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

Published online by Cambridge University Press:  04 September 2013

A. van Straten ,
J. Emmelkamp ,
J. de Wit ,
J. Lancee ,
G. Andersson ,
E. J. W. van Someren  and
P. Cuijpers
A. van Straten*
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, The Netherlands
J. Emmelkamp
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, The Netherlands
J. de Wit
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, The Netherlands
J. Lancee
Affiliation:
University of Amsterdam (UvA), Department of Clinical Psychology, The Netherlands
G. Andersson
Affiliation:
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
E. J. W. van Someren
Affiliation:
Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands Departments of Integrative Neurophysiology and Medical Psychology, Centre for Neurogenomics and Cognitive Research, VU University and Medical Centre, Amsterdam, The Netherlands
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, The Netherlands
*
* 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)
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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.

Keywords

Behaviour therapycognitive therapyInternetsleep disorderssleep initiation and maintenance disorders
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1521 - 1532
Copyright
Copyright © Cambridge University Press 2013 

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