Efficacy of an Internet-Based Behavioral Intervention for Adults With Insomnia
Efficacy of an Internet-Based Behavioral Intervention for Adults With Insomnia
Ritterband LM, Thorndike FP, Gonder-Frederick LA, et al
Arch Gen Psychiatry. 2009;66:692-698
One of the most effective treatments for insomnia is cognitive behavioral therapy (CBT), but availability of this treatment administered face-to-face is significantly limited. The goal of this study was to determine if a structured behavioral Internet intervention would be feasible and effective for adults with insomnia. Like conventional CBT for insomnia, the Internet intervention incorporated sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention.
Of 45 adult participants in this study, 22 were randomized to receive the Internet intervention and 23 to a wait-list control group. The analyses included 44 eligible participants with a history of sleep difficulties longer than 10 years on average (mean 10.59 ± 8.89 years). Of these, 34 were women; mean age was 44.86 ± 11.03 years.
Changes in insomnia severity, wake after sleep onset, and sleep efficiency were measured with the Insomnia Severity Index and daily sleep diary data, and analyses were by intention-to-treat.
On the Insomnia Severity Index, scores significantly improved from 15.73 (95% confidence interval [CI], 14.07-17.39) to 6.59 (95% CI, 4.73-8.45) for the Internet group but remained unchanged for the control group (16.27 [95% CI, 14.61- 17.94] to 15.50 [95% CI, 13.64-17.36]) (F1,42 = 29.64; P < .001).
At 6-month follow-up, improvements were maintained in the Internet group. Wake after sleep onset significantly decreased and sleep efficiency significantly increased in the Internet group, whereas the control group had no significant changes in these parameters. Although participants on average initially had moderate severity insomnia, those who received the Internet intervention no longer met criteria for clinically significant insomnia after treatment and at 6-month follow-up.
On the basis of this small study, a structured behavioral program delivered via an Internet intervention appears promising for treatment of insomnia. Sleep significantly improved in participants who received this intervention although not in the control group. In addition to small study size, limitations are that the sample was motivated, self-selected, relatively homogeneous, well educated, and only featured those without comorbid conditions. Sleep assessment was based on self-report and blinding of the participants was not feasible.
Although an Internet CBT intervention may not be appropriate for all patients, it may have potential as a first intervention in a stepped care model of treatment.
Abstract
Efficacy of an Internet-Based Behavioral Intervention for Adults With Insomnia
Ritterband LM, Thorndike FP, Gonder-Frederick LA, et al
Arch Gen Psychiatry. 2009;66:692-698
Summary
One of the most effective treatments for insomnia is cognitive behavioral therapy (CBT), but availability of this treatment administered face-to-face is significantly limited. The goal of this study was to determine if a structured behavioral Internet intervention would be feasible and effective for adults with insomnia. Like conventional CBT for insomnia, the Internet intervention incorporated sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention.
Of 45 adult participants in this study, 22 were randomized to receive the Internet intervention and 23 to a wait-list control group. The analyses included 44 eligible participants with a history of sleep difficulties longer than 10 years on average (mean 10.59 ± 8.89 years). Of these, 34 were women; mean age was 44.86 ± 11.03 years.
Changes in insomnia severity, wake after sleep onset, and sleep efficiency were measured with the Insomnia Severity Index and daily sleep diary data, and analyses were by intention-to-treat.
On the Insomnia Severity Index, scores significantly improved from 15.73 (95% confidence interval [CI], 14.07-17.39) to 6.59 (95% CI, 4.73-8.45) for the Internet group but remained unchanged for the control group (16.27 [95% CI, 14.61- 17.94] to 15.50 [95% CI, 13.64-17.36]) (F1,42 = 29.64; P < .001).
At 6-month follow-up, improvements were maintained in the Internet group. Wake after sleep onset significantly decreased and sleep efficiency significantly increased in the Internet group, whereas the control group had no significant changes in these parameters. Although participants on average initially had moderate severity insomnia, those who received the Internet intervention no longer met criteria for clinically significant insomnia after treatment and at 6-month follow-up.
Viewpoint
On the basis of this small study, a structured behavioral program delivered via an Internet intervention appears promising for treatment of insomnia. Sleep significantly improved in participants who received this intervention although not in the control group. In addition to small study size, limitations are that the sample was motivated, self-selected, relatively homogeneous, well educated, and only featured those without comorbid conditions. Sleep assessment was based on self-report and blinding of the participants was not feasible.
Although an Internet CBT intervention may not be appropriate for all patients, it may have potential as a first intervention in a stepped care model of treatment.
Abstract
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