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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: [email protected])
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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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References

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.Google Scholar
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, 259–262.CrossRefGoogle Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
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, 737–740.CrossRefGoogle ScholarPubMed
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, 231–235.CrossRefGoogle Scholar
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, 69–77.Google Scholar
Brooks, R (1996). EuroQoL: the current state of play. Health Policy 37, 53–72.Google Scholar
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, 1335–1350.CrossRefGoogle ScholarPubMed
Buysse, DJ, Ancoli-Israel, S, Edinger, JD, Lichstein, KL, Morin, CM (2006). Recommendations for a standard research assessment of insomnia. Sleep 29, 1155–1173.Google Scholar
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, 193–213.Google Scholar
Cheng, SK, Dizon, J (2012). Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychotherapy and Psychosomatics 81, 206–216.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: New York.Google Scholar
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, 1943–1957.Google Scholar
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, 55–64.Google Scholar
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, 427–438.Google Scholar
Edinger, JD, Means, MK (2005). Cognitive-behavioral therapy for primary insomnia. Clinical Psychology Review 25, 539–558.Google Scholar
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, 101–118.Google Scholar
Espie, C (2006). Overcoming Insomnia and Sleep Problems: A Self-help Guide using Cognitive Behavioral Techniques. Robinson: London.Google Scholar
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, 769–781.Google Scholar
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, 522–528.Google Scholar
Gallicchio, L, Kalesan, B (2009). Sleep duration and mortality: a systematic review and meta-analysis. Journal of Sleep Research 18, 148–158.Google Scholar
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, S4–S11.Google Scholar
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.Google Scholar
Kyle, SD, Espie, CA, Morgan, K (2010). Quality of life and daytime functioning in insomnia. Behavioral Sleep Medicine 8, 123–140.Google Scholar
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, 22–29.Google Scholar
Lichstein, KL, Durrence, HH, Taylor, DJ, Bush, AJ, Riedel, BW (2003). Quantitative criteria for insomnia. Behaviour Research and Therapy 41, 427–445.CrossRefGoogle ScholarPubMed
Lipsey, MW (1990). Design Sensitivity. Statistical Power for Experimental Research. SAGE Publications Inc.: Newbury Park, CA.Google Scholar
Lipsey, MW, Wilson, DB (1993). The efficacy of psychological, educational, and behavioral treatment. confirmation from meta-analysis. American Psychologist 48, 1181–1209.Google Scholar
Morin, CM (2003). Measuring outcomes of randomized clinical trials of insomnia treatments. Sleep Medicine Reviews 7, 263–279.CrossRefGoogle ScholarPubMed
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, 447–453.Google Scholar
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, 1398–1414.Google Scholar
Morin, CM, Espie, CA (2003). Insomnia: A Clinical Guide to Assessment and Treatment. Kluwer Academic/Plenum Publishers: New York.Google Scholar
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, 123–130.Google Scholar
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, 2005–2015.Google Scholar
Ohayon, MM (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Review 6, 97–111.CrossRefGoogle ScholarPubMed
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.Google Scholar
Redline, S, Foody, JA (2011). Sleep disturbances: time to join the top 10 potentially modifiable cardiovascular risk factors? Circulation 124, 2049–2051.Google Scholar
Richards, R, Richardson, T (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clinical Psychology Review 32, 329–342.Google Scholar
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.CrossRefGoogle ScholarPubMed
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, 692–698.CrossRefGoogle ScholarPubMed
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), S354–S358.Google Scholar
Siebern, AT, Manber, R (2011). New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychology Research and Behavior Management 4, 21–28.Google Scholar
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, 5–11.CrossRefGoogle ScholarPubMed
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, 319–328.Google Scholar
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, 363–370.CrossRefGoogle ScholarPubMed
Staner, L (2010). Comorbidity of insomnia and depression. Sleep Medicine Reviews 14, 35–46.Google Scholar
Ström, L, Pettersson, R, Andersson, G (2004). Internet-based treatment for insomnia: a controlled evaluation. Journal of Consulting and Clinical Psychology 72, 113–120.CrossRefGoogle ScholarPubMed
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, 387–399.CrossRefGoogle ScholarPubMed
Taylor, DJ, Lichstein, KL, Durrence, HH, Reidel, BW, Bush, AJ (2005). Epidemiology of insomnia, depression, and anxiety. Sleep 28, 1457–1464.CrossRefGoogle ScholarPubMed
Turek, FW (2005). Insomnia and depression: if it looks and walks like a duck…. Sleep 28, 1362–1363.Google Scholar
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, 295–302.Google Scholar
van Straten, A, Cuijpers, P (2009). Self-help therapy for insomnia: a meta-analysis. Sleep Medicine Reviews 13, 61–71.Google Scholar
Verbeek, I, Klip, E (2005). Insomnia [in Dutch]. Boom Uitgevers: Amsterdam.Google Scholar
Vincent, N, Lewycky, S (2009). Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep 32, 807–815.Google Scholar