Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

Abstract

Background. Insomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).Method. A total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).Results. Almost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.Conclusions. This study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.

Log in and breathe out: internet-based recovery training for sleepless employees with work-related strain – results of a randomized controlled trial

“…This is additionally supported by the low intervention-dropout rate (5%) and low study attrition. Intervention and study adherence was generally higher than with a traditional group face-to-face training (ie, 23) or guided and un-guided internet-based interventions targeting stress or insomnia (29,(64)(65). Our high adherence rates may be due to the guidance in the training in combination with the personal contact in the diagnostic interviews.…”

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

“…anxiety disorders, depression, body dissatisfaction, sexual dysfunction) have been meta-analytically shown to result in medium to large treatment effects that are comparable to those of their face-to-face equivalents (Andersson, Cuijpers, Carlbring, Riper, & Hedman, 2014). e-mental health interventions are usually based on CBT and they have been shown to be effective in reducing symptoms of common mental disorders such as PTSD (Kuester, Niemeyer, & Knaevelsrud, 2016; Sijbrandij, Kunovski, & Cuijpers, 2016), depression (Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010), phobia (Andrews et al, 2010), panic disorder (Carlbring et al, 2006), and insomnia (van Straten et al, 2014), among others.…”

No Need to Count Sheep: Investigating an Online Insomnia Intervention among Older Adults

“…Short periods of sleep also appear to be a risk factor for hypertension (Fernandez-Mendoza et al, 2012;Vgontzas, Liao, Bixler, Chrousos, & Vela-Bueno, 2009) and type 2 diabetes mellitus. More seriously, sleep problems are related to an increased risk of alcohol and substance use, suicide, and mortality (Taylor, Lichstein, & Durrence, 2003;van Straten et al, 2014). Additional research has revealed that insomnia is associated with impaired quality of life and functioning (Kyle, Morgan, & Espie, 2010) and incurs great societal and financial costs.…”

“…As is apparent, there are many well-documented concerns and negative effects of sleep medication use among older adults. In general, sleep medications increase daytime drowsiness and the risk of falls and traffic accidents, are associated with anterograde amnesia, and may lead to tolerance, abuse, adverse physical and psychological withdrawals, and insomnia symptom rebound problems, in which insomnia symptoms reappear (sometimes worse than when they first occurred) following the discontinuation of sleep medications (Holbrook, Crowther, Lotter, Cheng, & King, 2000;McCall, 2005;Taylor & Weiss, 2009;van Straten et al, 2014). Further, research examining the relationship between the prevalence of delirium in 374 hospitals across the U.S. and sedative medication use found a significant correlation between the use of diphenhydramine and short-acting benzodiazepines and risk of developing delirium (Rothberg, Herzig, Pekow, Avrunin, Lagu, & Lindenauer, 2013).…”

“…Insomnia increases in prevalence with age and affects older adults more than any other age group (Ancoli-Israel & Cooke, 2005). Current mainstream treatments for older adults with insomnia include pharmacotherapy and psychotherapy, and patients appear to have a preference for psychotherapy treatments, such as cognitive-behavioral therapy for insomnia, or CBT-I, which have longer-term benefits and fewer side effects and risks than pharmacotherapy (Casault, Savard, Ivers, & Savard, 2015; National Institutes of Health, 2005;Riedel, Lichstein, & Dwyer, 1995;Strom, Pettersson, & Andersson, 2004;van Straten et al, 2014;Wennberg, Canham, Smith, & Spira, 2013;Yan-Yee Ho et al, 2015). Additionally, Medicare coverage changes made in 2012 limited sleep medication reimbursement to 90 days per year, which is expected to substantially impact the types of treatments available to older adults for help with sleep (American Geriatrics Society, 2012).…”