0536 Motivation at Pretreatment and its Correlates in a Trial of Digital CBT For Insomnia: Preliminary Findings

Abstract

Introduction: Pretreatment motivation is a critical variable in any intervention seeking to modify behaviors. Lack of motivation may hamper the effects of cognitive-behavioral therapy for insomnia (CBT-I), especially when delivered online. This study aims to investigate baseline correlates of pretreatment motivation and its influence on treatment outcomes in the context of digitalized CBT-I. Method(s): This is a secondary analysis of an ongoing pragmatic trial conducted in primary care clinics of Quebec City, Canada. The trial was designed to assess the efficacy of a stepped-care intervention for chronic insomnia in which participants received a digital CBT-I (SHUTi), alone or in addition to sleep medication they were already using. Pre-treatment motivation was measured using two items based on the perceived importance of improving sleep and readiness to change behaviors to improve sleep (Score range: 0 to 20; cronbach's alpha 0.79). Baseline questionnaires included an extended version of Insomnia Severity Index (ISI), Fatigue Severity Scale (FFS), Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9). Treatment outcome was measured by a change in ISI scores (i.e. ISI post - ISI pre). Result(s): A total of 28 participants were included in the analysis. All participants preferentially selected ISI either as monotherapy (n=13)or in combination with their usual sleep medication (n=15). Participants' motivation before treatment was high (Mean: 18.04; SD: 1.93). We did not find any associations between motivation and ISI score change or incidence of dropout. However, baseline fatigue was positively correlated with pretreatment motivation (r = 0.51, p = 0.005) and more severe insomnia symptoms were also associated with higher motivation (r=0.43, p=0.03). Specifically, perceived importance was associated with both nighttime and daytime insomnia symptoms while readiness for behavioral change was only associated with daytime impairments on energy, mood and social activities (all p = 0.01). Baseline anxiety and depressive symptoms were not correlated with motivation. Conclusion(s): Insomnia-related daytime impairments and elevated fatigue levels appear to be linked to pretreatment motivation, especially for behavioral changes. Further study with greater statistic power is warranted to understand the relationship between participants' motivation and treatment adherence or outcomes.