Voice-activated therapy may reduce insomnia symptoms among breast cancer survivors
Click Here to Manage Email Alerts
A voice-activated, in-home cognitive behavioral therapy program alleviated symptoms of insomnia among breast cancer survivors, according to results of a randomized clinical trial.
Researchers enrolled 76 female breast cancer survivors (mean age, 49 years) who had finished active treatment at least 3 months earlier.
Eligible participants had Insomnia Severity Index (ISI) scores higher than 7 — of the scale’s maximum 28 points — and had not undergone other behavioral sleep interventions within the previous year.
Investigators randomly assigned half of the women to use a smart speaker with voice-activated cognitive behavioral therapy for insomnia for 6 weeks. They assigned the other half of participants to an educational control group.
Changes in ISI scores served as the primary outcome.
Seventy women completed the study.
Results showed greater changes in ISI scores from baseline in the intervention group (mean, –8.4 points; ±4.7) than the control group (mean, –2.6 points; ±3.5) in the control group (Cohen d, 1.41; 95% CI, 0.87-1.94).
“Plenty of previous studies have shown that digital forms of cognitive behavioral therapy for insomnia are effective [for] reducing insomnia symptoms,” study author Hannah Arem, PhD, scientific director of implementation science at MedStar Health, told Healio. “Our voice-activated approach is the first of its kind to serve as an in-home, daily interactive program where people were waking up in the morning, reporting their sleep the previous night, then receiving education on a daily cadence.”
Healio spoke with Arem about how this approach came about, how it has performed so far and its potential implications for reducing insomnia among cancer survivors.
Healio: How prevalent is insomnia among breast cancer survivors?
Arem: There is a wide range of what people describe in terms of insomnia symptoms, but the estimate is that 30% to 50% of breast cancer survivors experience longer-term insomnia. This isn’t just acute insomnia during treatment, but persistent insomnia over time. A big contributor to insomnia among breast cancer survivors is induced menopause. There also is anxiety around recurrence, as well as other late and long-term effects of treatment that are interrelated, including fatigue and pain.
Healio: What gave you the idea for voice-activated cognitive behavioral therapy and how does it work?
Arem: Our voice-activated approach uses a smart speaker. Instead of someone sitting at a computer and logging into a program— which is how previous programs delivered the therapy— ours is launched on the speaker.
We developed this by working with a few sleep therapists and existing manuals. Cognitive behavioral therapy for insomnia is a well-established therapy, so we weren’t creating a new kind of therapy. However, we did collaborate with experts to help refine manuals, give people cues and guidance, and then give personalized, tailored feedback about how to improve their sleep. The program adjusts recommendations based on a person’s daily responses. We wanted to see if this would increase engagement. Some of the previous digital programs have shown effectiveness, but they have had very high dropout rates. We were looking for an alternative way to deliver this therapy effectively.
Healio: What did you find?
Arem: This program did improve insomnia symptoms. The improvement was similar in magnitude to what you would see in other digital programs. We also had very high engagement. The 38 women who were in the intervention arm completed an average of 39 days of a 42-day program, so adherence was very good. We had a handful of people who either had technology issues or otherwise didn’t engage, but we were very happy with the engagement we saw and the significant impact on insomnia symptoms.
Healio: What are the next steps?
Arem: There are different directions we want to pursue. Obviously, there are questions of scale — we still need to truly understand the prevalence of insomnia and find a pathway to give people access to this type of treatment. This project was done under NIH’s Small Business in Research program. This was a joint multiple PI grant with a small business that has an interest in commercializing this project. So, there’s the commercialization aspect of this, but there are still research questions. My area of expertise is implementation research. This looks at how you deliver a program like this in practice. How do you get physicians to recommend it? How do you promote it outside physicians’ offices? There are many questions around uptake and education. Additionally, there are questions about different risk levels. Some people might be fine with a single session, and others might need the full 6-week program. Some might need this program to be complemented by a physician. There are many avenues to explore around scale and personalization.
Healio: Is there anything else you’d like to mention?
Arem: I believe this program could also be highly effective for survivors of other cancer types, or in the general population. That could be another potential step, offering it and tailoring it to other populations.
Reference:
For more information:
Hannah Arem, PhD can be reached at hannah.arem@medstar.net.
Collapse
Healio Interviews
Read more about
Click Here to Manage Email Alerts