Introduction
What Is “Digital CBT” for Insomnia?
Supportive to Fully Automated dCBT
dCBT as support | Guided dCBT | Fully automated dCBT | |
---|---|---|---|
Definition | dCBT elements are used to support conventional therapy | Automated dCBT with guidance of trained clinicians | Fully automated and tailored dCBT without clinical support |
Automatization | Limited | Partly | Fully |
Costs | Clinician time Development and maintenance dCBT | Clinician time Development and maintenance dCBT | No clinician time Development and maintenance dCBT |
Scalability | Capped by availability of trained clinicians | Capped by availability of trained clinicians | Fully extensible |
Clinician involvement | Comparable to conventional CBT | Up to 2 h | None |
Example programs | Bastien et al. [7] Gehrman et al. [8] Lichstein et al. [9] Kuhn et al. [10] | Kaldo et al. [11] Van Straten et al. [12] Thiart et al. [13] Anderson et al. [14] Feuerstein et al. [15] Lancee et al. [16] | Ritterband et al. [17] Vincent et al. [18] Espie et al. [19] |
(a) Digital CBT as Support
(b) Guided Digital CBT
(c) Fully automated digital CBT
Evidence in Support of dCBT
1. Is Digital CBT as Clinically and Cost-Effective as Conventional CBT for Insomnia?
2. Is Digital CBT Effective for Insomnia in People with Other Mental Health Conditions?
3. Is Digital CBT Effective for Insomnia in People with Other Physical Health Conditions?
4. Does Digital CBT Help People Reduce and Withdraw From Sleep Medications?
5. Does an Active Social Community Enhance Outcomes?
6. What Are the Mediators and Moderators of Digital CBT Treatment Outcome?
7. What Are the Demographic and Clinical Predictors of Improvement with Digital CBT?
8. What Are the Dose-Response Relationships Associated with Digital CBT for Insomnia?
9. Does digital CBT Integrated at Various Levels with Traditional Clinical Care Afford Health Benefits?
10. Can a Fully Mobile Version of CBT be Implemented Effectively?
Conclusion
The challenge for CBT is no longer to prove its credentials, but to punch its weight. For at least a decade, CBT should have been a contender as the treatment of first choice for insomnia. In reality, however, it has had very little impact on the high volume of insomnia patient care. Indeed, it has amounted to little more than a patchy cottage industry (Espie, 2009).