A new study has shown that using a digital form of psychotherapy combined with usual NHS care improves the mental health of more people with depression, anxiety and insomnia, compared with usual care alone
Whether it's struggling to get enough sleep for a couple of nights in a week, or a month-long phase of chronic sleeplessness, insomnia affects millions of people across the UK. In fact, it's estimated that one third of us will experience insomnia at some point in our lives.
Yet even though it's so common, insomnia isn't usually the first mental health issue you could name. It's also probably not an issue that you associate with particularly bad health outcomes. On the contrary though, insomnia can play a huge part in the severity of issues like depression and anxiety.
Cognitive behavioural therapy (CBT) – a type of talking therapy that is delivered through the NHS' Improving Access to Psychological Therapies (IAPT) programme – is the recommended first-line treatment for insomnia in the UK, but in most cases, medication is prescribed instead due to long waiting lists.
In order to provide people with insomnia the psychological support they need, digital therapeutics company Big Health launched Sleepio in 2012. The platform, which is delivered via a computer or mobile app, guides users through a 6-week programme that has been shown to improve sleep and day-to-day functioning. Its evidence of effectiveness was so impressive that Sleepio was one of the launch apps for the NHS Apps Library, where it remains to this day.
Now, Sleepio has even more evidence to back up its status as an effective tool for helping with mental health issues.
In a joint study between Big Health and Oxford Health NHS Foundation Trust, 65% of people with insomnia who were seeking treatment for depression or anxiety improved their mental health with Sleepio plus IAPT care, compared with 58% who were given IAPT alone. In addition, the combination therapy also reduced the number of people needing high-intensity IAPT treatment, which includes one-on-one sessions with therapists.
The study tracked more than 1000 people referred for IAPT treatment, half of whom were given Sleepio plus IAPT, while the other half were given IAPT alone. Improvements in mental health were recorded and measured using GAD-7, which analyses symptoms of anxiety, and PHQ-9, which analyses symptoms of depression.
For those who used Sleepio, symptoms of depression and anxiety were significantly lower, while social functioning was significantly improved.
“We are proud to collaborate with Big Health on this innovative study, which shows the opportunity to further improve clinical outcomes through integration of a digital therapeutic for insomnia and evidence-based psychological therapy for anxiety and depression,” says Dr John Pimm, clinical lead of Buckinghamshire IAPT service Healthy Minds. "Recovery rates for people with anxiety and depression receiving IAPT care in England are already good - however, we have found that we can improve them further with this additional digital intervention.
Covering all bases
The IAPT programme in England is structured as a 'stepped-care' model, i.e. people referred to it will begin on low-intensity therapy and by stepped-up to higher intensity therapy if they need to be.
Low-intensity therapy tends to consist of more informal group settings , such as a psychoeducation group class. High-intensity therapy sharpens the focus down to the individual, consisting of one-on-one weekly sessions with a trained therapist or other more personalised therapy options.
Almost all steps in the pathway are under strain as waiting lists for psychological support are growing across the country, influenced by the Covid-19 pandemic. The situation calls for "more scalable, evidenced digital interventions to augment our services, making care more efficient and effective," adds Pimm.
But with the amount of evidence in Sleepio's favour, says Dr Colin Espie, co-founder or Big Health, the app can act as a bridge between almost all steps of the mental health care pathway:
“This study represents Big Health’s unique ability to reach users across the clinical care pathway."
Find out more about Sleepio here.
Written by Marco Ricci
Editor and contributor for Talking Mental Health