NCT03322774

Brief Summary

This project will assess the effectiveness of a stepped-care model (i.e. digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) followed by face-to-face CBT-I) in improving severity of insomnia and sleep outcomes in an insomnia cohort. This project will also investigate the effectiveness of this stepped-care model in prevention of major depressive disorder, and will test rumination as a mediator of treatment response.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
1,237

participants targeted

Target at P75+ for not_applicable

Timeline
Completed

Started Mar 2018

Longer than P75 for not_applicable

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

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Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

October 16, 2017

Completed
10 days until next milestone

First Posted

Study publicly available on registry

October 26, 2017

Completed
4 months until next milestone

Study Start

First participant enrolled

March 9, 2018

Completed
5.1 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

April 30, 2023

Completed
1.2 years until next milestone

Study Completion

Last participant's last visit for all outcomes

June 27, 2024

Completed
Last Updated

October 1, 2024

Status Verified

September 1, 2024

Enrollment Period

5.1 years

First QC Date

October 16, 2017

Last Update Submit

September 27, 2024

Conditions

Keywords

Stepped Care

Outcome Measures

Primary Outcomes (3)

  • Preventing major depressive disorder development with dCBT-I/CBT-I stepped care treatment for insomnia.

    Clinical interview by phone administered by trained personnel to determine DSM-5 major depressive disorder incidence and relapse. Major depressive disorder will specifically be determined by the structured clinical interview for DSM-5 (SCID-5) at 1- and 2-year follow-ups. Antidepressant history in the past 1 year is collected via online-administered surveys at 1- and 2-year follow-ups.

    1 and 2 years after initial randomization.

  • Effectiveness of Stepped Care model of dCBT-I/CBT-I for insomnia remission.

    Insomnia remission rates based on the Insomnia Severity Index. Total score range 0-28 with higher scores meaning more insomnia. Remission = ISI \< 8.

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

  • Mediation of Depression Prevention by Reducing Rumination (Nocturnal rumination)

    Rumination as measured by the Pre-Sleep Arousal Scale, Cognitive factor. Scores range from 8 to 40 with higher scores indicating more rumination. Treatment-related changes in rumination will be operationalized as changes from pre- to posttreatment.

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

Secondary Outcomes (7)

  • Mediation of Depression Prevention by Reducing Rumination (Depressive rumination)

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

  • Mediation of Depression Prevention by Reducing Rumination (Worry)

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

  • Mediation of Depression Prevention by Reducing Rumination (Transdiagnostic)

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

  • Reducing subclinical depressive symptoms with dCBT-I/CBT-I stepped care treatment for insomnia.

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

  • Socioeconomic status as a moderator of depression prevention after stepped care insomnia treatment.

    Baseline, upon treatment completion, and then 1 and 2 years after initial randomization.

  • +2 more secondary outcomes

Study Arms (4)

Attention Control

SHAM COMPARATOR

This group receives sleep hygiene education, which serves as a credible control intervention to digital cognitive behavioral therapy for insomnia (dCBT-I). This intervention mimics the web-based patient contact inherent in dCBT-I but is inert with respect to sleep outcomes.

Behavioral: Sleep Hygiene Education Control

Stepped Care Model

EXPERIMENTAL

This group receives digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) through the third party program, "Sleepio." Following initial treatment with dCBT-I, individuals who do not experience remission of their insomnia will begin treatment with face-to-face Cognitive Behavioral Therapy for Insomnia with a trained staff member in behavioral sleep medicine.

Behavioral: digital Cognitive Behavioral Therapy for InsomniaBehavioral: face-to-face Cognitive Behavioral Therapy for Insomnia

Stepped Care Model Control

SHAM COMPARATOR

This group receives digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) through the third party program, "Sleepio." Following initial treatment with dCBT-I, individuals who do not experience remission of their insomnia will receive sleep hygiene education, serving as a credible control intervention for comparison to the Stepped Care Model.

Behavioral: digital Cognitive Behavioral Therapy for InsomniaBehavioral: Sleep Hygiene Education Control

digital CBT-I

EXPERIMENTAL

This group receives digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) through the third party program, "Sleepio." Treatment includes weekly sessions of CBT-I administered over the internet in hour-long video sessions. Daily sleep diaries are recorded online for individual tailoring of treatment.

Behavioral: digital Cognitive Behavioral Therapy for Insomnia

Interventions

Cognitive Behavioral Therapy for Insomnia administered online through the "Sleepio" program. Treatment utilizes sleep restriction, stimulus control, and cognitive therapy. Treatment is administered through 6 weekly, hour-long online video sessions with an animated figure called "The Prof," which delivers the treatment.

Also known as: Sleepio, dCBT-I
Stepped Care ModelStepped Care Model Controldigital CBT-I

Cognitive Behavioral Therapy for Insomnia administered by experienced staff trained in behavioral sleep medicine. Treatment utilizes sleep restriction, stimulus control, and cognitive therapy. Treatment is administered through 6 weekly, hour-long face-to-face sessions with an experienced staff member trained in behavioral sleep medicine.

Also known as: CBT-I
Stepped Care Model

Participants are provided with information about good sleep hygiene through 6 weekly emails. Participants practice good sleep hygiene as part of their sleep routine. In Step 1, sleep hygiene control will be exclusively online. In Step 2, sleep hygiene control includes an in-person, face-to-face component.

Attention ControlStepped Care Model Control

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Determination of Insomnia (ISI \> 14)
  • And no clinically significant depressive symptoms (Quick Inventory of Depressive Symptomatology \< 11)

You may not qualify if:

  • Age \< 18
  • Current use of antidepressants for depression
  • Bipolar or Seizure disorders
  • Known sleep disorders other than insomnia (e.g. obstructive sleep apnea, narcolepsy, restless leg syndrome).
  • Current DSM-5 major depressive disorder at baseline.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Henry Ford Medical Center - Columbus

Novi, Michigan, 48377, United States

Location

Related Publications (1)

  • Drake CL, Kalmbach DA, Cheng P, Ahmedani BK, Peterson EL, Joseph CLM, Roth T, Kidwell KM, Sagong C. Sleep to Reduce Incident Depression Effectively (STRIDE): study protocol for a randomized controlled trial comparing stepped-care cognitive-behavioral therapy for insomnia versus sleep education control to prevent major depression. Trials. 2022 Dec 1;23(1):967. doi: 10.1186/s13063-022-06850-4.

MeSH Terms

Conditions

Sleep Initiation and Maintenance DisordersDepressive Disorder, MajorRumination Syndrome

Condition Hierarchy (Ancestors)

Sleep Disorders, IntrinsicDyssomniasSleep Wake DisordersNervous System DiseasesMental DisordersDepressive DisorderMood DisordersGastrointestinal DiseasesDigestive System DiseasesFeeding and Eating Disorders

Study Officials

  • Christopher L Drake, PhD

    Henry Ford Health System

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
SINGLE
Who Masked
PARTICIPANT
Purpose
PREVENTION
Intervention Model
SEQUENTIAL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Principal Investigator

Study Record Dates

First Submitted

October 16, 2017

First Posted

October 26, 2017

Study Start

March 9, 2018

Primary Completion

April 30, 2023

Study Completion

June 27, 2024

Last Updated

October 1, 2024

Record last verified: 2024-09

Locations