A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility, Acceptability, and Potential Efficacy

Eric Kuhn; Katherine E Miller; Deloras Puran; Joseph Wielgosz; Sophie L YorkWilliams; Jason E Owen; Beth K Jaworski; Haijing Wu Hallenbeck; Shannon E McCaslin; Katherine L Taylor

doi:10.1016/j.beth.2021.11.003

A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility, Acceptability, and Potential Efficacy

Behav Ther. 2022 May;53(3):440-457. doi: 10.1016/j.beth.2021.11.003. Epub 2021 Nov 19.

Affiliations

¹ National Center for PTSD, VA Palo Alto Health Care System; Stanford University, School of Medicine. Electronic address: Eric.Kuhn@va.gov.
² Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center.
³ National Center for PTSD, VA Palo Alto Health Care System.
⁴ National Center for PTSD, VA Palo Alto Health Care System; Stanford University, School of Medicine; Sierra Pacific Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System.
⁵ National Center for PTSD, VA Palo Alto Health Care System; University of Colorado Boulder.
⁶ National Center for PTSD, VA Palo Alto Health Care System; Stanford University School of Medicine.

PMID: 35473648
DOI: 10.1016/j.beth.2021.11.003

Abstract

Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28-55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = -0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = -1.1, p = .001), sleep onset latency (d = -0.6, p = .021), global sleep quality (d = -0.9, p = .002), and depression symptoms (d = -0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.

Keywords: cognitive-behavioral therapy for insomnia; insomnia; mHealth; mobile apps; mobile phone intervention; smartphone; veterans.

Publication types

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

MeSH terms

Child, Preschool
Cognitive Behavioral Therapy*
Feasibility Studies
Female
Humans
Infant
Male
Mobile Applications*
Pilot Projects
Sleep Initiation and Maintenance Disorders* / therapy

Grants and funding

IK2 CX001874/CX/CSRD VA/United States