct you to other treatments as needed.
So, if you wonder how to ready yourself for the future and its unexpected challenges, consider dCBT-I for its long-lasting mental and physical health benefits!
Lydia is a Physical Therapist in Louisville, KY. She received her clinical doctorate from the University of Pittsburgh. Prior to that she completed a MS from the University of South Carolina with a thesis on succinated protein turnover and BS from the University of Michigan. Her areas of interest including health promotion, individual wellness, and scientific education.