Dokument: Wirksamkeit einer digitalen kognitiven Verhaltenstherapie für Insomnie bei komorbider Depression und Angst
| Titel: | Wirksamkeit einer digitalen kognitiven Verhaltenstherapie für Insomnie bei komorbider Depression und Angst | |||||||
| Weiterer Titel: | Efficacy of Digital Cognitive Behavioral Therapy for Insomnia in Comorbid Depression and Anxiety | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=74782 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20261113-162724-5 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Rötger, Alexander Theodor [Autor] | |||||||
| Dateien: |
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| Beitragende: | PD Dr. Gieselmann, Annika [Gutachter] Prof. Dr. phil. Pollok, Bettina [Gutachter] Prof. Dr. Wilhelm-Groch, Ines [Gutachter] | |||||||
| Stichwörter: | dKVT-I, DiGA, somnio, Insomnie, Depression, Angst, Komorbidität | |||||||
| Universitäts- und Landesbilbiothek: | Sonstiges | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Die Insomnie ist weltweit die häufigste Schlafstörung und ist häufig mit depressiven und ängstlichen Symptomen assoziiert. Die kognitive Verhaltenstherapie für Insomnie (CBT-I) hat sich in internationalen Leitlinien als evidenzbasierte Behandlung der ersten Wahl etabliert, wobei digitale Formen (dCBT-I) eine vielversprechende Alternative darstellen. Digitale Gesundheitsanwendungen ermöglichen seit Oktober 2020 den kassenärztlich verordneten Einsatz von dCBT-I in der deutschen Regelversorgung.
Die vorliegende Arbeit untersucht die Wirksamkeit von dCBT-I bei Patienten mit hoher komorbider Symptomatik. Aus der Gesamtstichprobe (ONSET-Studie; N = 238) wurden zwei Subgruppen definiert: Patienten mit Hinweis auf das Vorliegen einer klinisch relevanten Depression (Allgemeine Depressionsskala – Kurzform ADS-K ≥ 18, n = 88) und Patienten mit Hinweis auf das Vorliegen klinisch relevanter Angstssymptome (State-Trait Anxiety Inventory – Trait Version STAI-T ≥ 46, n = 120). Die Teilnehmer wurden im Verhältnis 1:1 randomisiert und erhielten über 8 Wochen entweder dCBT-I + treatment-as-usual (TAU) oder wurden der Wartelisten-Kontrollgruppe + TAU zugeteilt. TAU umfasste den offenen Zugang zu allen anderen Behandlungsoptionen und eigenständigen Maßnahmen zur Behandlung der Schlafstörung. Primäre Outcome-Parameter waren Insomnie-Schwere (Insomnia Severity Index; ISI), depressive Symptome (ADS-K) und Angstsymptome (STAI-T) nach 8 Wochen. Nach 8 Wochen zeigte dCBT-I in beiden Subgruppen große Effektstärken auf die Insomnie-Schwere (Depressions-Subgruppe: d = 2,37; Angst-Subgruppe: d = 2,13). Gleichzeitig wurden signifikante transdiagnostische Effekte beobachtet: depressive Symptomatik reduzierte sich mit d = 1,59, Angstsymptome mit d = 1,28. Die Remissionsrate für Insomnie betrug 28 % in der Depressions-Subgruppe und 34 % in der Angst-Subgruppe versus 0 % bzw. 2 % in den jeweiligen Kontrollgruppen. Die therapeutischen Effekte blieben über 12 Monate stabil. Die dCBT-I erwies sich als wirksame transdiagnostische Intervention bei Patienten mit Insomnie und komorbiden Symptomen. Die großen und nachhaltigen Effektstärken unterstreichen das therapeutische Potenzial digitaler Interventionen in versorgungsrealistischen Populationen. Die Befunde stützen den Einsatz von dCBT-I als Erstlinienbaustein in gestuften Versorgungsmodellen und liefern real-weltliche Evidenz für Patienten mit ausgeprägter komorbider Symptomatik.Insomnia is globally the most prevalent sleep disorder and is frequently associated with depressive and anxiety symptoms. Cognitive behavioral therapy for insomnia (CBT-I) has been established as the evidence-based first-line treatment in international guidelines, with digital forms (dCBT-I) representing a promising alternative. Digital health applications have enabled physician-prescribed deployment of dCBT-I in German routine care since October 2020. The present study investigates the effectiveness of dCBT-I in patients with high comorbid symptomatology. From the total sample (ONSET study; N = 238), two subgroups were defined: patients with indications of clinically relevant depression (Allgemeine Depressionsskala – Kurzform, ADS-K ≥ 18, n = 88) and patients with indications of clinically relevant anxiety symptoms (State-Trait Anxiety Inventory – Trait Version, STAI-T ≥ 46, n = 120). Participants were randomized in a 1:1 ratio and received either dCBT-I plus treatment-as-usual (TAU) or were assigned to the waitlist control group plus TAU for 8 weeks. TAU included unrestricted ac- cess to all other treatment options and self-initiated measures for insomnia. Primary outcome measures were insomnia severity (Insomnia Severity Index, ISI), depressive symptoms (ADS-K), and anxiety symptoms (STAI-T) at 8 weeks. After 8 weeks, dCBT-I demonstrated large effect sizes on insomnia severity in both subgroups (depression subgroup: d = 2.37; anxiety subgroup: d = 2.13). Simultaneously, significant transdiagnostic effects were observed: depressive symptoms decreased with d = 1.59, anxiety symptoms with d = 1.28. Remission rates for insomnia were 28% in the depression subgroup and 34% in the anxiety subgroup, compared to 0% and 2% in the respective control groups. Therapeutic effects remained stable over 12 months. Digital CBT-I proved to be an effective transdiagnostic intervention in patients with insomnia and comorbid symptoms. The large and sustained effect sizes underscore the therapeutic potential of digital interventions in real-world clinical populations. These findings have important implications for stepped-care models in which dCBT-I can be deployed as a first-line intervention. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Bezug: | 2022-2026 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät » Institute » Institut für Medizinische Psychologie | |||||||
| Dokument erstellt am: | 13.11.2026 | |||||||
| Dateien geändert am: | 13.11.2026 | |||||||
| Promotionsantrag am: | 10.03.2026 | |||||||
| Datum der Promotion: | 20.10.2026 |
