SEATTLE, WA—Internet-based cognitive behavioral therapy for insomnia (CBT-I) resulted in significant and lasting improvements in people’s sleep and daily functioning, according to data from a randomized controlled trial presented by Borge Sivertsen, PhD at SLEEP 2015.
Due to high costs and concentrated expertise in large cities, there has been a lack of CBT-I availability as a treatment for insomnia. The Internet has been proposed as a way to provide CBT-I in addressing the high incidence of insomnia and lack of available treatments.
Researchers from the National Institute of Public Health, Department of Public Mental Health, Bergen, Norway, aimed to study the efficacy of an unguided, Internet-based CBT-I treatment, Sleep Healthy Using the Internet (SHUTi), for adults with insomnia. The study enrolled 188 Norwegian adults (67% women, mean age 45) with insomnia and randomized them into interactive CBT-I treatment (SHUTi; n=99) or to passive education/sleep hygiene (n=89) for a six-week study period. Both study groups were assessed at baseline and post-intervention, which included questionnaires and sleep diary. This was followed by a six-month follow-up of the CBT-I group.
Study data showed that the Insomnia Severity Index was significantly improved for the CBT-I group, from 17.22 (pre) to 8.0 (post) (between-group effect size d=1.25). A significant difference between group effect size was seen as per the Bergen Insomnia Scale (d=0.87), and the Dysfunctional Beliefs and Attitudes about Sleep (d=1.14). After treatment, the amount of SHUTi-participants meeting the DSM-IV criteria for insomnia decreased from 94.8% at baseline to 41.0%. Secondary outcomes of Chalder Fatigue Scale and HADS, had between-group effect sizes from d=0.59–0.97. Sensitivity analyses on the completer sample yielded larger effect sizes, ranging from 0.8 to 1.7. The follow-up assessment showed that all improvements were maintained six months later.
Dr. Siversten, a coauthor, concluded that the current study findings “can contribute to make effective treatment for insomnia more widely accessible” and “should be available as standard treatment in health services.” This is especially important in Norway, he said, where insomnia rates have been increasing and there are few resources for affected individuals.