Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia:A Randomized Waitlist Controlled Trial

Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia. Objective: The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial. Methods: We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant’s progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition. Results: The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=–0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up. Conclusions: This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens. Trial Registration: Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4

A virtual sleepcoach for people suffering from insomnia

People suffering from insomnia have problems falling asleep or staying asleep. Insomnia impairs people’s daily life and their quality of life decreases. Approximately 10% of the population suffers from insomnia. The common treatment for insomnia is cognitive behavioural therapy for insomnia (CBT-I), mostly delivered by a therapist that people see once a week. A disadvantage of the current practice of insomnia treatment is the limited accessibility of insomnia treatment. Moreover, adherence to CBT-I exercises seems to be difficult. A virtual sleep coach that is provided through a smartphone might be a possible solution to both of these drawbacks. A virtual coach is never tired, never frustrated, never forgets things, and never gives up. Furthermore, it could improve accessibility, give tailored background information, offer personalized advice and feedback, monitor progress, provide support, and automatically trackbehaviour. Additionally, the majority of people in wealthy nations own a smartphone and emerging countries are expected to follow soon, making this type of intervention readily accessible to a large group of people. In short, a virtual sleep coach seems to be a good opportunity to improve traditional CBT-I. Concurrent to developing such a virtual sleep coach, answers to the question of how persuasive strategies can contribute to treatment adherence in an effective virtual sleep coach are explored.Interactive Intelligenc

Comparing performance and situation awareness in USAR unit tasks in a virtual and real environment

A convenient way to test Urban Search And Rescue (USAR) robots would be in virtual environments (VEs). Evaluations in VEs are generally accepted as alternative for real scenarios. There are obvious differences between operation in a real and virtual environment. Nonetheless, the current experiment showed no significant differences in situation awareness (SA) and performance during several elementary tasks (e.g. slalom) between a virtual world and a previous experiment in reality (Mioch, Smets, & Neerincx, 2012). Only small dependencies between the unit tasks were found. The effect of individual differences (like gender, km driven per year, and gaming experience), were significant for certain elementary tasks. Testing robots in virtual environments could still be useful even if differences between VE and reality exist, since comparisons of different conditions in VE seems to have the same results as the same comparison in the field (Bishop & Rohrmann, 2003; Van Diggelen, Looije, Mioch, Neerincx, & Smets, 2012).Intelligent SystemsElectrical Engineering, Mathematics and Computer Scienc

Revealing unexpected effects of rescue robots’ team-membership in a virtual environment

In urban search and rescue (USAR) situations resources are limited and workload is high. Robots that act as team players instead of tools could help in these situations. A Virtual Reality (VR) experiment was set up to test if team performance of a human-robot team increases when the robot act as such a team player. Three robot settings were tested ranging from the robot as a tool to the robot as a team player. Unexpectedly, team performance seemed to be the best for the tool condition. Two side-effects of increasing robot’s teammembership could explain this result: mental workload increased for the humans who had to work with the team-playing robot, whereas the tendency to share information was reduced between these humans. Future research should, thus, focus on team-memberships that improve communication and reduce cognitive workload.Intelligent SystemsElectrical Engineering, Mathematics and Computer Scienc

Comparing performance and situation awareness in USAR unit tasks in a virtual and real environment

A convenient way to test Urban Search And Rescue (USAR) robots would be in virtual environments (VEs). Evaluations in VEs are generally accepted as alternative for real scenarios. There are obvious differences between operation in a real and virtual environment. Nonetheless, the current experiment showed no significant differences in situation awareness (SA) and performance during several elementary tasks (e.g. slalom) between a virtual world and a previous experiment in reality (Mioch, Smets, & Neerincx, 2012). Only small dependencies between the unit tasks were found. The effect of individual differences (like gender, km driven per year, and gaming experience), were significant for certain elementary tasks. Testing robots in virtual environments could still be useful even if differences between VE and reality exist, since comparisons of different conditions in VE seems to have the same results as the same comparison in the field (Bishop & Rohrmann, 2003; Van Diggelen, Looije, Mioch, Neerincx, & Smets, 2012)

Exploratory study of a mobile location-based real-time notification system for frontline police officers

The police organization is highly dependent on information. Frontline police officers are working on the streets and need the right information at the right time. Mobile technology can provide location-based information and could be of great assistance to them. We developed a mobile location-based real-time notification system and conducted an exploratory study in two real-life experiments. The system provides information on a point of interest (PoI) when frontline police officers are close to that PoI. Usability, recall of information, and situational awareness were measured to assess the impact of the system on police work. The results show that the system usability was adequate, recall of information varied between police officers working with the system and without, whereas little difference in situational awareness was found. Interviews suggest that awareness regarding PoI’s was increased and new behaviour was triggered by the system. Future research will evaluate further developments of the system and its impact on police work.System Engineerin

Factors Affecting User’s Behavioral Intention and Use of a Mobile-Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Small-Scale UTAUT Analysis

A mobile app could be a powerful medium for providing individual support for cognitive behavioral therapy (CBT), as well as facilitating therapy adherence. Little is known about factors that may explain the acceptance and uptake of such applications. This study, therefore, examines factors from an extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT2) model to explain variation between people’s behavioral intention to use a CBT for insomnia (CBT-I) app and their use-behavior. The model includes eight aspects of behavioral intention: performance expectancy, effort expectancy, social influence, self-efficacy, trust, hedonic motivation, anxiety, and facilitating conditions, and investigates further the influence of the behavioral intention and facilitating conditions on app-usage behavior. Data were gathered from a field trial involving people (n = 89) with relatively mild insomnia using a CBT-I app. The analysis applied the Partial Least Squares-Structural Equation Modeling method. The results found that performance expectancy, effort expectancy, social influence, self-efficacy, trust, and facilitating conditions all explained part of the variation in behavioral intention, but not beyond the explanation provided by hedonic motivation, which accounted for R2 = 0.61. Both behavioral intention and facilitating conditions could explain the use-behavior (R2 = 0.32). We anticipate that the findings will help researchers and developers to focus on: (1) users’ positive feelings about the app as this was an indicator of their acceptance of the mobile app and usage; and (2) the availability of resources and support as this also correlated with the technology use.Interactive IntelligenceSystem Engineerin

Talk and Tools: The best of both worlds in mobile user interfaces for E-coaching

In this paper, a user interface paradigm, called Talk-and-Tools, is presented for automated e-coaching. The paradigm is based on the idea that people interact in two ways with their environment: symbolically and physically. The main goal is to show how the paradigm can be applied in the design of interactive systems that offer an acceptable coaching process. As a proof of concept, an e-coaching system is implemented that supports an insomnia therapy on a smartphone. A human coach was replaced by a cooperative virtual coach that is able to interact with a human coachee. In the interface of the system, we distinguish between a set of personalized conversations (“Talk”) and specialized modules that form a coherent structure of input and output facilities (“Tools”). Conversations contained a minimum of variation to exclude unpredictable behavior but included the necessary mechanisms for variation to offer personalized consults and support. A variety of system and user tests was conducted to validate the use of the system. After a 6-week therapy, some users spontaneously reported the experience of building a relationship with the e-coach. It is concluded that the addition of a conversational component fills an important gap in the design of current mobile systems.Interactive Intelligenc