It is well known that people with Generalized Anxiety Disorder (GAD) tend to worry a lot more than other people about most things. Although people with GAD are sometimes referred to as the “worried well,” GAD has been shown to be associated with a variety of troubling symptoms including chronic muscle tension, fatigue, and headaches. Among the most common symptoms that individuals report is difficulty falling or staying asleep, known as insomnia.
Indeed, insomnia has been shown to be linked to multiple other conditions, notably depression. Anxiety, depression, and insomnia have all been shown to be highly interrelated. About 58% of patients with depression report having a lifetime anxiety disorder (Kessler et al., 2003). Furthermore, when individuals report having both depression and an anxiety disorder, the insomnia is far more severe (van Mill et al., 2010).
These findings have highlighted the value of developing treatment options to help combat insomnia and further improve an individual’s mental and physical quality of life. Currently, insomnia treatment consists of both pharmacological/drug (e.g. benzodiazepines) and psychotherapeutic (e.g. cognitive behavioral therapy for insomnia) treatment routes. While pharmacotherapy (drug therapy) is shown to be successful for treatment of insomnia in the short-term, it has been shown to have limited effects during long-term use and has also been demonstrated to induce a medley of negative side effects. However, Cognitive Behavioral Therapy for Insomnia (CBT-I) is proven to be highly effective and to have long-lasting effects. But, the large limitation associated with CBT-I is that there are not enough qualified healthcare professionals available to deliver it. Unfortunately, this means that not everyone who needs CBT-I is able to access it. In fact, this shortage of qualified healthcare professionals is an issue that can limit access to many different types of psychotherapies. Due to these shortcomings, researchers have aimed to develop solutions to provide increased access to these important mental health resources.
Digital therapies have emerged as an answer to these problems. The term for these digital therapies or online healthcare practices is E-Health. The primary benefits of E-Health initiatives are that they make healthcare more accessible and less costly for the general public. But are online interventions as effective as face-to-face ones? In fact, the online treatment version of CBT-I has been shown to have similar levels of effectiveness as compared to CBT-I delivered face-to-face (Zachariae, Lyby, Ritterband, & O’Toole, 2016). Importantly, these therapies do not require a mental health specialist (for example, a psychiatrist or a clinical psychologist) for their delivery. As a result, these therapies can be conducted completely online with only the assistance of non-specialists who will provide guidance or coaching.
Additionally, treatments for insomnia that are entirely delivered online with the help of virtual therapists, are available. One such treatment is Sleepio (https://www.sleepio.com). Sleepio is a fully automated sleep treatment program based on the principles of CBT that is made up of six 20-minute long sessions. These sessions help individuals become more informed about insomnia (for example: What is insomnia? What does it mean to have insomnia?), provide information regarding self-help techniques that can help people deal with and improve their insomnia, and importantly also provide support to help deal with the struggle of not being able to have a regular sleep pattern. Further research has also shown that Sleepio is successful at helping people improve their quality of sleep! In a study conducted in 2016 with 98 participants who reported sleep problems and used Sleepio, insomnia symptoms improved after they completed the program (Luik et al., 2016).
71% of the participants in the study conducted by Luik and colleagues also had moderate to severe symptoms of depression or anxiety. But how does this relate to GAD? Due to the fact that many people with GAD have problems with sleep, there is an intriguing possibility that by treating the symptoms of insomnia we can also help improve symptoms of worry and GAD. However, as of now, there’s still a lot of research that needs to be done on the connection between GAD, depression, and insomnia.
As sleep difficulties can be a feature of GAD, conducting further research into more accessible treatment options for insomnia is important, and may help improve treatment outcomes for the disorder as a whole.