To improve access to effective psychological treatment, Internet-delivered Cognitive
Behaviour Therapy (ICBT) has been developed. ICBT delivers therapeutic content via
structured online lessons usually over several months, teaching the same skills that are
taught in face-to-face cognitive behaviour therapy. In routine practice, ICBT is often
accompanied by brief therapist support offered via secure messaging and/or phone calls. A
growing body of research supports the effectiveness of ICBT for a variety of conditions,
including depression, anxiety, alcohol misuse, and insomnia. For insomnia, ICBTi has been
shown to result in improvements on various sleep measures, comorbid anxiety and
depression, and quality of life, with outcomes comparable to face-to-face treatment.
Importantly, there are a growing number of studies showing the effectiveness of ICBT for
depression and anxiety extends to routine care. However, there are fewer studies
exploring ICBTi in routine care, particularly when minimal exclusion criteria are
imposed. This research is important because sleep difficulties and insomnia are common,
distressing and often disabling and frequently comorbid with mood or anxiety disorders as
well as various physical conditions. Moreover, access to specialized psychological
services, such as CBTi, is often limited, despite CBTi being a well-established
first-line treatment, which many clients find more acceptable than medication. Two key
aspects of CBTi are stimulus control and sleep restriction though other strategies such
as cognitive restructuring and relaxation are also commonly included. ICBTi offers a
promising approach for expanding access to evidence-based treatment for insomnia. This is
especially critical given the high personal and societal costs of leaving insomnia
untreated.
From past research, the investigators have found that approximately 73% of clients
enrolled in the routine clinic that offers ICBT for anxiety and depression also reported
significant sleep problems. Of these, only 30% accessed an additional sleep resource to
address their sleep concerns. While improvements in sleep were observed among all clients
enrolled in ICBT, average post-test treatment scores indicated many clients still had
significant difficulties with insomnia. In another study conducted within the
investigators' Unit, the investigators explored whether offering an insomnia-focussed
lesson at the beginning of ICBT would improve insomnia symptoms. In this study, the
investigators found that clients experienced large reductions in insomnia symptoms at a
faster rate than when clients did not receive the insomnia lesson at the beginning of
ICBT. However, even with these improvements, many clients continued to report clinically
significant levels of insomnia post-treatment, indicating that further support for
insomnia symptoms may be beneficial.
Overall, given that the investigators ICBT program does not appear to be fully meeting
the sleep needs of clients who have depression and anxiety, as well as the needs of
clients who have sleep problems or insomnia and do not want ICBT for depression and
anxiety, the investigators believe it would be valuable to explore the benefits of
offering ICBTi in the routine care clinic. This is especially important for routine care
settings where inclusivity is key and services should be broadly accessible.
One such program that shows promise among clients with diverse sleep difficulties is the
Sleep Course. The current study therefore aims to explore the extent to which this ICBTi
program will be used by clients seeking services within the routine online clinic.
Additionally, the study will explore the demographic and clinical characteristics of
clients who seek ICBTi, as well as the acceptability and effectiveness of the ICBTi
program. The data collected will shape long-term practices within the Online Therapy Unit
and has potential to significantly enhance service delivery. The research will also
provide valuable insights for other online clinics regarding the potential of offering
ICBTi in routine online care. By exploring the program's use, client characteristics,
acceptability, and effectiveness, this study will contribute to a broader understanding
of how ICBTi can be successfully integrated into routine online services, ultimately
improving access to evidence-based treatment for insomnia.