![]() Here, a therapist or other health professional provides the therapy, and specific digital elements are used to support the therapy. This is the least extensive form of digital involvement in treating insomnia it also comprises the field of telemedicine. For clinicians and patients wherever they may be to have ready and sustained access to high quality, engaging, and effective CBT, we need both clinical excellence and creative genius, as illustrated in Fig. Consequently, it will not be the provenance, content, validation, or outcome data associated with any particular dCBT program that determines its longevity but its level of execution. The corollary to this, however, is that all forms of dCBT will be perpetually out of date unless they remain at the forefront of digital innovation. ![]() There can be little doubt that the pace of change in this digital age will afford unrelenting opportunity for the dissemination of dCBT. computer or internet) that will soon enough be lost in the mists of time. Potentially, technology can bridge that feasibility gap, with digital solutions offering the possibility of true scalability.Īlthough several terms have been used to describe technological advances, for example internet CBT (iCBT), computerized CBT (cCBT), electronic CBT (eCBT), or online CBT (oCBT), we have suggested that the field recognizes and evolves towards the term “digital CBT (dCBT)” to reflect the contemporary spectrum of digital technology, rather than one specific, and most likely historical aspect (e.g. It is in fact a perfectly reasonable ambition to provide CBT to the tens of millions of people who might benefit, considering that CBT’s evidence base is stronger than that of pharmacotherapy-the problem is that providing CBT to a large population is not even remotely feasible using traditional methods of dissemination. However, they are by no stretch sufficient if our ambition is to make CBT as ubiquitous as pharmacotherapy. These methods reflect attempts at “scaling” CBT to meet the population need. It also has been demonstrated that CBT can be provided successfully as a group therapy, in large workshops, as a self-help bibliotherapy, or by telephone. Similar to the dissemination of conventional CBT, the dissemination of dCBT remains limited.ĬBT has traditionally been a face-to-face talking therapy, delivered in a direct one-to-one relationship between patient and therapist. However, CBT for insomnia, in whichever form, still faces a lot of challenges such as costs and scalability. Undoubtedly, therefore, the evidence base has substantially increased. Correspondingly, perhaps the 5-year period ending in December 2016 saw a substantial increase in published papers, with approximately one paper featuring digital CBT (dCBT) for insomnia published per month, whereas less than a handful of articles were published prior to 2012. ![]() These are of particular interest to the insomnia field because CBT has emerged as the recommended first-line therapy for insomnia. Over the past decade, digital solutions, for example via web and mobile devices, have been developed to support the dissemination of Cognitive Behavioral Therapy (CBT). In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.The ubiquitous nature of web and smartphone technology has changed our lives in every way imaginable, including offering new approaches to the evaluation and treatment of many disorders. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 wk follow-up. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges's g) ranging from 0.21 to 1.09. Eleven randomized controlled trials examining a total of 1460 participants were included. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs.
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