0443 Change in Sleep-Cognitions After Digital or Therapist-Led Cognitive Behavioral Therapy for Insomnia in Older Adults

Abstract Introduction Traditional therapist-led cognitive behavioral therapy for insomnia (CBTI) is associated with a shift to more adaptive cognitions about sleep, as measured by the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS). To address unhelpful beliefs about sleep, CBTI uses cognitive therapy strategies. This study sought to assess the degree to which changes in DBAS differ between patients receiving digital CBTI (dCBTI) and those receiving therapist-led CBTI after two months of treatment access. Methods The RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study evaluated a triaged stepped-care framework for delivering dCBTI and therapist-led CBTI. Based on a study-developed checklist, 137 (M age=63.26 years [SD=7.79], 69% female) participants were identified as candidates who would likely benefit from higher intensity CBTI. However, these candidates were randomly assigned to one of two study arms: online only (n=68) or stepped care (n=69). Those in the online only arm received dCBTI, and those in the stepped care arm received therapist-led CBTI. Both arms included the same CBTI components, but therapist-led CBTI additionally included a module on supporting reduction in sleep medications. Participants completed the 16-item DBAS at baseline and two months post randomization. Multilevel modeling was used to examine changes in DBAS scores and subscale scores, including Expectations, Worry/Helplessness, Consequences, and Medication subscales. Results There were no significant differences in DBAS scores between participants receiving dCBTI and those receiving therapist-led CBTI (Beta=-0.05, SE=0.21, p=.82). At the level of subscale scores, compared to dCBTI, therapist-led CBTI was associated with greater reduction in dysfunctional beliefs in the 3-item Medication subscale (Beta=-1.10, SE=0.34, p=.001). Conclusion Whereas there was no differential impact of delivery mode on overall DBAS scores, therapist-led treatment resulted in greater change in DBAS Medication subscale scores for participants pre-identified as those who would benefit from higher intensity treatment. Specifically, therapist-led interventions might be especially effective for changing beliefs that insomnia has a biochemical etiology and that sleep medications are necessary for better sleep. Changing such beliefs may be an important element in supporting sustained improvement and potentially reducing sleep medication use. Support (if any) R01AG057500