title: Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Randomized Waitlist Controlled Trial.
abstract: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia.
  
  
  
  The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial.
  
  
  
  We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant's progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition.
  
  
  
  The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=-0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up.
  
  
  
  This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens.
  
  
  
  Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4).
authors.affiliation: Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands.
authors.forename: Corine Hg
authors.identifier: 0000-0001-7595-8641
authors.initials: CH
authors.lastname: Horsch
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Jaap
authors.identifier: 0000-0002-7722-5780
authors.initials: J
authors.lastname: Lancee
authors.affiliation: Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Fiemke
authors.identifier: 0000-0002-8913-5619
authors.initials: F
authors.lastname: Griffioen-Both
authors.affiliation: Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Sandor
authors.identifier: 0000-0001-8006-7405
authors.initials: S
authors.lastname: Spruit
authors.affiliation: Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Siska
authors.identifier: 0000-0002-8172-5315
authors.initials: S
authors.lastname: Fitrianie
authors.affiliation: Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands.
authors.forename: Mark A
authors.identifier: 0000-0002-8161-5722
authors.initials: MA
authors.lastname: Neerincx
authors.affiliation: Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Robbert Jan
authors.identifier: 0000-0002-8628-6446
authors.initials: RJ
authors.lastname: Beun
authors.affiliation: Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands.
authors.forename: Willem-Paul
authors.identifier: 0000-0001-8485-7092
authors.initials: WP
authors.lastname: Brinkman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040421:Cell Phone; 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*; D017216:Telemedicine / Q000379:methods*; D014850:Waiting Lists; D055815:Young Adult
keywords: cognitive behavioral therapy; eHealth; insomnia; smartphone app