title: Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial.
abstract: The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy (CBT) for insomnia. We conducted an 8-week randomized controlled non-inferiority trial with 6-months follow-up. Participants were forty-eight adults with insomnia, recruited via media. Interventions were guided Internet-delivered CBT (ICBT) and group-delivered CBT (GCBT) for insomnia. Primary outcome measure was the Insomnia Severity Index (ISI), secondary outcome measures were sleep diary data, depressive symptoms, response- and remission rates. Both treatment groups showed significant improvements and large effect sizes for ISI (Within Cohen's d: ICBT post = 1.8, 6-months follow-up = 2.1; GCBT post = 2.1, 6-months follow-up = 2.2). Confidence interval of the difference between groups post-treatment and at FU6 indicated non-inferiority of ICBT compared to GCBT. At post-treatment, two thirds of patients in both groups were considered responders (ISI-reduction > 7p). Using diagnostic criteria, 63% (ICBT) and 75% (GCBT) were in remission. Sleep diary data showed moderate to large effect sizes. We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity, sleep parameters and depressive symptoms. The results are in line with previous research, and strengthen the evidence for guided Internet-CBT for insomnia.
  
  
  BACKGROUND
  The study protocol was approved by, and registered with, the regional ethics review board in Linköping, Sweden, registration number 2010/385-31.
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden. Electronic address: kerstin.blom@ki.se.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Blom
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Tarkian Tillgren
authors.affiliation: Department of Pain and Rehabilitation Center, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wiklund
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Ewa
authors.initials: E
authors.lastname: Danlycke
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Forssén
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Söderström
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Johansson
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Hugo
authors.initials: H
authors.lastname: Hesser
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Section of Psychology, Stockholm, Sweden.
authors.forename: Susanna
authors.initials: S
authors.lastname: Jernelöv
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Lindefors
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Viktor
authors.initials: V
authors.lastname: Kaldo
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods*; D019114:Remote Consultation / Q000379:methods*; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: CBT; Group therapy; Insomnia; Internet; Non-inferiority; Psychotherapy