‘Better sleep, better wellbeing’: qualitative process evaluation of a hybrid, digital cognitive behavioural therapy programme for employees with sleep and emotion regulation problems

Introduction

Sleep and mental health problems are common across the working adult population. This process evaluation provides insight into the experiences of employees who took part in a digital intervention trial: Supporting Employees with Insomnia and Emotional Regulation Problems (SLEEP). The programme combined digital CBT for insomnia with emotion regulation. Digital content was supported by remote therapy. The objectives of this process evaluation were to explore participants' experiences of the intervention, and identify how the intervention achieved change.

Methods

Twenty-one semi-structured interviews were conducted using videoconferencing. A stratified sample of participants from within each of five cohorts of the SLEEP trial was interviewed. Thematic analysis utilized a collaborative codebook and framework approach. To conceptualize mechanisms of change, behaviour change techniques were retrospectively coded onto participant interview data.

Results

An overarching theme: ‘Better sleep, better wellbeing’ was generated, with three interlinking themes conceptualizing the process by which positive changes to sleep and wellbeing were achieved. These were: ‘Procedure: The value of therapy sessions versus digital-only’, ‘Context: Working on mental health from home during COVID-19’, and ‘Mechanisms: Practice, feedback and problem solving.’

Conclusions

Participants' experiences of SLEEP were predominantly positive and suggested a spillover effect of improved sleep on overall wellbeing. Triangulation of quantitative outcomes showed congruent improvements. Maintaining therapist contact to facilitate behaviour change throughout the programme was important. Furthermore, providing a private space for therapist calls was essential to facilitate the intervention in the workplace; an important insight for the development of digital mental health interventions intended for the workplace.