Patient Perceptions of Treatment Delivery Platforms for Cognitive Behavioral Therapy for Insomnia

ABSTRACT

Objective: Stepped care has given rise to the proliferation of abbreviated CBT-I programs and delivery formats. This includes interventions delivered by allied health professionals and those delivered electronically through the Internet. This article aims to explore patient perceptions between electronic and face-to-face (FTF) delivery platforms for (abbreviated) CBT-I. Participants: Patients with insomnia from specialist sleep or psychology clinics and those from the general community in Sydney, Australia. Method: Semistructured interviews were conducted with patients with insomnia, guided by a schedule of questions and a choice task to explore patient perceptions of the different CBT-I treatment delivery platforms (e.g., perceived advantages and disadvantages or willingness to engage with either platform). Interviews were transcribed verbatim and analyzed using Framework Analysis. Participants also completed a battery of clinical mood and insomnia measures. Results: Fifty-one interviews were conducted with patients with insomnia from specialist sleep or psychology clinics (n = 22) and the general community (n = 29). Synthesis of the qualitative data set revealed three themes pertinent to the patients’ perspective toward electronic and FTF CBT-I delivery: Concepts of Efficacy, Concerns About Treatment, and Treatment on My Terms. Participants’ choice to engage with either platform was also informed by diverse factors including perceived efficacy of treatment, personal commitments, lifestyle, and beliefs about sleep and insomnia. Conclusion: Clarifying patient treatment priorities and allaying potential concerns about engaging with an electronic treatment platform represent important steps for disseminating eCBT-I into mainstream practice.

SUPPLEMENTAL MATERIAL

Supplemental data for this article can be accessed on the publisher’s website.

Notes

¹ The University of Sydney campus, primary care physicians (general practitioners) and community pharmacies.

² The Woolcock Institute of Medical Research (WIMR) and Brain and Mind Centre, formerly Brain and Mind Research Institute.

³ The ISI is a 7-item Likert-type scale that measures the nature and symptoms of insomnia. Score ranges from 0 to 28. Insomnia severity is classified as (a) no clinically significant insomnia (Score: 0 to 7), (b) subthreshold insomnia (Score: 8 to 14), (c) moderate clinical insomnia (Score: 15 to 21), and (d) severe clinical insomnia (22 to 28).

⁴ The DASS-21 is a 21-item measure (i.e., a score of 0 to 3 for each item) that is composed of three 7-item subscales: a depression subscale (Normal: 0 to 4, Mild: 5 to 6, Moderate: 7 to 10, Severe: 11 to 13, and Extremely Severe: ≥ 14), an anxiety subscale (Normal: 0 to 3, Mild: 4 to 5, Moderate: 6 to 7, Severe: 8 to 9, Extremely Severe: ≥10), and a stress subscale (Normal: 0 to 7, Mild: 8 to 9, Moderate: 10 to 12, Severe: 13 to 16, and Extremely Severe: ≥ 17; Ng et al., 2007).

⁵ The FIRST is a 9-item self-measure of the likelihood of the occurrence of sleep disturbance; score ranges from 9 to 36. A cutoff score of 19 is indicative of high vulnerability to stress-related sleep disturbance (Fernández-Mendoza et al., 2010).

⁶ The BMQ general is made up of two components: a General Harm scale (5 items, total scores range from 5 to 25) and a General Overuse scale (3 items, total scores range from 3 to 15) assessing beliefs about pharmaceuticals as a class of treatment (Kumar et al., 2008).

¹⁰ Participants were presented with all three treatment options in the interview. However, only the results derived from participant discussion of Option B and Option C are presented in the current article.