GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population. 

Objective: Cognitive therapy (CT) and behavior therapy (BT) are both effective for insomnia but are expected to work via different pathways. Empirically, little is known about their symptom-specific effects. Method: This was a secondary analysis of a randomized controlled trial of online treatment for insomnia disorder (N = 219, 72.9% female, mean age = 52.5 years, SD = 13.9). Participants were randomized to CT (n = 72), BT (n = 73), or wait-list (n = 74). Network Intervention Analysis was used to investigate the symptom-specific treatment effects of CT and BT throughout treatment (wait-list was excluded from the current study). The networks included the Insomnia Severity Index items and the sleep diary-based sleep efficiency and were estimated biweekly from Week 0 until Week 10. Results: Participants in the BT condition showed symptom-specific effects compared to CT on sleep efficiency (Week 4-8, post-test), difficulty maintaining sleep (Week 4), and dissatisfaction with sleep (post-test). Participants in the CT showed symptom-specific effects compared to BT on interference with daily functioning (Week 8, posttest), difficulty initiating sleep, early morning awakenings, and worry about sleep (all post-test). Conclusions: This is the first study that observed specific differential treatment effects for BT and CT throughout the course of their treatment. These effects were more pronounced for BT than for CT and were in line with the theoretical background of these treatments. We think the embedment of the theoretical background of CT and BT in empirical data is of major importance to guide further treatment development.

Study Objectives: Our aim was to compare the effects of Internet-delivered cognitive therapy (CT) and behavior therapy (BT) against a waitlist (WL) condition to better understand their unique contribution in the treatment of insomnia.

Methods: Two hundred and nineteen participants with insomnia disorder were randomized to CT (n = 72), BT (n = 73), or WL (n = 74). The treatment arms consisted of 10 weekly internet-delivered modules with 15 min of telephone support per week. At pre, post, and follow-up, participants completed measures of insomnia severity, sleep diaries, functional impairment, anxiety, depression, quality of life, adverse events, satisfaction and perception of content, workload, and activity in treatment. Measures of completed exercises, modules, therapist support, and platform logins were also measured at posttreatment.

Results: Moderate to large effect sizes for both CT and BT outperformed the WL on the majority of outcomes, with significant differences in favor of both therapy groups. Both treatment groups had significantly larger proportion of treatment remitters (CT: 35.8%, BT: 40%, WL: 2.7%) and responders (CT: 74.6%, BT 58.6%, WL: 10.8%) compared to the WL at posttreatment. There were no significant differences between the two therapy groups in terms of outcomes, except for sleep onset latency in favor of BT (6 min difference at posttreatment) and adverse events in favor of CT (CT 14.1% vs BT 43.2%).

Conclusions: This study indicates that both Internet-delivered CT and BT are effective as stand-alone therapies for insomnia disorder. Results highlight the need for examining which therapy and subcomponents that are necessary for change.

ClinicalTrials.gov Identifier: NCT02984670

Aim: The purpose of this study was to examine the psychometric properties of two brief versions of previously validated cognitive process measures in insomnia: the Anxiety and Preoccupation about Sleep Questionnaire and the Sleep-Associated Monitoring Index.

Methods: Two samples (168 students and 219 patients with insomnia disorder) completed original and brief versions of the two measures (Anxiety and Preoccupation about Sleep Questionnaire-Brief version and Sleep-Associated Monitoring Index-Brief version). Also, they filled out sociodemographic questions, sleep items, and the Insomnia Severity Index.

Results: In both samples, the internal consistencies of the two brief versions were acceptable at alpha = .70 to.72. The correlations between the original and brief versions were significant at .79 to .82. The two brief versions were also significantly associated with insomnia severity and nighttime symptomatology. In the student sample, those with likely insomnia disorder (14.9% of the sample) scored significantly higher on the two brief versions, relative to those without insomnia.

Conclusion: The two brief versions, Anxiety and Preoccupation about Sleep Questionnaire-Brief version and Sleep-Associated Monitoring Index-Brief version, displayed acceptable psychometric properties. This implies that the two brief versions might be viable alternatives for use in clinical and research settings.

The purpose was to examine whether sleep hygiene practices are associated with the course of insomnia (incidence, persistence and remission) over 1year in the general population. This longitudinal study was carried out in the general population. After excluding anyone with other primary sleep disorder than insomnia, 1638 participants returned a baseline and a 1-year follow-up survey. Questions regarding sleep hygiene practices were administered at baseline, and the status of insomnia was assessed at baseline (T1) and at the 1-year follow-up (T2). Age, gender, mental ill-health, and pain were used as covariates in the analyses. Nicotine use, mental ill-health and pain were independently associated with an increased risk for concurrent insomnia at T1, while mental ill-health was the only risk factor for incident insomnia at T2. Relative to not reporting insomnia at the two time-points, nicotine use, light or noise disturbance, mental ill-health, and pain significantly increased the risk for persistent insomnia over 1year. In comparison with those whose insomnia had remitted at the follow-up, reporting an irregular sleep schedule was a significant risk factor for persistent insomnia. Of the nine sleep hygiene practices examined in this study, only three were independently linked to concurrent and future insomnia, respectively; using nicotine late in the evening, light or noise disturbance, and having an irregular sleep schedule. This may have implications for the conceptualization and management of insomnia as well as for future research.

Objective: To examine if the processes in the cognitive model mediate cognitive therapy (CT) and behavior therapy (BT) for insomnia.

Method: Individuals diagnosed insomnia disorder (n=219) were randomized to telephone supported internet-delivered cognitive therapy (n=72), behavior therapy (n=73), or a waitlist (n=74). Cognitive processes (worry, dysfunctional beliefs, monitoring and safety behaviors) proposed to maintain insomnia and treatment outcome (insomnia severity; ISI) were assessed biweekly. Criteria for evaluating mediators were assessed via parallel process growth modeling and cross-lagged panel models.

Results: Parallel process growth modeling showed that dysfunctional beliefs, monitoring and safety behaviors significantly mediated the effects of both CT and BT. Cross-lagged panel models confirmed that dysfunctional beliefs and monitoring, which approached significance, drove the change for CT. In BT, however, prior changes in ISI predicted later changes in worry and monitoring, and reciprocal influences among processes and outcomes were observed for dysfunctional beliefs and safety behaviors. The effect of safety behavior on outcome was significantly larger for BT compared to CT.

Conclusion: Together, the findings support the role of dysfunctional beliefs and monitoring as processes of change in CT, and safety behaviors as a specific mediator in BT. Limited evidence was provided for worry as a mediator. These findings have relevance for the conceptualizations of insomnia, future research, and clinical management.