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

Modeling interaction in automated e-coaching: a case from insomnia therapy

Abstract—This paper presents the work in progress on the Sleepcare-project. The aim of the project is to enhance the understanding of personalized self-help therapy with the aid of existing (mobile) technology, in particular in the domain of insomnia. For that, an agent-based e-coaching system is being developed in which various persuasion strategies for sustaina-ble behavior change are evaluated. The e-coach is considered as a cooperative partner that combines various interaction modalities (e.g., dialogue, buttons, sensors) and that supports the individual with various exercises for insomnia therapy. Central in the approach is to improve the individual’s adher-ence to these exercises. In this paper, we focus on the basic interaction model of the e-coach and some of its requirements, such as transparency, mutual commitment and adaptation. Keywords-cooperative agent; interaction model; e-coaching; cognitive behavioral therapy; insomnia. I

Modeling interaction in automated e-coaching: a case from insomnia therapy

This paper presents the work in progress on the Sleepcare-project. The aim of the project is to enhance the understanding of personalized self-help therapy with the aid of existing (mobile) technology, in particular in the domain of insomnia. For that, an agent-based e-coaching system is being developed in which various persuasion strategies for sustainable behavior change are evaluated. The e-coach is considered as a cooperative partner that combines various interaction modalities (e.g., dialogue, buttons, sensors) and that supports the individual with various exercises for insomnia therapy. Central in the approach is to improve the individual’s adherence to these exercises. In this paper, we focus on the basic interaction model of the e-coach and some of its requirements, such as transparency, mutual commitment and adaptation

Improving adherence in automated e-coaching: A case from insomnia therapy

Non-adherence is considered a problem that seriously undermines the outcome of behavior change therapies, in particular of self-help therapies delivered without human interference. This paper presents the design rationale behind a computer system in the domain of adherence enhancing strategies in automated e-coaching. A variety of persuasive strategies is introduced and implemented in a mobile e-coaching system in the domain of insomnia therapy. The system integrates two types of interface elements, i.e. dedicated tools and natural language conversation, to simplify therapy related activities and to include social strategies to improve motivation. We focus on the crucial role of communication and adaptation

Negotiation in Automated E-Coaching : An Application in Mobile Insomnia Treatment

In this paper, we present the design of a negotiation protocol for behaviour change exercises that are supported by automated e-coaching systems. Negotiation is introduced as an interactive per-suasive strategy with the aim to improve adherence of exercises. The protocol is implemented in a mobile application, called SleepCare, that supports cognitive behaviour therapy for insomnia. The interaction design of the application is centred around the paradigm of Talk-and-Tools. Talk repre-sents personalized conversations with a virtual e-coach, while Tools are represented by special-ized modules that form a coherent structure of input and output facilities. We focus on the tech-nique of sleep restriction, an intensive form of behaviour change that requires strong perseverance from the user. Both user and e-coach may negotiate about the attributes of the sleep restriction technique, here the duration of the total time in bed. The algorithm that calculates the negotiation space is personalized on the basis of previous sleeping behaviour of the coachee, the stage of the program and general constraints of the insomnia therapy. The system is evaluated by means of au-tomated simulations and data from a randomized controlled trial. More than 50% of the subjects who did sleep restriction as a behaviour changing exercise used the protocol in the first round and negotiated with the system about an agreed time in bed. We expect that negotiation includes a number of important adherence enhancing strategies in e-coaching: increase of the coachee’s au-tonomy, a sense of shared decision making and commitment