Decreased Transition Rate From Situational Insomnia to Chronic Insomnia by One-Week Internet Cognitive Behavioral Treatments for Insomnia During the COVID-19 Pandemic

Fei Feng; Chenxi Zhang; Hanwen Liang; Guojian Xu; Xian Luo; Shuai Liu; Yan Xu; Lulu Yang; Li Zhang; Lianhong Lin; Bin Zhang

doi:10.3389/fpsyt.2022.837399

Decreased Transition Rate From Situational Insomnia to Chronic Insomnia by One-Week Internet Cognitive Behavioral Treatments for Insomnia During the COVID-19 Pandemic

Front Psychiatry. 2022 Mar 22:13:837399. doi: 10.3389/fpsyt.2022.837399. eCollection 2022.

Authors

Fei Feng^{1

2

3}, Chenxi Zhang^{1

2}, Hanwen Liang^{1

2}, Guojian Xu³, Xian Luo^{1

2}, Shuai Liu^{1

2}, Yan Xu^{1

2}, Lulu Yang^{1

2

4}, Li Zhang^{1

2}, Lianhong Lin^{1

2}, Bin Zhang^{1

2}

Affiliations

¹ Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China.
³ Shenzhen Kangning Hospital, Shenzhen, China.
⁴ Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Abstract

Purpose: The purpose of the study was to determine the long-term effects of one-week self-guided internet cognitive behavioral treatments for insomnia (CBTI) on situational insomnia during the COVID-19 pandemic.

Patients and methods: The participants with situational insomnia (n = 194) were recruited from March 2020 to April 2020 in Guangzhou, China. The insomnia severity index (ISI), pre-sleep arousal scale (PSAS), and hospital anxiety and depression scale (HADS) were evaluated at baseline and a one-week internet CBTI program was delivered to all individuals. The participants were divided into the complete treatment group (the participants completed all seven modules of the CBTI course, n = 75), and the incomplete treatment group (the participants completed 0-6 modules of the CBTI course, n = 119). A total of 135 participants completed the post-intervention assessments. At 3 months follow-up, a total of 117 participants (complete treatment group: n = 51; incomplete treatment group: n = 66) completed the assessments of the ISI, PSAS and HADS. The transition rate from situational insomnia to chronic insomnia (duration of insomnia ≥ 3 months and ISI ≥ 8) was calculated in the two groups. Linear mixed effect model was used to investigate the effect of group (between the two groups), time (baseline vs. follow-up), and interaction (group x time) on various questionnaire score.

Results: The transition rate from situational insomnia to chronic insomnia was significantly lower in the complete treatment group compared to the incomplete treatment group (27.5%, 14/51 vs. 48.5%, 32/66, p = 0.023). There were significant differences in group effect (p = 0.032), time effect (p = 0.000) and group × time effect (p = 0.048) between the two groups in the ISI total score. The ISI total scores decreased in both groups during follow-up compared to their baseline values, with a greater magnitude of decrease in the complete treatment group. There were no significant group x time effects between the two groups in the PSAS-total score, PSAS-somatic, PSAS-cognitive score, HADS total score, HADS anxiety score or HADS depression score.

Conclusion: Our results suggested that one-week self-guided internet CBTI prevented the development of chronic insomnia from situational insomnia during the COVID-19 pandemic.

Keywords: CBTI; COVID-19; hospital anxiety and depression scale (HADS); hyperarousal; insomnia severity index (ISI); pre-sleep arousal scale (PSAS).