title: Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial.
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).
  
  
  METHODS
  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.
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Straten
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Emmelkamp
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Wit
authors.affiliation: University of Amsterdam (UvA), Department of Clinical Psychology, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Lancee
authors.affiliation: Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
authors.forename: E J W
authors.initials: EJ
authors.lastname: van Someren
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D016896:Treatment Outcome