@Article{info:doi/10.2196/65228,
author="Isaac, Fadia
and Klein, Britt
and Nguyen, Huy
and Watson, Shaun
and Kennedy, Gerard A",
title="Digital Cognitive Behavioral Therapy--Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="14",
volume="12",
pages="e65228",
keywords="insomnia; nightmares; posttraumatic stress disorder; PTSD; wildfires; cognitive behavioral therapy for insomnia; CBTi; exposure, relaxation, and rescripting therapy; ERRT; Sleep Best-i; mobile health; mHealth; digital health; computer; eHealth; bushfires",
abstract="Background: Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. Objective: This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Methods: Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53{\%}) or the waitlist control group (n=14, 47{\%}) in a sequential manner. Participants' ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63{\%} (19/30) female and 37{\%} (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder--7, the Patient Health Questionnaire--9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Results: Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention's effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition {\texttimes} time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire--9. No changes were detected on the Generalized Anxiety Disorder--7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. Conclusions: The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054 ",
issn="2292-9495",
doi="10.2196/65228",
url="https://humanfactors.jmir.org/2025/1/e65228",
url="https://doi.org/10.2196/65228"
}