Digital CBT for Insomnia and Emotion Regulation in the Workplace: A Randomised Controlled Trial

Importance: Cognitive Behavioural Therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia. Dissemination of this proven effective treatment at scale in places where it is most needed remains a challenge and requires sensitive adaptation and evaluation.Objective: To determine whether a hybrid digital CBT-I and emotion regulation (ER) delivered through workplaces improves insomnia, depression, anxiety, and productivity.Design: Randomised waitlist-controlled trial, with assessments at baseline and at eight weeks post randomisation.Setting: Online treatment, accessed in confidence through workplaces or self-referral.Participants: 159 non-shift workers with at least mild symptoms of insomnia, depression or anxiety, randomised to either digital CBT-I+ER or a waitlist control group.Intervention: dCBT-I+ER was delivered through a web-based platform and four therapy sessions via video-conferencing. Participants were asked to track their sleep using actigraphy and a sleep diary that was used to pace the intervention delivered.Main outcomes and measures: Primary outcomes were scores on standardised measures for insomnia, depression and anxiety. Secondary outcomes comprised psychological wellbeing, quality of life, work productivity and satisfaction, as well as self-reported and objective sleep parameters collected through sleep diaries and actigraphy, respectively.Results: Among 159 participants (mean age 43.6±9.4 years, 76.7% female, 80.5% white), 80 were assigned to dCBT-I+ER and 79 to waitlist control. Using general linear models, case-complete analyses showed that dCBT-I+ER had significant improvements on insomnia [F1, 134=71.46, p<.0001], depression [F1, 134=35.67, p<.0001], and anxiety [F1, 134=17.63, p<.0001]. Intention to treat analyses showed equivalent results for insomnia [F1, 1429=513.79, p<.001], depression [F1, 1429=243.53, p<.001] and anxiety [F1, 1429=136.20, p<.001]. Bonferroni corrected significance at p=0.01667 was reached except for psychological wellbeing [F1, 132.13=10.64, p<0.001], with a large effect size of d=1.05 in dCBT-I+ER. Actigraphy data showed no significant effects, while sleep diary data demonstrated significant improvements in all parameters except total sleep time, favouring dCBT-I+ER with large effect sizes (0.7<d<1.5). Improvements in quality of life, work productivity and satisfaction outcomes were not significant.Conclusions and relevance: Given its efficacy in workplaces, delivering dCBT-I+ER could be an effective scalable intervention with longer-term efficacy and economic benefits to be further evaluated.Trial registration: ISRCTN13596153, Registered on 08/06/2021.