Tag: CBT

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SleepPathfinder: A Socratic Questioning and Self-Decision–Based Chatbot to Support User Engagement in Digital CBT-I: Usability and Feasibility Study

Background: Chronic insomnia is a highly prevalent sleep disorder that adversely affects quality of life and mental health. Cognitive behavioral therapy for insomnia (CBT-I) is internationally recommended as the first-line treatment, and digital CBT-I (dCBT-I) has been developed to improve accessibility and scalability. While existing dCBT-I systems effectively support structured behavioral training through standardized protocols, they provide relatively limited support for users’ cognitive exploration and meaning-making processes, particularly in helping users reflect on and internalize the rationale behind CBT-I practices in daily life. These limitations may contribute to challenges in sustained engagement and long-term adherence. Objective: This study aimed to examine the usability and feasibility of SleepPathfinder, a conversational CBT-I support chatbot that integrates Socratic questioning and a self-decision mechanism to support users’ understanding of and engagement with CBT-I practices. Methods: SleepPathfinder was designed around a 4-stage conversational flow: education on CBT-I techniques, Socratic cognitive exploration, self-decision, and advice provision. We conducted (1) a single-session pilot usability study (n=45) to assess system stability and user experience and (2) a 5-day condition-based comparative experiment (n=30) consisting of daily sessions, comparing an exploratory dialogue condition with a directive, protocol-guided dialogue condition. Quantitative measures assessed usability, cognitive appraisals related to sleep problems, autonomy-related experiences, and behavioral readiness, while qualitative feedback and conversational log analyses were used to examine interaction patterns and engagement characteristics. Results: In the comparative experiment, the exploratory dialogue condition showed a tendency toward reduced perceived threat and severity appraisal of sleep problems compared with the directive condition, accompanied by moderate effect sizes in cognitive perception measures. Autonomy-related experiences, including perceived choice and engagement, demonstrated suggestive upward trends in the exploratory condition. Behavioral intention changes were comparable across conditions, while overall readiness for change increased across participants. Conversational log analyses indicated that greater depth and volume of user self-narrative were associated with larger shifts in cognitive appraisals, whereas the frequency of chatbot questions alone was not. The pilot usability study indicated generally positive evaluations of system usability and content credibility, while identifying areas for improvement in emotional responsiveness and conversational naturalness. Conclusions: These findings suggest that a Socratic questioning–based and self-decision–based conversational structure is usable and feasible as a supportive interaction layer within dCBT-I systems. Rather than altering the directive behavioral structure of CBT-I, such an approach may complement existing protocols by facilitating cognitive exploration and supporting user-perceived autonomy. This study provides design-oriented evidence to inform the refinement of dialogue-supported digital CBT-I systems aimed at enhancing user engagement with CBT-I practices.
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Evaluating an Abbreviated Internet-Delivered Stress Recovery Intervention for Health Care Workers: Pre-Post Feasibility Study of Outcomes, Usability, and Acceptability

<strong>Background:</strong> Health care workers face numerous occupational stressors that place them at heightened risk for burnout and poor mental health. Internet-delivered interventions have shown promise in reducing stress and related symptoms, yet adherence is often low, and users do not complete programs. Abbreviated interventions may help address engagement barriers such as high workload, limited time, and varying user preferences. There is a need to evaluate brief, accessible formats of internet-delivered programs for this population. <strong>Objective:</strong> This study aimed to examine the initial outcomes, usability, and acceptability of a 4-week abbreviated internet-delivered stress recovery intervention for health care workers. Specifically, it evaluated changes in stress recovery, perceived stress, depression and anxiety symptoms, and psychological well-being. The study also sought to understand participants’ experiences with the brief format to determine whether it meets their needs. <strong>Methods:</strong> This single-arm pre-post study examined a 4-week abbreviated version of the online guided cognitive behavioral therapy-based stress recovery program FOREST among self-enrolled health care workers recruited through professional networks (N=52; mean age 39.31, SD 11.31 years; 49/52, 94.2% women). Outcomes included stress recovery (the Recovery Experience Questionnaire), perceived stress (the Perceived Stress Scale-4), depression and anxiety symptoms (the Patient Health Questionnaire-4), psychological well-being (the World Health Organization Well-being Index), and usability and acceptability ratings. <strong>Results:</strong> We found that after the abbreviated version of the FOREST intervention participants showed moderate improvements in stress recovery (<i>d</i>=0.54, 95% CI 0.25-0.83); reductions in stress (<i>d</i>=–0.43, 95% CI –0.72 to –0.14), anxiety and depression symptoms (<i>d</i>=–0.51, 95% CI –0.80 to –0.22); and increase in psychological well-being (<i>d</i>=0.39, 95% CI 0.08-0.70). The majority (37/52, 71.2%) accessed all 6 modules. Users reported high satisfaction with the abbreviated program. <strong>Conclusions:</strong> While preliminary and limited by the pre-post design, these findings indicate that abbreviated internet-based stress recovery programs are a promising and practical tool for supporting the mental health of health care workers. Future research should examine the long-term effects, compare the abbreviated and standard versions, and explore implementation in routine practice. <strong>Trial Registration:</strong>
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Spectral EEG-guided adaptive neuromodulation for social anxiety disorder, performance-only subtype: a case report

Social anxiety disorder (SAD) is often complicated by anticipatory anxiety, hyperarousal, and variability in response to first-line treatments such as cognitive behavioral therapy (CBT) and pharmacotherapy. These limitations highlight the need for adjunctive modalities capable of enhancing the magnitude and durability of treatment response. This case report explores outcomes following spectral EEG-guided personalized repetitive transcranial magnetic stimulation (PrTMS) in a patient with SAD, performance-only subtype. Weekly psychometric assessments revealed reductions in social anxiety intensity, avoidance behaviors, and negative self-appraisal, along with improvements in mood and daily function. Symptom changes were quantified using the Liebowitz Social Anxiety Scale (LSAS), Social Phobia Inventory (SPIN), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Clinical improvements were accompanied by increased alpha band power, decreased delta band power, and an increased alpha-delta ratio on serial spectral resting-state EEGs. Our findings suggest that PrTMS may warrant further investigation as a potential adjunctive treatment for SAD. Further large-scale, blinded, and randomized studies are warranted to validate our observations on the feasibility of PrTMS for SAD.
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<![CDATA[New evidence shows CBT timed after ketamine boosts lasting depression relief; Yale tests digital therapy Rejoyn to scale the neuroplasticity window.]]>
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Wearable low-level laser therapy (laser acupuncture) versus manual acupuncture for chronic insomnia: protocol for a randomized, assessor-blinded, superiority trial

BackgroundChronic insomnia is a prevalent and disabling condition associated with impaired daytime functioning, psychiatric comorbidity, and autonomic dysregulation. Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment, access is limited. Acupuncture has demonstrated therapeutic benefits for insomnia but requires trained practitioners and repeated clinic visits. Low-level laser therapy (LLLT), an acupoint-targeted form of photobiomodulation that is also referred to as laser acupuncture when applied to acupuncture points, offers a non-invasive and standardized modality that may serve as a practical alternative.MethodsThis single-center, parallel-group, assessor-blinded, superiority randomized controlled trial will compare wearable LLLT with manual acupuncture in 106 adults with chronic insomnia. Participants aged 18–65 years who meet DSM-5 criteria for chronic insomnia and have an Insomnia Severity Index (ISI) score between 8 and 21 will be randomly allocated (1:1) to the LLLT group or acupuncture group. Both interventions will target bilateral HT7, PC6 and SP6 (six acupoints in total) for 30 minutes per session, three times per week, over two weeks (six sessions total). In the LLLT group, 650-nm laser irradiation will be delivered simultaneously to all six acupoints. The primary outcome is the change in ISI score from baseline to week 2. Secondary outcomes include sleep quality (Pittsburgh Sleep Quality Index, PSQI), fatigue (Fatigue Severity Scale, FSS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-7, GAD-7) and heart rate variability (HRV) indices. The ISI will be assessed at baseline, post-treatment (week 2), and follow-up (week 6). Secondary outcomes, including PSQI, FSS, PHQ-9, GAD-7, and HRV indices, will be assessed at baseline and week 2. Analyses will follow the intention-to-treat principle using analysis of covariance and prespecified longitudinal or repeated-measures models where appropriate.DiscussionThis trial will provide comparative evidence on the short-term efficacy and safety of wearable LLLT versus manual acupuncture for chronic insomnia. By directly comparing an established acupuncture protocol with a non-invasive intervention that has potential for future home-based implementation, the study aims to clarify the clinical value of LLLT as a less invasive alternative within the framework of complementary and integrative sleep medicine.Clinical trial registrationhttps://itmctr.ccebtcm.org.cn/Home/ProjectView?pid=d0e46c39-0647-4cbd-ba40-e2b02830fd28, identifier ITMCTR2025000977.
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Imagery Control Therapy and Lucid Dreaming for REM-Related Symptoms in Narcolepsy

Conditions: Narcolepsy Type 1; Hypnagogic Hallucinations; Sleep Paralysis; REM Sleep Intrusion Symptoms; Central Disorders of Hypersomnolence

Interventions: Behavioral: Cognitive Behavioral Therapy for Narcolepsy (CBT-NAR) With Lucid Dreaming and Imagery Control Therapy; Behavioral: Sleep Hygiene Education and Structured Clinical Follow-up

Sponsors: Institute of Behavioral Sleep Medicine, Colombia

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