Cognitive Behavioral Therapy for Suicidal Thoughts in Older Adults

(ANSWERS-OA Trial)

Overseen By Andrew S Tubbs, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: MICHAEL A GRANDNER

Must not be taking: Psychotropics

Disqualifiers: Bipolar, Psychotic disorders, Untreated apnea, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 4 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) can reduce suicidal thoughts in older adults with insomnia. Researchers aim to determine if better sleep can also enhance mental health in this group. Two groups will participate: one will receive immediate therapy, while the other will be on a waitlist before receiving therapy. This trial is best suited for English-speaking individuals aged 55 and older who have recently experienced suicidal thoughts and are dealing with ongoing insomnia. As an unphased trial, participants can contribute to groundbreaking research that may improve mental health treatments for older adults.

Will I have to stop taking my current medications?

If you are taking psychotropic medications (like antidepressants or sleep aids), you must not have changed the dose in the past 6 weeks and agree not to change it during the trial. If you are not on such medications, you need to be medication-free for at least 6 weeks before starting the trial and agree not to start any new medications during the trial.

What prior data suggests that digital Cognitive Behavioral Therapy for Insomnia is safe for older adults?

Research shows that digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is safe and well-tolerated by older adults. Studies have found that it effectively reduces insomnia symptoms without causing significant side effects. Unlike medications, this behavioral treatment usually avoids the side effects drugs might cause. Additionally, studies combining results from multiple research projects confirm the safety and lasting benefits of CBT-I for older adults. Therefore, evidence suggests that dCBT-I is a safe option for treating insomnia and may also help improve suicidal thoughts in this age group. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) because it offers a unique approach to addressing suicidal thoughts in older adults by targeting insomnia, a significant risk factor. Unlike traditional therapies, which might involve medications or face-to-face sessions, dCBT-I is delivered online via a program called Sleep Healthy Using the Internet (SHUTi), making it accessible and convenient for users. This digital format allows for personalized, self-paced treatment, which can be especially beneficial for older adults who may have mobility issues or prefer the privacy of home-based therapy. By directly addressing insomnia, researchers hope to indirectly reduce suicidal ideation, providing a holistic approach to mental health care.

What evidence suggests that digital Cognitive Behavioral Therapy for Insomnia might be an effective treatment for suicidal thinking in older adults?

Research has shown that Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I), which participants in this trial may receive, effectively reduces insomnia and improves sleep quality in older adults. One study found that using dCBT-I to treat insomnia can help reduce and prevent suicidal thoughts, which is crucial since insomnia can increase the risk of such thoughts. Additionally, dCBT-I has improved symptoms of anxiety and depression in people aged 65 and older. These findings suggest that dCBT-I might be a valuable tool for reducing suicidal thoughts by enhancing sleep and mental health in older adults. Participants in the waitlist control group will initially undergo monitoring before receiving dCBT-I. ^{6 7 8 9 10}

Who Is on the Research Team?

Michael A Grandner, PhD

Principal Investigator

University of Arizona

Are You a Good Fit for This Trial?

This trial is for English-speaking individuals aged 65 or older with insomnia and recent suicidal thoughts. They must be willing to share information between the research team and their mental health provider, not work night shifts, have internet access, and not plan to change psychotropic medications during the trial.

Inclusion Criteria

English speaking

All participants must consent to a release of information between the research team and their treatment provider (either their prescribing psychiatrist, their masters-level non-trainee therapist, or their doctoral-level psychologist)

I currently have trouble sleeping.

Exclusion Criteria

Cognitive impairment sufficient to impair delivery or retention of dCBT-I as indicated by the Short Blessed Test

I do not have bipolar, psychotic disorders, or other serious mental illnesses.

I might have a sleep disorder like sleep apnea or restless legs syndrome that hasn't been treated.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 8 weeks of digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) or are placed in a waitlist control group with weekly monitoring

8 weeks

Weekly monitoring

Crossover Treatment

Participants in the waitlist control group crossover to receive 8 weeks of dCBT-I, while those initially receiving dCBT-I undergo active monitoring

8 weeks

Weekly monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 6- and 12-months post-treatment

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Digital Cognitive Behavioral Therapy for Insomnia

Trial Overview The study tests digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) in older adults to see if it reduces suicidal thinking. It's a preliminary investigation into whether treating sleep problems can help alleviate suicide risk factors without necessarily improving cognition.

How Is the Trial Designed?

Group I: digital Cognitive Behavioral Therapy for Insomnia Experimental Treatment 1 Intervention

Following baseline evaluation, participants in this group will receive 8 weeks of digital Cognitive Behavioral Therapy for Insomnia delivered using Sleep Healthy Using the Internet (SHUTi). After the interim assessment, participants will then crossover to 8 weeks of active monitoring.

Group II: Waitlist Control Active Control 1 Intervention

Following baseline evaluation, participants in this group will undergo weekly monitoring of insomnia and suicidal ideation for 8 weeks. Participants will continue whatever treatments they are currently receiving, but will receive no specific instructions or behavioral interventions for insomnia. After the interim assessment, participants will then crossover to receive digital Cognitive Behavioral Therapy for Insomnia.

Digital Cognitive Behavioral Therapy for Insomnia is already approved in United States, European Union, Canada for the following indications:

Approved in United States as CBT-I for:

• Insomnia
• Suicidal ideation

Approved in European Union as CBT-I for:

• Insomnia

Approved in Canada as CBT-I for:

• Insomnia

Who Is Running the Clinical Trial?

MICHAEL A GRANDNER

Lead Sponsor

Trials

1

Recruited

70+

University of Pennsylvania

Collaborator

Trials

2,118

Recruited

45,270,000+

Published Research Related to This Trial

In a study of 144 older veterans with insomnia, cognitive behavioral therapy for insomnia (CBTI) led to significant reductions in dysfunctional sleep-related beliefs, which were linked to improvements in various sleep and daytime functioning outcomes.

The CBTI group showed stronger associations between improved sleep-related beliefs and better scores on sleep quality and fatigue measures, indicating that addressing these beliefs is crucial for enhancing the effectiveness of CBTI in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial. Song, Y., Kelly, MR., Fung, CH., et al.[2022]

Digital cognitive behavior therapy for insomnia (dCBT-I) significantly improves sleep quality in patients with insomnia, particularly in those with anxiety disorders, as shown in a study of 6,002 patients over a 12-week period.

Patients receiving dCBT-I monotherapy and those with combined therapy showed notable improvements in sleep quality, with the most significant changes observed in the anxiety group, indicating that dCBT-I is a practical and effective treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital cognitive behavior therapy for insomnia improving sleep quality: a real-world study. Liang, S., Mao, H., Yang, J., et al.[2022]

A brief cognitive behavioral therapy for insomnia (CBT-I) intervention delivered by public health nurses significantly improved depressive symptoms in community-dwelling older adults, as shown by a decrease in Geriatric Depression Scale scores over a 3-month follow-up.

The study, which used a randomized controlled design with a wait-list control group, found a small effect size (Cohen's d = 0.34), indicating that while effective, the intervention's impact on depression was modest.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Brief Cognitive Behavioral Therapy for Insomnia on Improving Depression Among Community-Dwelling Older Adults: A Randomized Controlled Comparative Study. Tanaka, M., Kusaga, M., Nyamathi, AM., et al.[2022]

Digital cognitive behavioral therapy (dCBT) significantly improves functional health, psychological well-being, and sleep-related quality of life in adults with chronic insomnia, with these benefits sustained up to 48 weeks after treatment.

dCBT also reduces the use of both prescription and non-prescription sleep medications compared to sleep hygiene education, indicating its effectiveness in managing insomnia without relying heavily on medication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial. Luik, AI., Marsden, A., Emsley, R., et al.[2021]

A smartphone-based, culturally adapted digital cognitive behavioral therapy for insomnia (DCBT-I) significantly reduced insomnia severity compared to sleep education in a randomized trial with 82 participants over 6 weeks.

Participants in the DCBT-I group experienced greater improvements in total sleep time and sleep efficiency at both 3 and 6 months follow-up, indicating its efficacy in enhancing sleep quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital Cognitive Behavioral Therapy for Insomnia Using a Smartphone Application in China: A Pilot Randomized Clinical Trial. Zhang, C., Liu, Y., Guo, X., et al.[2023]

Digital cognitive behavioral therapy for insomnia (dCBT-I) was found to be more effective than medication alone in reducing insomnia symptoms, with significant improvements in Pittsburgh Sleep Quality Index scores over 6 months for dCBT-I and combination therapy.

While dCBT-I showed comparable effectiveness to combination therapy, its benefits were less stable over time, indicating that while it is a strong treatment option, further research is needed to understand its long-term reliability in different patient groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of Digital Cognitive Behavioral Therapy vs Medication Therapy Among Patients With Insomnia. Lu, M., Zhang, Y., Zhang, J., et al.[2023]

The internet-based cognitive-behavioral therapy for insomnia (CBT-I) program significantly reduced symptoms of depression, anxiety, and insomnia within just 4 weeks, with these improvements lasting for over 18 months in a study of 1,149 adults.

While the CBT-I program effectively lowered depressive symptoms long-term, its impact on suicidal ideation was only temporary, indicating a need for additional support for individuals at risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression. Batterham, PJ., Christensen, H., Mackinnon, AJ., et al.[2020]

A randomized controlled trial involving 1149 Australian adults showed that self-guided digital Cognitive Behavioral Therapy for insomnia (CBT-I) significantly improved various sleep outcomes, including sleep-onset latency and sleep quality, compared to a control program.

These improvements were not only evident immediately after the intervention but were also sustained over 18 months, highlighting the long-term effectiveness of digital CBT-I for individuals with insomnia and depressive symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sleep-specific outcomes attributable to digitally delivered cognitive behavioral therapy for insomnia in adults with insomnia and depressive symptoms. Batterham, PJ., Thorndike, FP., Gerwien, R., et al.[2023]

Digital cognitive behavioral therapy (dCBT) significantly improves functional health, psychological well-being, and sleep-related quality of life in individuals with insomnia, based on a study of 1711 participants over 24 weeks.

The reduction in insomnia symptoms was a key factor mediating these improvements, highlighting that dCBT effectively addresses both daytime and nighttime issues related to poor sleep.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial. Espie, CA., Emsley, R., Kyle, SD., et al.[2023]

In a study involving 1720 adults with insomnia, digital cognitive behavioral therapy for insomnia (dCBT-I) significantly reduced intraindividual variability in sleep metrics, particularly in sleep onset latency, which is crucial for improving sleep quality.

The reduction in variability in sleep metrics was found to mediate significant improvements in both insomnia severity and psychological distress, highlighting the effectiveness of dCBT-I as a therapeutic intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of sleep-wake intraindividual variability in digital cognitive behavioral therapy for insomnia: a mediation analysis of a large-scale RCT. Vestergaard, CL., Vedaa, Ø., Simpson, MR., et al.[2021]

Citations

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Cognitive-behavioral therapy for insomnia prevents and ... Our trial showed that treating insomnia to remission with digital CBTI alleviates and prevents suicidal ideation. This study is the first to support treating ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT04986007

NCT04986007 | Addressing Nocturnal Sleep/Wake Effects ... Consequently, this study will help inform future study designs and provide preliminary data on whether dCBT-I is effective for suicidal thinking in older adults ...

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Efficacy of digital cognitive behavioral therapy for treating ... Conclusion: dCBT can effectively improve symptoms of insomnia, anxiety, and depression in adults aged 65+. Digital CBT may serve as an accessible means for ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT05842863

Combined Dialectical Behavior Therapy and Digital ... The goal of this clinical trial is to learn providing insomnia treatment in conjunction with suicide-focused treatment leads to greater reductions in ...

5. withpower.com withpower.com/trial/phase-sleep-initiation-and-maintenance-disorders-7-2021-654ac

Cognitive Behavioral Therapy for Suicidal Thoughts in ... Research shows that Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is effective in reducing insomnia severity, improving sleep quality, and ...

6. nature.com nature.com/articles/s41746-025-01847-0

A randomized controlled trial of a digital cognitive ... Meta-analyses support CBT-I as efficacious and safe, with long-lasting effects in older adults. As a behavioral rather than pharmacological ...

7. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40681664/

A randomized controlled trial of a digital cognitive ... Results indicate that digital CBT-I provides important benefits for older adults, offering strong potential to expand access to insomnia ...

8. academic.oup.com academic.oup.com/sleep/article/46/Supplement_1/A156/7181980

0352 Digital cognitive behavioral therapy in treating insomnia ... Digital CBT led to significantly greater improvements at post-treatment and follow-up relative to control for the combined sleep (ds≤-1.34, ps<.

9. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT05173844

Digital Sleep Therapy for Older Adults with Cognitive ... This study aims to determine the efficacy of digital Behavioural Therapy for Insomnia (dBTi) compared to online sleep health education (control) at reducing ...

10. jcsm.aasm.org jcsm.aasm.org/doi/10.5664/jcsm.11756

main outcomes of a randomized dismantling trial All groups exhibited insomnia symptom reduction at posttreatment (CT: d = −2.53, P < .001; BT: d = −2.39, P < .001; CBT: d = −2.90, P < .001) ...