Keywords
CBT-I
digital interventions
sleep
mental health
war
Ukraine
How to Cite
Abstract
This study evaluates the effectiveness of Sleep2Ukraine, a Ukrainian-language mobile application based on Cognitive Behavioral Therapy for Insomnia (CBT-I), in improving sleep quality and mental health among Ukrainian adults during wartime. The relevance of this research is driven by a sharp increase in sleep disturbances and psychological distress following the onset of the full-scale war, as documented in numerous empirical studies. Chronic stress, forced displacement, ongoing threat exposure, and prolonged traumatic experiences have substantially increased the prevalence of insomnia, anxiety, depression, post-traumatic stress disorder (PTSD), and somatic symptoms, highlighting the urgent need for accessible digital mental health interventions.
The study employed an uncontrolled longitudinal design, analyzing changes in sleep and psychological outcomes among 72 participants who used the application for six weeks. Assessments were conducted at baseline (T0) and post-intervention (T2). A battery of validated self-report measures was administered, including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Fear of Sleep Inventory (FoSI), Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), PTSD Checklist for DSM-5 (PCL-5), Perceived Stress Scale (PSS-4), and Somatic Symptom Scale (SSS-8). Sociodemographic data were collected to examine the potential moderating effects of age, gender, and financial status.
The results demonstrated statistically significant improvements across most outcome measures, including reductions in insomnia severity, anxiety, depressive symptoms, PTSD symptoms, somatic complaints, fear of sleep, and perceived stress. The largest effect sizes were observed for insomnia and PTSD-related symptoms. Although younger participants exhibited higher baseline levels of psychological distress, all age groups showed comparable responses to the intervention, with no significant moderating effect of age. Similarly, financial status was associated with baseline symptom severity but did not significantly influence the magnitude of treatment-related improvement.
These findings are consistent with international evidence supporting the efficacy of digital CBT-I interventions and demonstrate their applicability in contexts of prolonged war-related stress. Sleep2Ukraine appears to be a promising, scalable, and accessible tool for supporting mental health under conditions of limited access to traditional psychotherapeutic services. The study underscores the need for future randomized controlled trials, long-term follow-up assessments, and targeted adaptations for populations exposed to high levels of traumatic stress.
References
Amani, O., Mazaheri, M. A., Malekzadeh Moghani, M., & Zarani, F. (2023). Effectiveness of internet-delivered cognitive behavioral therapy for insomnia: a systematic review and meta-analysis. Biological Rhythm Research, 54(10), 647-663. https://doi.org/10.1080/09291016.2023.2242063
Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., ... & Riemann, D. (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of affective disorders, 135(1-3), 10-19. https://doi.org/10.1016/j.jad.2011.01.011
Bai, N., Cao, J., Zhang, H., Liu, X., & Yin, M. (2024). Digital cognitive behavioural therapy for patients with insomnia and depression: A systematic review and meta‐analysis. Journal of Psychiatric and Mental Health Nursing, 31(4), 654-667. https://doi.org/10.1111/jpm.13024
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep medicine, 2(4), 297–307. https://doi.org/10.1016/s1389-9457(00)00065-4
Carstensen, L. L., Fung, H. H., & Charles, S. T. (2003). Socioemotional selectivity theory and the regulation of emotion in the second half of life. Motivation and emotion, 27(2), 103-123. https://doi.org/10.1023/A:1024569803230
Charles, S. T., Reynolds, C. A., & Gatz, M. (2001). Age-related differences and change in positive and negative affect over 23 years. Journal of personality and social psychology, 80(1), 136. https://doi.org/10.1037//0022-3514.80.1.I36
Eshel, Y., Kimhi, S., Marciano, H., & Adini, B. (2023). Predictors of PTSD and psychological distress symptoms of Ukraine civilians during war. Disaster medicine and public health preparedness, 17, e429. https://doi.org/10.1017/dmp.2023.69
Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. L. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35(6), 769–781. https://doi.org/10.5665/sleep.1872
Gierk, B., Kohlmann, S., Kroenke, K., Spangenberg, L., Zenger, M., Brähler, E., & Löwe, B. (2014). The somatic symptom scale–8 (SSS-8): a brief measure of somatic symptom burden. JAMA internal medicine, 174(3), 399-407. https://doi.org/10.1001/jamainternmed.2013.12179
Hasan, F., Tu, Y. K., Yang, C. M., Gordon, C. J., Wu, D., Lee, H. C., ... & Chiu, H. Y. (2022). Comparative efficacy of digital cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis. Sleep medicine reviews, 61, 101567.
Hertenstein, E., Trinca, E., Wunderlin, M., Schneider, C. L., Zuest, M. A., Feher, K. D., ... & Nissen, C. (2022). Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis. Sleep medicine reviews, 62, 101597. https://doi.org/10.1016/j.smrv.2022.101597
Huang, K., Li, S., He, R., Zhong, T., Yang, H., Chen, L., ... & Jia, Y. (2022). Efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older adults with insomnia: A systematic review and meta-analysis. Australasian Psychiatry, 30(5), 592-597. https://doi.org/10.1177/10398562221118516
Hürlimann, P., Bodenmann, G., Riemann, D., & Weitkamp, K. (2023). Cognitive behavioural therapy to treat stress and insomnia: A randomized wait list‐controlled trial of two online courses. Journal of Sleep Research, 32(4), e13874. https://doi.org/10.1111/jsr.13874
Kurapov, A., Balashevych, O., Borodko, Y., Vovk, Y., Borozenets, A., & Danyliuk, I. (2025а). Psychological Well-Being of Ukrainian Civilians: A Data Report on the Impact of Traumatic Events on Mental Health. Frontiers in Psychology, 16, 1553555. https://doi.org/10.3389/fpsyg.2025.1553555
Kurapov, A., Blechert, J., Hinterberger, A., Topalidis, P., & Schabus, M. (2025b). Non-guided, mobile, CBT-I-based sleep intervention in War-torn Ukraine: A feasibility study. PLoS One, 20(5), e0310070. https://doi.org/10.1371/journal.pone.0310070
Kurapov, A., Schabus, M., Kahveci, S., Wilhelm, F. H., & Blechert, J. (2024). Explaining post-traumatic stress symptoms and sleep disturbance in Ukrainian civilians: perceived threat versus objective war exposure. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2024.2381371
Lee, S., Oh, J. W., Park, K. M., Lee, S., & Lee, E. (2023). Digital cognitive behavioral therapy for insomnia on depression and anxiety: a systematic review and meta-analysis. NPJ digital medicine, 6(1), 52. https://doi.org/10.1038/s41746-023-00800-3
Lin, W., Li, N., Yang, L., & Zhang, Y. (2023). The efficacy of digital cognitive behavioral therapy for insomnia and depression: a systematic review and meta-analysis of randomized controlled trials. PeerJ, 11, e16137. https://doi.org/10.7717/peerj.16137
Pavlova, I., & Rogowska, A. M. (2023). Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine. Journal of affective disorders, 342, 148-156. https://doi.org/10.1016/j.jad.2023.09.003
Pruiksma, K. E., Taylor, D. J., Ruggero, C., Boals, A., Davis, J. L., Cranston, C., DeViva, J. C., & Zayfert, C. (2014). A psychometric study of the Fear of Sleep Inventory-Short Form (FoSI-SF). Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 10(5), 551–558. https://doi.org/10.5664/jcsm.3710
Silva, M., Loureiro, A., & Cardoso, G. (2016). Social determinants of mental health: a review of the evidence. The European Journal of Psychiatry, 30(4), 259-292.
Simon, L., Steinmetz, L., Feige, B., Benz, F., Spiegelhalder, K., & Baumeister, H. (2023). Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis. Scientific Reports, 13(1), 1929. https://doi.org/10.1038/s41598-023-28853-0
Solonenko, O. (2025). Manifestations of Continuous Traumatic Stress Among Adolescents in War. Psychological Prospects Journal, 45, 152-160. https://doi.org/10.29038/2227-1376-2025-45-sol
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
Vanek, J., Prasko, J., Genzor, S., Ociskova, M., Holubova, M., Sova, M., & Nesnidal, V. (2020). Insomnia and emotion regulation. Neuroendocrinol Lett, 41(5), 255-269. PMID: 33315339
Walker, J., Muench, A., Perlis, M. L., & Vargas, I. (2022). Cognitive behavioral therapy for insomnia (CBT-I): a primer. Klinicheskaia i spetsial'naia psikhologiia= Clinical psychology and special education, 11(2), 123. https://doi.org/10.17759/cpse.2022110208
Warttig, S. L., Forshaw, M. J., South, J., & White, A. K. (2013). New, normative, English-sample data for the short form perceived stress scale (PSS-4). Journal of health psychology, 18(12), 1617-1628. https://doi.org/10.1177/1359105313508346
Wogan, R., Enrique, A., Adegoke, A., Earley, C., Sollesse, S., Gale, S., Chellingsworth, M., & Richards, D. (2021). Internet-delivered CBT intervention (Space for Sleep) for insomnia in a routine care setting: Results from an open pilot study. Internet interventions, 26, 100443. https://doi.org/10.1016/j.invent.2021.100443
Xu, W., Pavlova, I., Chen, X., Petrytsa, P., Graf-Vlachy, L., & Zhang, S. X. (2023). Mental health symptoms and coping strategies among Ukrainians during the Russia-Ukraine war in March 2022. International journal of social psychiatry, 69(4), 957-966. https://doi.org/10.1177/00207640221143919
Karachevskiy, A. B. (2016). AdaptatsIya shkal ta opituvalnikIv ukraYinskoyu ta rosIyskoyu movami schodo posttravmatichnogo stresovogo rozladu. ZbIrnik naukovih prats spIvrobItnikIv NMAPO Im. PL Shupika, (25), 607-623.
Korost, Ya. V., & Shkvarok, A. K. (2023). Assessment of sleep quality in Ukrainians during the martial law and the risk of cardiovascular complaints development in the context of clinically severe insomnia. KlInIchna ta profIlaktichna meditsina, (7), 68-73. https://doi.org/10.31612/2616-4868.7.2023.09
LagutIna S. (2023). DoslIdzhennya zdorov’ya snu postrazhdalih vId vIyni v UkraYinI za dopomogoyu tsifrovogo Instrumentu // PsihIatrIya, nevrologIya ta medichna psihologIya. – 2023. – No21. – S. 32–37. https://doi.org/10.26565/2312-5675-2023-21-04
Mazur, L. P., Maruschak, M. I., & Batyuk, O. V. (2021). Opituvalniki yak osnovnI Instrumenti v dIagnostitsI rozladIv snu. VIsnik medichnih I bIologIchnih doslIdzhen, 3, 96–100. https://doi.org/10.11603/bmbr.2706-6290.2021.3.12575
Marushko T., Smulska N., Kozachuk V., Taranenko T. (2024). OtsInka stanu snu v dItey pId chas vIyni v UkraYinI. Zdorov’ya ditini, Tom 19, # 2, s. 31-35. http://www.mif-ua.com/archive/article/53408
Ministerstvo ohoroni zdorov’ya UkraYini. (2014, 25 grudnya). UnIfIkovaniy klInIchniy protokol pervinnoYi, vtorinnoYi (spetsIalIzovanoYi) ta tretinnoYi (visokospetsIalIzovanoYi) medichnoYi dopomogi. MInIsterstvo ohoroni zdorov’ya UkraYini.
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Copyright (c) 2026 Oleksandra Balashevych, Mariia Sydorova,Hanna Chomko , Anton Kurapov