Efficacy of an Internet-Based Behavioral Intervention for Adults With Insomnia

Abstract

Context: Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability to one of the most effective insomnia treatments, Cognitive Behavioral Therapy (CBT), is significantly limited. The Internet may be a key conduit for delivering this intervention. Objective: To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia. Design, Setting, and Participants: 45 adults were randomly assigned to an Internet intervention (n=22) or wait-list control group (n=23). 44 eligible participants were included in the analyses (mean age, 44.86±11.03 years; 34 women), who had, on average, a history of sleep difficulties greater than 10 years (10.59±8.89). Intervention: The Internet intervention is based on well-established face-to-face CBT, incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention. Main Outcome Measure(s): The Insomnia Severity Index (ISI) and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset (WASO) and sleep efficiency (SE). Results: Intent-to-treat analyses showed that scores on the ISI significantly improved from 15.73 (95% CI, 14.07-17.39) to 6.59 (95% CI, 4.73-8.45) for the Internet group, but did not change for the control group, 16.27 (95% CI, 14.61-17.94) to 15.50 (95% CI, 13.64-17.36), F (1, 42) = 29.64, p<.001. The Internet group maintained their gains at six month follow-up. Internet participants also achieved significant decreases in WASO (55%; 95% CI, 34%-76%) and increases in SE (16%; 95% CI, 9%-22%) compared to the non-significant control group changes of WASO (8%; 95% CI, −17%-33%) and SE (3%; 95% CI, −4%-9%). Conclusions: Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia.

Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context

“…Our effect size compared to control was moderate, and tallies with studies finding that iCBT can be effective for reducing insomnia in both community (Ritterband, et al, 2009;Ström et al, 2004) and patient (Vincent & Lewycky, 2009) populations, with effect sizes ranging from small to moderate (Ström et al, 2004) and small to large (Vincent and Lewycky, 2009). …”

“…Ritterband, et al (2009) found that an internet delivered program was effective at reducing insomnia in a US community sample of insomnia sufferers. Ström, Pettersson & Andersson (2004) found that an iCBT A c c e p t e d M a n u s c r i p t 6 ICBT FOR ANXIETY AND INSOMNIA IN UNDERGRADUATES program for insomnia was effective at improving sleep time, total wake time in bed, and sleep efficiency in a Swedish community sample of insomnia sufferers, albeit with small effect sizes.…”

“…Meta-analyses have found CBT to be effective at treating anxiety (Norton & Price, 2007;Morin et al, 2006) and insomnia (Harvey & Tang, 2003;Okajima, Komada, & Yuichi, 2011) in a range of populations. Over the past decade, the Internet has increasingly been used to deploy CBT based self-help for common mental health problems including anxiety (Paxling et al, 2011) and insomnia (Ritterband et al, 2009). Such treatments are referred to as 'internet-delivered CBT' (iCBT).…”

“…The power analysis revealed that a sample size of 147 would be required to detect a medium effect size. This number was increased to 180, to account for attrition rates of between 4-35% found in previous research using iCBT (Orbach, et al, 2007, Ritterband et al, 2009Stöm et al, 2004;Trockel et al, 2011;Vincent & Lewycky;. Of the original 180 students who contacted the experimenters, 138 (n = 93 women, mean age of 20.5 years, SD = 1.95, range = 18-34 years) attended the introductory session and were included in the study.…”

Is it time to get some SHUT-i?

“…Moreover, using established treatment outcome criteria, 69.7% were considered treatment responders and 56.6% were considered in remission at the final assessment point (1-year post treatment) in the SHUTi condition compared to 43% and 27.3%, respectively, in the control condition. Interestingly the effect sizes reported broadly match those typically seen in CBT-I studies employing face-to-face methods (15). Of note, however, almost 40% (39.7%) of those enrolled to the SHUTi condition did not complete all the prescribed modules.…”