Efficacy of digital CBT for insomnia to reduce depression across demographic groups: A randomized trial

Philip Cheng*, Annemarie I. Luik, Cynthia Fellman-Couture, Edward Peterson, Christine L.M. Joseph, Gabriel Tallent, Kieulinh Michelle Tran, Brian K. Ahmedani, Timothy Roehrs, Thomas Roth, Christopher L. Drake

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

53 Citations (Scopus)


Background Insomnia and depression are highly comorbid and mutually exacerbate clinical trajectories and outcomes. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces both insomnia and depression severity, and can be delivered digitally. This could substantially increase the accessibility to CBT-I, which could reduce the health disparities related to insomnia; however, the efficacy of digital CBT-I (dCBT-I) across a range of demographic groups has not yet been adequately examined. This randomized placebo-controlled trial examined the efficacy of dCBT-I in reducing both insomnia and depression across a wide range of demographic groups.Methods Of 1358 individuals with insomnia randomized, a final sample of 358 were retained in the dCBT-I condition and 300 in the online sleep education condition. Severity of insomnia and depression was examined as a dependent variable. Race, socioeconomic status (SES; household income and education), gender, and age were also tested as independent moderators of treatment effects.Results The dCBT-I condition yielded greater reductions in both insomnia and depression severity than sleep education, with significantly higher rates of remission following treatment. Demographic variables (i.e. Income, race, sex, age, education) were not significant moderators of the treatment effects, suggesting that dCBT-I is comparably efficacious across a wide range of demographic groups. Furthermore, while differences in attrition were found based on SES, attrition did not differ between white and black participants.Conclusions Results provide evidence that the wide dissemination of dCBT-I may effectively target both insomnia and comorbid depression across a wide spectrum of the population.

Original languageEnglish
Pages (from-to)491-500
Number of pages10
JournalPsychological Medicine
Issue number3
Early online date24 May 2018
Publication statusPublished - 1 Feb 2019
Externally publishedYes

Bibliographical note

Funding Information:
Acknowledgments. Support for this study was provided from the Robert Wood Johnson Foundation, and from the National Institute of Mental Health R56MH115150 awarded to CLD. Funding for PC was provided from the National Heart Lung and Blood Institute (K23HL138166). We would also like to thank David Adler for his continued support of our research program.

Publisher Copyright:
Copyright © Cambridge University Press 2018.


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