Skip to main content Accessibility help
×
Home

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

  • A. van Straten (a1) (a2), J. Emmelkamp (a1) (a2), J. de Wit (a1) (a2), J. Lancee (a3), G. Andersson (a4) (a5), E. J. W. van Someren (a6) (a7) and P. Cuijpers (a1) (a2)...

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.

Copyright

Corresponding author

* Address for correspondence: A. van Straten, Ph.D., VU University, FPP, Department of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: a.van.straten@vu.nl)

References

Hide All
Andrews, G, Cuijpers, P, Craske, MG, McEvoy, P, Titov, N (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One 5, e13196.
Andersson, G, Kaldo-Sandström, V, Ström, L, Strömgren, T (2003). Internet administration of the Hospital Anxiety and Depression Scale (HADS) in a sample of tinnitus patients. Journal of Psychosomatic Research 55, 259262.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.
Backhaus, J, Junghanns, K, Broocks, A, Riemann, D, Hohagen, F (2002). Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. Journal of Psychosomatic Research 53, 737740.
Beekman, AT, Deeg, DJ, Van Limbeek, J, Braam, AW, De Vries, MZ, Van Tilburg, W (1997). Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychological Medicine 27, 231235.
Bjelland, I, Dahl, AA, Haug, TT, Neckelmann, D (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research 52, 6977.
Brooks, R (1996). EuroQoL: the current state of play. Health Policy 37, 5372.
Buscemi, N, Vandermeer, B, Friesen, C, Bialy, L, Tubman, M, Ospina, M, Klassen, TP, Witmans, M (2007). The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. Journal of General Internal Medicine 22, 13351350.
Buysse, DJ, Ancoli-Israel, S, Edinger, JD, Lichstein, KL, Morin, CM (2006). Recommendations for a standard research assessment of insomnia. Sleep 29, 11551173.
Buysse, DJ, Reynolds, CF, Monk, TH, Berman, SR, Kupfer, DJ (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193213.
Cheng, SK, Dizon, J (2012). Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychotherapy and Psychosomatics 81, 206216.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: New York.
Cuijpers, P, Donker, T, van Straten, A, Li, J, Andersson, G (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine 40, 19431957.
Daley, M, Morin, CM, LeBlanc, M, Grégoir, JP, Savard, J (2009 a). The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep 32, 5564.
Daley, M, Morin, CM, LeBlanc, M, Grégoir, JP, Savard, J, Baillargeon, L (2009 b). Insomnia and its relationship to health-care utilization, work absenteeism, productivity and accidents. Sleep Medicine 10, 427438.
Edinger, JD, Means, MK (2005). Cognitive-behavioral therapy for primary insomnia. Clinical Psychology Review 25, 539558.
Edinger, JD, Wolgemuth, WK (1999). The significance and management of persistent primary insomnia: the past, present and future of behavioral insomnia therapies. Sleep Medicine Reviews 3, 101118.
Espie, C (2006). Overcoming Insomnia and Sleep Problems: A Self-help Guide using Cognitive Behavioral Techniques. Robinson: London.
Espie, CA, Kyle, SD, Williams, C, Ong, JC, Douglas, NJ, Hames, P, Brown, JLS (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, 769781.
Fairholme, CP, Carl, JR, Farchione, TJ, Schonwetter, SW (2012). Transdiagnostic processes in emotional disorders and insomnia: results from a sample of adult outpatients with anxiety and mood disorders. Behaviour Research and Therapy 50, 522528.
Gallicchio, L, Kalesan, B (2009). Sleep duration and mortality: a systematic review and meta-analysis. Journal of Sleep Research 18, 148158.
Griffiths, KM, Farrer, L, Christensen, H (2010). The efficacy of Internet interventions for depression and anxiety disorders: a review of randomized controlled trials. Medical Journal of Australia 192, S4S11.
Jernelöv, S, Lekander, M, Blom, K, Rydh, S, Ljótsson, B, Axelsson, J, Kaldo, V (2012). Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia – a randomized controlled trial. BMC Psychiatry 12, 5.
Kyle, SD, Espie, CA, Morgan, K (2010). Quality of life and daytime functioning in insomnia. Behavioral Sleep Medicine 8, 123140.
Lancee, J, van den Bout, J, van Straten, A, Spoormaker, VI (2012). Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial. Behaviour Research and Therapy 50, 2229.
Lichstein, KL, Durrence, HH, Taylor, DJ, Bush, AJ, Riedel, BW (2003). Quantitative criteria for insomnia. Behaviour Research and Therapy 41, 427445.
Lipsey, MW (1990). Design Sensitivity. Statistical Power for Experimental Research. SAGE Publications Inc.: Newbury Park, CA.
Lipsey, MW, Wilson, DB (1993). The efficacy of psychological, educational, and behavioral treatment. confirmation from meta-analysis. American Psychologist 48, 11811209.
Morin, CM (2003). Measuring outcomes of randomized clinical trials of insomnia treatments. Sleep Medicine Reviews 7, 263279.
Morin, CM, Bélanger, L, LeBlanc, M, Ivers, H, Savard, J, Espie, CA, Mérette, C, Baillargeon, L, Grégoire, JP (2009 a). The natural history of insomnia. a population-based 3-year longitudinal study. Archives of Internal Medicine 169, 447453.
Morin, CM, Bootzin, RR, Buysse, DJ, Edinger, JD, Espie, CA, Lichstein, KL (2006 a). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 29, 13981414.
Morin, CM, Espie, CA (2003). Insomnia: A Clinical Guide to Assessment and Treatment. Kluwer Academic/Plenum Publishers: New York.
Morin, CM, LeBlanc, M, Daley, M, Grégoire, JP, Merette, C (2006 b). Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine 7, 123130.
Morin, CM, Vallieres, A, Guay, B, Ivers, H, Savard, J, Merette, C, Bastien, C, Baillargeon, L (2009 b). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia a randomized controlled trial. Journal of the American Medical Association 301, 20052015.
Ohayon, MM (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Review 6, 97111.
Olsson, I, Mykletun, A, Dahl, AA (2005). The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 5, 46.
Redline, S, Foody, JA (2011). Sleep disturbances: time to join the top 10 potentially modifiable cardiovascular risk factors? Circulation 124, 20492051.
Richards, R, Richardson, T (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Review 32, 329342.
Riper, H, Spek, V, Boon, B, Conijn, B, Kramer, J, Martin-Abello, K, Smit, F (2011). Effectiveness of E-self-help interventions for curbing adult problem drinking: a meta-analysis. Journal of Medical Internet Research 13, e42.
Ritterband, LM, Thorndike, FP, Gonder-Frederick, LA, Magee, JC, Bailey, ET, Saylor, DK, Morin, CM (2009). Efficacy of an Internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry 66, 692698.
Roth, T, Ancoli-Israel, S (1999). Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. II. Sleep 22 (Suppl. 2), S354S358.
Siebern, AT, Manber, R (2011). New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychology Research and Behavior Management 4, 2128.
Smith, MT, Perlis, ML, Park, A, Smith, MS, Pennington, JM, Giles, DE, Buysse, DJ (2002). Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry 159, 511.
Spek, V, Cuijpers, P, Nyklicek, I, Riper, H, Keyzer, J, Pop, V (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analyses. Psychological Medicine 37, 319328.
Spinhoven, P, Ormel, J, Sloekers, PP, Kempen, GI, Speckens, AE, Van Hemert, AM (1997). A validation study of the Hospital Anxiety and Depression Scale in different groups of Dutch subjects. Psychological Medicine 27, 363370.
Staner, L (2010). Comorbidity of insomnia and depression. Sleep Medicine Reviews 14, 3546.
Ström, L, Pettersson, R, Andersson, G (2004). Internet-based treatment for insomnia: a controlled evaluation. Journal of Consulting and Clinical Psychology 72, 113120.
Suzuki, E, Tsuchiya, M, Hirokawa, K, Taniguchi, T, Mitsuhashi, T, Kawamai, N (2008). Evaluation of an Internet-based self-help program for better quality of sleep among Japanese workers: a randomized controlled trial. Journal of Occupational Health 50, 387399.
Taylor, DJ, Lichstein, KL, Durrence, HH, Reidel, BW, Bush, AJ (2005). Epidemiology of insomnia, depression, and anxiety. Sleep 28, 14571464.
Turek, FW (2005). Insomnia and depression: if it looks and walks like a duck…. Sleep 28, 13621363.
Van den Berg, JF, Van Rooij, FJA, Vos, H, Tulen, JHM, Hofman, A, Miedema, HME, Knuistingh Neven, A, Tiemeier, H (2008). Disagreement between subjective and actigraphic measures of sleep duration in a population-based study of elderly persons. Journal of Sleep Research 17, 295302.
van Straten, A, Cuijpers, P (2009). Self-help therapy for insomnia: a meta-analysis. Sleep Medicine Reviews 13, 6171.
Verbeek, I, Klip, E (2005). Insomnia [in Dutch]. Boom Uitgevers: Amsterdam.
Vincent, N, Lewycky, S (2009). Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep 32, 807815.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed