Internet-based cognitive behaviour therapy for insomnia before and during the COVID-19 pandemic

Objective Online cognitive behavioural therapy for insomnia (iCBT-I) provides scalable access to psychological interventions; however, the effectiveness of these courses during COVID-19 has not been examined. This study investigated the uptake and potential effectiveness of iCBT-I during the first 10 months of the pandemic in Australia (March- December 2020) and compared outcomes in the year prior. Method Two thousand six hundred and ninety-four adults commenced a four-lesson iCBT-I course (1,883 during the pandemic; 811 in the year before). Measures of insomnia and psychological distress were administered pre-, mid- and post-treatment. Results In the COVID-19 period, we observed a 140% increase in monthly course registrations compared to the year prior (with a peak increase of 257% from April-June 2020). Insomnia symptom severity was marginally lower for the during-COVID group compared to the pre-COVID group, although levels of psychological distress were similar. Before and during COVID-19, iCBT-I was associated with large effect size reductions in insomnia symptom severity (gs = .86-1.09) and small effect size improvements in psychological distress and wellbeing (gs = 0.34-0.41). Conclusion iCBT-I uptake substantially increased during the pandemic; treatment outcomes were similar. The findings demonstrate the scalability and potential effectiveness of iCBT-I. What is already known about this topic: Insomnia is a significant public health issue. Internet delivered cognitive behaviour therapy (iCBT) is effective in reducing insomnia symptom severity. The COVID-19 pandemic has had a large impact on mental health with higher estimated rates of insomnia during the pandemic. What this topic adds: Uptake of an online insomnia course increased by >180% during COVID-19. The course was associated with large effect size reductions in insomnia symptoms. Results highlight the utility and scalability of digital mental health services.