An interventional study of SilverCloud in Insomnia, sponsored by Silver Cloud Health. Completed at 1 site in United Kingdom. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2021-01-29.
Sponsored by Silver Cloud Health · Not applicable, Interventional, and Treatment
Among 59 studies in Sleep Initiation and Maintenance Disorders with a site in United Kingdom — 11 open to participants now, 13 under way, 1 of them phase 3. Sleep Initiation and Maintenance Disorders · United Kingdom.
Among the 59 studies in Sleep Initiation and Maintenance Disorders with a site in United Kingdom, this one is the 22nd largest by enrollment of the 49 interventional ones, is one of 3 that started in 2019, is one of 31 with no phase, and was the 30th registered.
2,722 studies on the registry are indexed under Sleep Initiation and Maintenance Disorders; 726 are open to participants now.
This study's enrollment of 60 is below the median of 68 across 2,350 interventional studies indexed under Sleep Initiation and Maintenance Disorders.
Browse Sleep Initiation and Maintenance Disorders studies →11 of the 59 studies in Sleep Initiation and Maintenance Disorders with a site in United Kingdom are open now, in 4 countries. Each count lists the studies.
Of the 386 Sleep Initiation and Maintenance Disorders studies recruiting now, 152 (39%) set no upper age limit and 204 (53%) stop at 75 or younger; 59 take children under 18; 108 take healthy volunteers.
This study: 18 Years to 80 Years · all sexes · no healthy volunteers.
The full table on the hub →59 studies; the count open now beside each. This study's row is marked.
First in 2000; this study’s year is marked. 3 started in 2019.
Median enrollment 52 across the 49 interventional studies, 200 across the 7 observational. Of the 39 that completed or were terminated, 9 (23%) have results posted.
23 of 59 have an industry lead sponsor. The 10 most frequent:
Silver Cloud Health is the lead sponsor of 7 studies on the registry; none are open to participants now.
Silver Cloud Health has 1 study filed under Sleep Initiation and Maintenance Disorders — fewer than ten, so there is no comparison to draw.
2 of the studies in Sleep Initiation and Maintenance Disorders with a site in United Kingdom that are under way reach primary completion within a year, 1 of them phase 3. Phase 3 first, then by date:
| Study | Primary completion |
|---|---|
| NCT06953869Phase 3Vanda PharmaceuticalsEvaluating the Effects of Tasimelteon vs. Placebo in Treating Pediatric Insomnia | 2027-11 |
| NCT07754981University of SheffieldSelf-Help Booklets for Sleep in Adults With Pulmonary Hypertension | 2027-03 |
Among the 59 studies in Sleep Initiation and Maintenance Disorders with a site in United Kingdom, from their registry updates:
The principal objective of the study is to assess the feasibility and preliminary efficacy of an online-delivered CBT-I intervention for those with insomnia or reporting sleep difficulties. The program will be offered to service users of IAPT to establish criteria for the planning of a future large scale RCT study.
Meta-analytic evidence have shown that internet-delivered CBT-I works at improving insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment (Zachariae et al., 2016). Furthermore, these interventions have also been shown efficacious in decreasing depressive symptoms (Christensen et al., 2016).
However, no studies have explored the effects of internet-delivered CBT-I in routine care settings and all of them recruited a self-selected sample, which limits the generalizability of the results. In this sense, the present study is a first step to assess the feasibility and preliminary efficacy of internet-delivered CBT-I in a real-world setting: the Improving Access to Psychological Therapies (IAPT) program, National Health service, England.
The IAPT program is part of a stepped care model that principally addresses depression and anxiety in the population (Clark, 2011). It sees over a million users per year and delivers both low-intensity (e.g. internet-delivered CBT for depression and anxiety disorders; group wellbeing courses, bibliography) and high-intensity (e.g. counseling for depression, face-to-face CBT for depression and anxiety) services (Clark, 2011).
Within IAPT, SilverCloud Health as a global leader in the development and implementation of internet-delivered interventions for mental health, wellbeing and long-term condition management, has supported patients at a low-intensity level (i.e. Step 2) over the past 5 years. SilverCloud has recently developed an intervention for insomnia that will form part of the overall mental health care suite of programs that include interventions for depression and anxiety disorders. The outcomes of these online interventions have been equal to other low-intensity interventions used within IAPT. The current study seeks to pilot the newly developed CBT-I intervention to assess its initial clinical impact and to establish criteria for the planning of a future large scale RCT study.
Objective As part of service evaluation, patients at Berkshire NHS Foundation trust availed of the Space for Sleep program. The current study seeks to carry out research on the progress of these patients, assessing the program's initial clinical impact and to establish criteria for the planning of a future large scale RCT study.
Specific research questions will be the following:
Design Moving from service evaluation to an open feasibility trial design to examine the potential clinical impact of an online CBT intervention for insomnia disorder (ID).
Hypotheses SilverCloud online interventions for mental health have proved highly successful. The investigators anticipate that the current intervention for ID will show preliminary effectiveness at post-treatment in terms of greater sleep efficiency and significant reductions in symptoms of insomnia and co-morbid depression and anxiety.
Study Setting The study will be conducted within Berkshire Healthcare NHS Foundation Trust through Talking Therapies, an NHS IAPT provider that serves a population of 900,000 across 7 Clinical Commissioning Groups (CCGs), all of which are demographically and economically diverse, ranging from rural West Berkshire to urban commuter towns close to London. Talking Therapies aims to provide an easily accessible and clinically effective service for those within the community who suffer from sleep disorders. Those wishing to access the service can do so through self-referral, GP referral or referral from allied services. If suitable, clients are offered treatment either at Step 2 or Step 3 based on their need. Step 2 services include low-intensity CBT-based treatments such as self-help, iCBT and group treatment, supported by trained psychological wellbeing practitioners (PWP).
Recruitment procedures The aim is to recruit 35 patients as part of service evaluation. A 50% uplift is added to buffer against the effects of dropout/missing data. Therefore, a total of 52 participants will be included in the study. Patients who are already using the program as part of the service evaluation will be provided with an information sheet and asked if they wish to retrospective consent to for their data to be part of the research trial.
For those who will be recruited into the research, firstly, individuals are given an initial assessment by phone with a PWP clinician at Berkshire IAPT service as per normal service provision. The assessment determines if an individual meets the eligibility criteria and a diagnosis of sleep disorder will be advised by the PWP. The PWP then describes the trial and invites the client to participate. Those interested will receive an email with information detailing the study and a link to the consent form to give consent by means of a digital signature. Upon giving consent, participants complete the primary and secondary outcomes for the study online. PWPs will reiterate details of the research and the program, describing what is involved and the importance of their participation in the trial. Participants receive an email informing them on how to proceed.
All participants are informed that they are free to withdraw if they no longer wish to take part in the trial. In this case, they will be removed from the trial and they will be offered treatment as usual.
Support during treatment Each participant will be assigned a PWP clinician who will monitor participants' progress throughout the trial. Once assigned to the active treatment condition the participant will receive a message from their PWP clinician at their first login. This message welcomes them to the program, highlights aspects of the program, and encourages them in use of the program. Over the course of the 8-week supported intervention, on 6 separate occasions the PWP will login and review participants progress, leaving feedback for them and responding to the work they have completed. The basic share level allows supporters to view users' goals for the week; key messages and progress points. If users wish to share more with their supporter, they can share journal entries. Each supporter will provide post-session feedback of between 10 and 15 minutes per participant per session, over the eight-week intervention period.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
SilverCloud internet-delivered CBT intervention for Insomnia
Behavioral: SilverCloud
'Space for Sleep' is a seven-module online CBT-based intervention for sleep. The structure and content of the programme modules follow evidence-based CBT principles for insomnia. Each module is structured to incorporate introductory quizzes. videos, informational content, interactive activities, as well as homework suggestions and summaries. In addition, personal stories and accounts from other users are incorporated into the presentation of the material. As per normal service provision, each participant will be assigned a clinician (PWP) who will monitor participants' progress through the program. Every one to two weeks, the PWP will login and review participants' progress, leaving feedback for them and responding to the work they have completed.
Changes in insomnia severity (as measured by the Insomnia Severity Index, ISI)
The 7-item ISI (Yang, Morin, Schaefer, \& Wallenstein, 2009) provides a quantitative index of overall sleep impairment. Participants rate the severity of sleep problems (e.g. problems with sleep onset, sleep maintenance, and early morning awakening), interference with daytime functioning, how noticeable the impairment is to others, distress or concern caused by the sleep problem(s), as well as satisfaction with the current sleep pattern on a 5-point Likert scale. Scores range from 0-28, with higher scores indicating more severe insomnia. The ISI has been shown to be a valid and reliable measure that is sensitive to changes in treatment studies (Bastien, Vallières, \& Morin, 2001; Thorndike et al., 2011).
Time frame: Baseline - Immediately after the intervention
Changes in average sleep efficiency (i.e. total time spent asleep divided by the total time spent in bed in a given day)
Sleep efficiency is the result of total time spent asleep divided by the total time spent in bed and multiplied by 100. Participants will be encouraged to complete a sleep diary which is available to them as a tool on the platform. They will be encouraged to complete this throughout treatment and will be prompted to do so upon their daily login. Data from the first and last week will be used as pre- and post-treatment measurements. Sleep efficiency of 85% or above is considered normal, with really good efficiency being 90% or above.
Time frame: Baseline - Immediately after the intervention
Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 (Kroenke, Spitzer, \& Williams, 2001; Spitzer, Kroenke, \& Williams, 1999) is a self-report measure of depression that has been widely used in research and is a regular screening measure utilised in primary care and hospital settings. The PHQ-9 items reflect the diagnostic criteria for depression outlined by the DSM-V (American Psychiatric Association, 2013). Summary scores range from 0 to 27, where larger scores reflect a greater severity of depressive symptoms. The PHQ 9 has been found to discriminate well between depressed and non-depressed individuals using the cut-off total score ≥ 10, with good sensitivity (88.0%), specificity (88.0%) and reliability (Kroenke et al., 2001; Spitzer et al., 1999).
Time frame: Baseline - Immediately after the intervention
Generalized Anxiety Disorder-7 (GAD-7)
The GAD-7 (Spitzer, Kroenke, Williams, \& Löwe, 2006) comprises 7 items measuring symptoms and severity of anxiety based on the DSM-V (American Psychiatric Association, 2013) diagnostic criteria for GAD. The measure has good internal consistency (α = .92) and good convergent validity with other anxiety scales (Spitzer et al., 2006). Higher scores indicate greater severity of symptoms. The GAD-7 has increasingly been used in large-scale studies as a generic measure of change in anxiety symptomatology, using a cut-off score of 8 (Richards \& Suckling, 2009).
Time frame: Baseline - Immediately after the intervention
Work and Social Adjustment Scale (WSAS)
The WSAS (Mundt, Marks, Shear, \& Greist, 2002) is a simple and reliable (α \>.75) 5-item self-report measure of impaired functioning, which provides an experiential impact of a disorder from the patient's point of view. It looks at how the disorder impairs the patient's ability to function day to day on five dimensions: work, social life, home life, private life and close relationships. Scores range from 0 to 40, with higher score indicating poorer adjustment. WSAS has demonstrated good internal reliability (α = 0.82) (Zahra et al., 2014).
Time frame: Baseline - Immediately after the intervention
Patient Experience Questionnaire (PEQ)
This will be used to assess patient experience and satisfaction. This questionnaire forms a part of the IAPT minimum data set and is a national requirement in the UK. The PEQ contains several quantitative questions and open-ended questions that are used to assess participant's views and satisfaction with service provision.
Time frame: Immediately after the intervention
Acceptability of the modules
Each module contains 5 questions that assess the perceived usefulness and acceptability of the module. 4 questions are rated in a 4-point Likert scale ranging from 1 (strongly agreee) to 4 (strongly disagree) where the users report their level of agreement, while the last question is an open box where the users may include additional feedback about the module. Lower scores are indicative of higher acceptability of the module.
Time frame: Immediately after each module of the intervention
Time spent in the platform
This metric corresponds to the combination of the time spent in each session (in minutes) from the first to the last log-in.
Time frame: During the intervention
Number of sessions
This metrics relates to the number of times (log-ins) the user accessed the program.
Time frame: During the intervention
Number of Activities
This metric is calculated by counting all the times users interacted actively with the platform, that is, every time that they completed a journal entry, used an interactive tool, or downloaded or played relaxation audios.
Time frame: During the intervention
Percentage of the Program Viewed
This metric refers to the percentage of the total program content that the user has gone through.
Time frame: During the intervention
Number of Reviews
This metric refers to the number of messages that the supporter sent to the user to encourage use of the platform while providing feedback about the progress from the last review.
Time frame: During the intervention
Plan to share: No
Ran from Sep 2019 to primary completion in Jun 2020, 9 months.
Of 1,207 non-industry interventional studies with no phase under Sleep Initiation and Maintenance Disorders, half reached primary completion within 15 months of starting (the median), counting those still running; a quarter within 6 and three quarters within 35. This study's 9 months is below that.
Counting every sponsor, half of 1,285 studies reached it within 15 months; a quarter within 6 and three quarters within 34.
How these figures are worked out, and which studies are left out of them.
This study is completed, as verified in Jan 2021. You cannot join it, but the record below documents what was studied.
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