title: Guided internet cognitive behavioral therapy for insomnia compared to a control treatment - A randomized trial.
abstract: OBJECTIVE
  To evaluate if internet-delivered Cognitive Behavioral Therapy for insomnia (ICBT-i) with brief therapist support outperforms an active control treatment.
  
  
  METHODS
  Adults diagnosed with insomnia were recruited via media (n = 148) and randomized to either eight weeks of ICBT-i or an active internet-based control treatment. Primary outcome was the insomnia severity index (ISI) assessed before and after treatment, with follow-ups after 6 and 12 months. Secondary outcomes were use of sleep medication, sleep parameters (sleep diary), perceived stress, and a screening of negative treatment effects. Hierarchical Linear Mixed Models were used for intent-to-treat analyses and handling of missing data.
  
  
  RESULTS
  ICBT-i was significantly more effective than the control treatment in reducing ISI (Cohen's d = 0.85), sleep medication, sleep efficiency, sleep latency, and sleep quality at post-treatment. The positive effects were sustained. However, after 12 months the difference was no longer significant due to a continuous decrease in ISI among controls, possibly due to their significantly higher utilization of insomnia relevant care after treatment. Forty-six negative effects were reported but did not differ between interventions.
  
  
  CONCLUSIONS
  Supported ICBT-i is more effective than an active control treatment in reducing insomnia severity and treatment gains remain stable one year after treatment.
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden. Electronic address: viktor.kaldo@ki.se.
authors.forename: Viktor
authors.initials: V
authors.lastname: Kaldo
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: Kerstin
authors.initials: K
authors.lastname: Blom
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Section of Psychology, Stockholm, Sweden.
authors.forename: Brjánn
authors.initials: B
authors.lastname: Ljótsson
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Brodin
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Jörgensen
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Kraepelien
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Rück
authors.affiliation: Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Lindefors
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*
keywords: CBT; Guided self-help; Insomnia; Internet; Psychological treatment; Psychotherapy