From the Journals

Internet-based CBT may be effective treatment for chronic insomnia

Publish date: December 1, 2016
By
Lucas Franki
MDedge News

 

FROM JAMA PSYCHIATRY

Internet-delivered cognitive-behavioral therapy is effective at overcoming chronic insomnia, a randomized controlled trial of 303 adults showed.

In the trial, patients who were randomized to receive cognitive-behavioral therapy for insomnia (CBT-I) used a Web-based program called Sleep Healthy Using the Internet (SHUTi), which “incorporates the primary tenets of face-to-face CBT-I, including sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention,” wrote Lee M. Ritterband, PhD, and his associates. Meanwhile, patients in the control group received online, nonspecific patient education.

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The mean age of the participants was 43.3 years, and almost 72% were female. Most of the participants were white and non-Hispanic, most had at least a college degree, and almost 50% had a medical or psychiatric comorbidity – or both. The participants reported a high comfort rate with using the Internet, and most said that they checked email and the Internet every day.

After a 9-week study period, the investigators found that sleep-onset latency, wake after sleep onset, and ratings on the Insomnia Severity Index all were significantly reduced in the SHUTi group, compared with the control group. The effect remained after the 6-month and 1-year follow-ups, reported Dr. Ritterband of the Center for Behavioral Health and Technology at the University of Virginia, Charlottesville, and his associates.

No significant difference was found in total sleep time between the SHUTi group and the control group, but sleep efficiency and sleep quality did improve. In addition, the number of awakenings dropped in the SHUTi group. Both groups reported a decrease in the use of sleep aids, such as medication. After completing the post assessment and 6-month follow-up, participants received online gift certificates of $50 each, and after completing the assessment at the 1-year follow-up, they received $100 gift certificates.

“Internet-delivered CBT-I provides a less expensive, scalable treatment option that could reach previously unimaginable numbers of people,” the investigators said. “Future studies are necessary to determine who may be best served by this type of intervention and how the next steps of dissemination should occur. Ensuring that these interventions work with different patient populations, whether tailored or not for those groups, should also be examined,” they noted.

Find the full study in JAMA Psychiatry (2016 Nov 30. doi: 10.1001/jamapsychiatry.2016.3249)

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