Effectiveness of Guided Internet-delivered Cognitive Behavioral Therapy for Insomnia in Autistic Adults (i-Sleep Autism): a Randomized Controlled Trial.
An estimated 60% of autistic adults suffer from insomnia symptoms, which significantly impairs daily functioning and wellbeing. This study evaluated the effectiveness of i-Sleep Autism, a 5-week, guided self-help internet-delivered cognitive behavioral therapy-based intervention (ICBT-I) for insomnia in autistic adults. In co-creation with seven autistic adults with sleeping problems, i-Sleep Autism was adapted from i-Sleep, a pre-existing non-autism specific intervention. A total of 163 adults with autism and insomnia (ISI≥10) was randomly allocated to i-Sleep Autism (n=82) or waitlist control (n=81; receiving psychoeducation and sleep hygiene). Participants were assessed at baseline (T0), mid-intervention (T1; 3-weeks), post-test (T2; 6-weeks), and follow-up (T3; 6 months) on insomnia severity (primary outcome), pre-sleep arousal, anxiety, depression, daily functioning, and quality of life. In the intervention group, 56.1% completed four, and 50% all five modules. Intent-To-Treat analyses revealed a significant reduction in insomnia severity at T1 and T2 (d = 1.02, 95%CI = [0.65, 1.40]), and cognitive- and somatic pre-sleep arousal at post-test, when comparing intervention to control. The intervention group showed significantly higher quality of life at post-test. At T2, 37.8% of the intervention group versus 11.1% of the control group showed clinically meaningful improvement of insomnia. Effects on insomnia severity were maintained at 6-month follow up. No significant effects were found for anxiety, depression, or daily functioning. This is the first RCT to investigate autism-adapted ICBT-I for autistic adults suffering from insomnia. i-Sleep Autism effectively and sustainably improves insomnia. Additional strategies are needed to support dropouts and those who did not benefit.
Authors
Spaargaren Spaargaren, Begeer Begeer, Nieuwenhuis Nieuwenhuis, Bradley Bradley, Riper Riper, Greaves-Lord Greaves-Lord, van Straten van Straten
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