Efficacy of Email-delivered Versus Face-to-face Group Cognitive Behavioral Therapy for Insomnia in Youths: A Randomized Controlled Trial

Ngan Yan Chan; Siu Ping Lam; Jihui Zhang; Joey Wing Yan Chan; Mandy Man Wai Yu; Sooyeon Suh; Chien-Ming Yang; Isa Okajima; Albert Martin Li; Yun Kwok Wing; Shirley Xin Li

doi:10.1016/j.jadohealth.2021.11.005

Efficacy of Email-delivered Versus Face-to-face Group Cognitive Behavioral Therapy for Insomnia in Youths: A Randomized Controlled Trial

J Adolesc Health. 2022 May;70(5):763-773. doi: 10.1016/j.jadohealth.2021.11.005. Epub 2022 Feb 4.

Authors

Affiliations

¹ Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
² Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
³ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
⁴ Department of Psychology, Sungshin Women's University, Seoul, Korea.
⁵ Department of Psychology, National Chengchi University, Taipei, Taiwan.
⁶ Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan.
⁷ Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁸ Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China. Electronic address: shirley.li@hku.hk.

PMID: 35125265
DOI: 10.1016/j.jadohealth.2021.11.005

Abstract

Purpose: The purpose of the study was to compare the efficacy of group-based therapy (GT) and email-delivered self-help (ESH) cognitive behavioral therapy for insomnia (CBT-I) with the wait-list (WL) control group in youths.

Methods: The study involved an assessor-blind, parallel group randomized controlled trial in youths meeting the diagnostic criteria for insomnia disorder. Participants were randomized to one of the three groups (8-week GT, 8-week ESH, or WL). Participants in all three groups were assessed at baseline and after treatment (week 9 for the WL group). The two treatment groups were additionally assessed at one month and six months after the intervention. Treatment effects were examined using linear mixed models.

Results: A total of 135 youths (mean age: 20.0 ± 2.5 years, female: 67.4%) were recruited. After treatment, both active treatment groups showed significant improvements in insomnia symptoms (GT vs. WL: Cohen's d = -1.03, ESH vs. WL: d = -.63), less presleep arousal (d = -.52 to -1.47), less sleep-related dysfunctional belief (d = -.88 to -1.78), better sleep hygiene practice (d = -.79 to -.84), and improved daytime functioning (d = -.56 to -.96) compared with the WL group. In addition, GT outperformed ESH in improving maladaptive sleep-related beliefs and mood symptoms at post-treatment and 6-month follow-up. A reduction of suicidality with moderate effect size favoring GT emerged at 6-month follow-up.

Discussion: Our findings suggested that both group-based and email-delivered CBT-I were effective in treating youth insomnia, but group-based CBT-I showed superior effects on reducing maladaptive beliefs and mood symptoms.

Keywords: Adolescence; Cognitive behavioral therapy; Email-delivered; Group-based; Insomnia; Self-help; Sleep; Youths.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Cognitive Behavioral Therapy*
Electronic Mail
Female
Humans
Sleep Hygiene
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome
Young Adult