title: Internet-delivered or mailed self-help treatment for insomnia?: a randomized waiting-list controlled trial.
abstract: Cognitive Behavioral Therapy (CBT) is effective in reducing insomnia complaints, but the effects of self-help CBT have been inconsistent. The aim of this study was to determine the effectiveness of self-help for insomnia delivered in either electronic or paper-and-pencil format compared to a waiting-list. Participants kept a diary and filled out questionnaires before they were randomized into electronic (n = 216), paper-and-pencil (n = 205), or waiting-list (n = 202) groups. The intervention consisted of 6 weeks of unsupported self-help CBT, and post-tests were 4, 18, and 48 weeks after intervention. At 4-week follow-up, electronic and paper-and-pencil conditions were superior (p < .01) compared to the waiting-list condition on most daily sleep measures (Δd = 0.29-0.64), global insomnia symptoms (Δd = 0.90-1.00), depression (Δd = 0.36-0.41), and anxiety symptoms (Δd = 0.33-0.40). The electronic and paper-and-pencil groups demonstrated equal effectiveness 4 weeks after treatment (Δd = 0.00-0.22; p > .05). Effects were sustained at 48-week follow-up. This large-scale unsupported self-help study shows moderate to large effects on sleep measures that were still present after 48 weeks. Unsupported self-help CBT for insomnia therefore appears to be a promising first option in a stepped care approach.
authors: Department of Clinical and Health Psychology, Utrecht University, the Netherlands. j.lancee@uu.nl
authors: Jaap
authors: J
authors: Lancee
authors: Jan
authors: J
authors: van den Bout
authors: Annemieke
authors: A
authors: van Straten
authors: Victor I
authors: VI
authors: Spoormaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001638:Bibliotherapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists