Efficacy of Mobile App-Based Cognitive Behavioral Therapy for Insomnia: Multicenter, Single-Blind Randomized Clinical Trial.

BACKGROUND: Cognitive behavioral therapy for insomnia (CBTi) is the first-line therapy for chronic insomnia. Mobile app-based CBTi (MCBTi) can enhance the accessibility of CBTi treatment; however, few studies have evaluated the effectiveness of MCBTi using a multicenter, randomized controlled trial design. OBJECTIVE: We aimed to assess the efficacy of Somzz, an MCBTi that provides real-time and tailored feedback to users, through comparison with an active comparator app. METHODS: In our multicenter, single-blind randomized controlled trial study, participants were recruited from 3 university hospitals and randomized into a Somzz group and a sleep hygiene education (SHE) group at a 1:1 ratio. The intervention included 6 sessions for 6 weeks, with follow-up visits over a 4-month period. The Somzz group received audiovisual sleep education, guidance on relaxation therapy, and real-time feedback on sleep behavior. The primary outcome was the Insomnia Severity Index score, and secondary outcomes included sleep diary measures and mental health self-reports. We analyzed the outcomes based on the intention-to-treat principle. RESULTS: A total of 98 participants were randomized into the Somzz (n=49, 50%) and SHE (n=49, 50%) groups. Insomnia Severity Index scores for the Somzz group were significantly lower at the postintervention time point (9.0 vs 12.8; t95=3.85; F2,95=22.76; ηp2=0.13; P<.001) and at the 3-month follow-up visit (11.3 vs 14.7; t68=2.61; F2,68=5.85; ηp2=0.03; P=.01) compared to those of the SHE group. The Somzz group maintained their treatment effect at the postintervention time point and follow-ups, with a moderate to large effect size (Cohen d=-0.62 to -1.35; P<.01 in all cases). Furthermore, the Somzz group showed better sleep efficiency (t95=-3.32; F2,91=69.87; ηp2=0.41; P=.001), wake after sleep onset (t95=2.55; F2,91=51.81; ηp2=0.36; P=.01), satisfaction (t95=-2.05; F2,91=26.63; ηp2=0.20; P=.04) related to sleep, and mental health outcomes, including depression (t95=2.11; F2,94=29.64; ηp2=0.21; P=.04) and quality of life (t95=-3.13; F2,94=54.20; ηp2=0.33; P=.002), compared to the SHE group after the intervention. The attrition rate in the Somzz group was 12% (6/49). CONCLUSIONS: Somzz outperformed SHE in improving insomnia, mental health, and quality of life. The MCBTi can be a highly accessible, time-efficient, and effective treatment option for chronic insomnia, with high compliance. TRIAL REGISTRATION: Clinical Research Information Service (CRiS) KCT0007292; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22214&search_page=L.

Different divergence processes of isoglosses of folk nomenclature between wild trees and rice landraces imply the need for different conservation planning based on the type of plant resources.

BACKGROUND: The intensification of production and socio-economic changes have accelerated the loss of local traditional knowledge and plant resources. Understanding the distribution and determinants of such biocultural diversity is essential in planning efficient surveys and conservation efforts. Because the concept of biocultural diversity in socio-ecological adaptive systems comprises biological, cultural, and linguistic diversity, linguistic information should serve as a surrogate for the distribution of local biological and cultural diversity. In this study, we spatio-linguistically evaluated the names of local trees and rice landraces recorded in Ehime Prefecture, southwestern Japan. METHODS: Hierarchical clustering was performed separately for the names of local trees and rice landraces. By considering innate flora differences and species having multiple local names, a novel distance index was adopted for local tree names. For the names of rice landraces, Jaccard distance was adopted. V-measure and factor detector analysis were used to evaluate the spatial association between the isogloss maps of the folk nomenclature derived from the clustering and multiple thematic maps. RESULTS: Local tree names showed stronger spatial association with geographical factors than rice landrace names. One folk nomenclature group of trees overlapped well with the slash-and-burn cultivation area, suggesting a link between the naming of trees and the traditional production system. In contrast, rice landraces exhibited stronger associations with folklore practices. Moreover, influences of road networks and pilgrimages on rice landraces indicated the importance of human mobility and traditional rituals on rice seed transfer. High homogeneity and low completeness in the V-measure analysis indicated that the names of local trees and rice landraces were mostly homogenous within current municipalities and were shared with a couple of adjacent municipalities. The isogloss maps help to illustrate how the biological and cultural diversity of wild trees and rice landraces are distributed. They also help to identify units for inter-municipal collaboration for effective conservation of traditional knowledge related to those plant resources and traditional rice varieties themselves. CONCLUSIONS: Our spatio-linguistic evaluation indicated that complex geographical and sociological processes influence the formation of plant folk nomenclature groups and implies a promising approach using quantitative lexico-statistical analysis to help to identify areas for biocultural diversity conservation.

Amygdala resting-state functional connectivity alterations in patients with chronic insomnia disorder: correlation with electroencephalography beta power during sleep.

STUDY OBJECTIVES: This study investigated alterations in resting-state functional connectivity (RSFC) and hyperarousal biomarkers in patients with chronic insomnia disorder (CID), compared with good sleepers (GS). We also examined the relationships between altered RSFC and hyperarousal biomarkers. METHODS: Fifty patients with CID and 52 GS completed self-reporting questionnaires, and then underwent polysomnography and resting-state functional magnetic resonance imaging. We analyzed RSFC in the amygdala (AMG) and anterior insula (aINS), which are core regions of the salience network that are likely to be involved in hyperarousal. We also analyzed electroencephalography (EEG) relative beta power and heart rate variability (HRV) parameters (e.g. low and high frequency) during sleep. We then tested between-group differences in the RSFC and hyperarousal biomarkers; we examined correlations of RSFC with EEG beta power and HRV. RESULTS: Compared with GS, patients with CID showed more negative RSFC between the right amygdala (R.AMG) and left supramarginal gyrus (L.SMG), but less positive RSFC between the left aINS and bilateral lateral prefrontal cortex. The R.AMG-L.SMG RSFC was negatively correlated with EEG beta power in central regions (C3: r = -0.336, p = 0.012; C4: r = -0.314, p = 0.024). CONCLUSIONS: Decreased RSFC between the R.AMG and L.SMG in patients with insomnia may reflect the difficulty in cortical top-down regulation of the AMG, indicating daytime hyperarousal. Individuals who experience hyperarousal during the daytime may also exhibit cortical hyperarousal during sleep, as indicated by increased EEG beta power.