0397 Efficacy of second-stage clinician-led CBTI in non-responders to digital CBTI: Is alleviation of cognitive arousal a mechanism?

Abstract Introduction Cognitive-behavioral therapy for insomnia (CBTI) is first-line treatment insomnia, but a provider shortage limits access. eHealth technology can increase access to behavioral interventions, and digital CBTI (fully automated programs) are effective. However, >50% of patients do not remit, non-remission linked undertreated cognitive arousal, central feature insomnia. In randomized controlled trial, we non-remitters second-stage clinician-led or control. We evaluated whether effectively reduced depression, tested reductions in arousal mediated these effects. Methods 207 whose did remit with presented therapy. Patients were sleep education control via telemedicine. Study outcomes included (insomnia severity index, ISI), depression (quick inventory depressive symptomatology self-report 16-item survey, QIDS-SR16), three indices (pre-sleep scale’s factor [PSASC], perseverative thinking questionnaire [PTQ], daytime symptoms response scale [DISRS]). Results Before therapy, all reported clinically significant (ISI≥10), 13.0% moderate 69.5% high arousal. Step 2 patients, relative Controls, larger decreases ISI (-6.43±4.31 vs -2.58±4.83, t=6.05, p<.001, Cohen’s d=.84). At posttreatment, 56.3% remitted (ISI≤7) just 16.3% Controls (Χ2=35.77, RR=3.45). control, which was small-to-medium effect (-2.63±3.11 -1.11, t=3.15, p=.002, d=.44). Contrary hypotheses, reduce Control as measured by the PSASC (p=.195), PTQ (p=.840), DISRS (p=.643). Conclusion Clinician-led effective alleviating comorbid who initially CBTI. reducing mediate As most present alternative approaches that better target may represent viable options Support (if any) This RCT (NCT03322774) supported NIMH R01-MH122636.