Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression

Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d)...

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Main Authors: Kerstin Blom, Susanna Jernelöv, Nils Lindefors, Viktor Kaldo
Format: Article
Language:English
Published: Elsevier 2016-05-01
Series:Internet Interventions
Subjects:
CBT
Online Access:http://www.sciencedirect.com/science/article/pii/S2214782916300161
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spelling doaj-360e76fb5e3c48e5b81f9b6e1cf59a672020-11-25T00:14:35ZengElsevierInternet Interventions2214-78292016-05-014P1516010.1016/j.invent.2016.03.004Facilitating and hindering factors in Internet-delivered treatment for insomnia and depressionKerstin Blom0Susanna Jernelöv1Nils Lindefors2Viktor Kaldo3Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, SwedenKarolinska Institutet, Department of Clinical Neuroscience, Section of Psychology, Stockholm, SwedenKarolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, SwedenKarolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, SwedenInsomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission. Aims: To identify facilitating and hindering factors for patients in ICBT-i and ICBT-d and formulate hypotheses for future research. Method: Qualitative telephone interviews at the time of the 6-month follow-up. Thirty-five interviews were done and analyzed with a grounded theory approach. Based on the qualitative results, an iterative method-triangulation including quantitative and semi-qualitative was performed. Results: The interviews were coded into 738 sentences, condensed into 47 categories and finally 11 themes. Four areas were investigated further with method triangulation: Opinions about treatment, adherence, hindering symptoms and acceptance. Patients in ICBT-i were more positive regarding the treatment than patients in ICBT-d. Using treatment components was positively associated with outcome in both groups. Symptoms of insomnia, depression and other comorbidities were perceived as more hindering for ICBT-d than for ICBT-i. Acceptance of diagnose-related problems as well as negative emotions and cognitions was positively associated with outcome for ICBT-i. Proposed future research hypotheses: 1) A combination of CBT for insomnia and CBT for depression is more effective than only one of the treatments. 2) Additional therapist support increases outcomes for patients with more comorbidities. 3) Acceptance is a mechanism of change in CBT-i.http://www.sciencedirect.com/science/article/pii/S2214782916300161InsomniaDepressionQualitativePsychotherapyInternetMethod-triangulationCBTICBTCBT-i
collection DOAJ
language English
format Article
sources DOAJ
author Kerstin Blom
Susanna Jernelöv
Nils Lindefors
Viktor Kaldo
spellingShingle Kerstin Blom
Susanna Jernelöv
Nils Lindefors
Viktor Kaldo
Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
Internet Interventions
Insomnia
Depression
Qualitative
Psychotherapy
Internet
Method-triangulation
CBT
ICBT
CBT-i
author_facet Kerstin Blom
Susanna Jernelöv
Nils Lindefors
Viktor Kaldo
author_sort Kerstin Blom
title Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
title_short Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
title_full Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
title_fullStr Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
title_full_unstemmed Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
title_sort facilitating and hindering factors in internet-delivered treatment for insomnia and depression
publisher Elsevier
series Internet Interventions
issn 2214-7829
publishDate 2016-05-01
description Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission. Aims: To identify facilitating and hindering factors for patients in ICBT-i and ICBT-d and formulate hypotheses for future research. Method: Qualitative telephone interviews at the time of the 6-month follow-up. Thirty-five interviews were done and analyzed with a grounded theory approach. Based on the qualitative results, an iterative method-triangulation including quantitative and semi-qualitative was performed. Results: The interviews were coded into 738 sentences, condensed into 47 categories and finally 11 themes. Four areas were investigated further with method triangulation: Opinions about treatment, adherence, hindering symptoms and acceptance. Patients in ICBT-i were more positive regarding the treatment than patients in ICBT-d. Using treatment components was positively associated with outcome in both groups. Symptoms of insomnia, depression and other comorbidities were perceived as more hindering for ICBT-d than for ICBT-i. Acceptance of diagnose-related problems as well as negative emotions and cognitions was positively associated with outcome for ICBT-i. Proposed future research hypotheses: 1) A combination of CBT for insomnia and CBT for depression is more effective than only one of the treatments. 2) Additional therapist support increases outcomes for patients with more comorbidities. 3) Acceptance is a mechanism of change in CBT-i.
topic Insomnia
Depression
Qualitative
Psychotherapy
Internet
Method-triangulation
CBT
ICBT
CBT-i
url http://www.sciencedirect.com/science/article/pii/S2214782916300161
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