title: The Short-Term Efficacy of an Unguided Internet-Based Cognitive-Behavioral Therapy for Insomnia: A Randomized Controlled Trial With a Six-Month Nonrandomized Follow-Up.
abstract: Insomnia is a major health problem, and the need for effective and accessible treatment is urgent. The aim of the current study was to evaluate the short-term efficacy of an unguided Internet-based cognitive-behavioral treatment program for insomnia (CBTi), called SHUTi (Sleep Healthy Using the Internet).
  
  
  
  This study used a parallel arm randomized controlled trial in Norway. Participants were randomly allocated to the SHUTi condition or a Web-based patient education condition. Both groups were assessed before and after the nine-week intervention period (online sleep diaries and questionnaires). The SHUTi participants were reassessed in a six-month nonrandomized follow-up. Primary outcome measures were the Insomnia Severity Index (ISI) and the Bergen Insomnia Scale (BIS).
  
  
  
  A total of 181 participants were included in the study; SHUTi condition (n = 95), patient education condition (n = 86). Intention-to-treat mixed-model repeated-measures analysis revealed that the SHUTi group had better short-term outcomes compared with the patient education group on most sleep measures. The SHUTi group showed a significant decrease on the primary outcomes, the ISI (dbetween= -1.77, 95% CI = -2.23, -1.31) and the BIS (dbetween= -1.00, 95% CI = -1.32, -.68). Improvements were maintained among the completing SHUTi participants at the six-month nonrandomized follow-up. However, dropout attrition was high.
  
  
  
  Unguided Internet-based CBTi produced significant short-term improvements in sleep in patients with chronic insomnia. This highlights the benefits of making Internet-delivered CBTi programs available as a standard first-line treatment option in public health services. Nevertheless, the rate of dropout attrition (participants not completing post-assessment) in this trial limits the generalizability of the findings.
authors.affiliation: a Department of Health Promotion , Norwegian Institute of Public Health , Bergen , Norway.
authors.forename: Susanne
authors.initials: S
authors.lastname: Hagatun
authors.affiliation: a Department of Health Promotion , Norwegian Institute of Public Health , Bergen , Norway.|b Department of Psychosocial Science , University of Bergen , Bergen , Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Vedaa
authors.affiliation: c Department of Clinical Psychology , University of Bergen , Bergen , Norway.|d Anxiety Disorders Research Network, Haukeland University Hospital , Bergen , Norway.
authors.forename: Tine
authors.identifier: 0000-0003-1282-6902
authors.initials: T
authors.lastname: Nordgreen
authors.affiliation: a Department of Health Promotion , Norwegian Institute of Public Health , Bergen , Norway.
authors.forename: Otto R F
authors.initials: ORF
authors.lastname: Smith
authors.affiliation: b Department of Psychosocial Science , University of Bergen , Bergen , Norway.|e Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital , Bergen , Norway.
authors.forename: Ståle
authors.initials: S
authors.lastname: Pallesen
authors.affiliation: c Department of Clinical Psychology , University of Bergen , Bergen , Norway.
authors.forename: Odd E
authors.initials: OE
authors.lastname: Havik
authors.affiliation: e Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital , Bergen , Norway.|f Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bjorvatn
authors.affiliation: g Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences , University of Virginia Health System , Charlottesville , Virginia.
authors.forename: Frances P
authors.initials: FP
authors.lastname: Thorndike
authors.affiliation: g Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences , University of Virginia Health System , Charlottesville , Virginia.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ritterband
authors.affiliation: a Department of Health Promotion , Norwegian Institute of Public Health , Bergen , Norway.|h The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health , Bergen , Norway.|i Department of Research and Innovation , Helse Fonna HF , Haugesund , Norway.
authors.forename: Børge
authors.initials: B
authors.lastname: Sivertsen
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet / Q000295:instrumentation*; D008297:Male; D007319:Sleep Initiation and Maintenance Disorders / Q000473:pathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome