Long-Term Effects of an Unguided Online Cognitive Behavioral Therapy for Chronic Insomnia

Abstract

The aim of this study was to test the efficacy of fully automated Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) 18 months after the intervention period on sleep, daytime functioning, and beliefs about sleep for adults with chronic insomnia. Methods: Participants in this study had participated in a randomized controlled trial comparing the efficacy of unguided Internet CBT-I with web-based patient education. Participants who had received Internet CBT-I (n = 95) completed online questionnaires and online sleep diaries 18 months after the intervention period. We used linear mixed models to study changes from baseline to postassessment and to 18-month follow-up, and a separate mixed-models analysis to study changes from postassessment to 18-month follow-up. Results: Mean age of the participants was 45.5 years (standard deviation = 12.6) and 64% were females. Sixty-six participants (70%) completed the 18-month follow-up assessment. There were significant improvements from baseline to 18-month follow-up on the Insomnia Severity Index (ISI) (Cohen d = 2.04 [95% confidence interval (CI) 1.66-2.42]) and the Bergen Insomnia Scale (BIS) (d = 1.64 [95% CI 1.30-1.98]), levels of daytime fatigue (d = 0.85 [95% CI 0.59-1.11]), psychological distress (d = 0.51 [95% CI 0.29-0.73]), and beliefs about sleep (d = 1.44 [95% CI 1.15-1.73]). Moderate to large effect size improvements were also shown on the diary-derived sleep variables. All improvements from baseline to postassessment were essentially maintained to 18-month follow-up. Conclusions: Unguided Internet CBT-I appears to have sustained effects on sleep, daytime functioning, and beliefs about sleep up to 18 months after the intervention period. Clinical Trial Registration: This study presents long-term follow-up data of a previous clinical trial. Registry: ClinicalTrials.

Digitale Behandlungsangebote für Insomnie – eine Übersichtsarbeit

“…Grundsätzlich zeigte sich in den Originalstudien bei erwachsenen Insomniepatienten direkt im Anschluss an die durchgeführte Therapie eine gute Effektivität der Onlinebehandlung. Zu den Followup-Messzeitpunkten ergab sich darüber hinaus auch eine Stabilität der erzielten Behandlungserfolge bis zu 3 Jahre nach Beendigung der eigentlichen Therapie [8,42,53]. Die Studie von Ritterband et al [42] zeigte beispielsweise auch in der Follow-up-Untersuchung nach einem Jahr noch große Effektstärken für die Schwere der insomnischen Symptomatik, die Einschlaflatenz und die nächtliche Wachzeit nach dem Einschlafen gegenüber Psychoedukation allein.…”

Internet-Based Cognitive-Behavioral Therapy for Employees With Anxiety, Depression, Social Phobia, or Insomnia: Clinical and Work Outcomes

“…Social anxiety has also started to receive attention with iCBT interventions (Kampmann et al, 2016;Klein et al, 2011). And finally, sleep problems and insomnia have also been successfully addressed with iCBT programs (Espie et al, 2012(Espie et al, , 2019Hagatun et al, 2019;Lancee et al, 2012;Ritterband et al, 2017;Seyffert et al, 2016;Vedaa et al, 2019).…”

Cognitive-behavioral therapy for insomnia: A review of 8 studies

“…dCBT-I is effective for treating insomnia in the short term; however, little is known about the long-term effectiveness of dCBT-I on sleep and daytime symptoms. Vedaa et al 10 evaluated the efficacy of dCBT-I at 18 months after the intervention.…”

“…7,8 Here we review 8 recent studies that examined CBT-I. These studies are summarized in the Table [9][10][11][12][13][14][15][16] (page 41). Although CBT-I is a first-line treatment for chronic insomnia, it is underutilized in clinical practice primarily due to limited availability.…”