Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial

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. Inte...

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Bibliographic Details
Published in:	Behaviour research and therapy Vol. 70; pp. 47 - 55
Main Authors:	Blom, Kerstin, Tarkian Tillgren, Hanna, Wiklund, Tobias, Danlycke, Ewa, Forssén, Mattias, Söderström, Alexandra, Johansson, Robert, Hesser, Hugo, Jernelöv, Susanna, Lindefors, Nils, Andersson, Gerhard, Kaldo, Viktor
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-07-2015 Elsevier Science Ltd
Subjects:	Adult Aged Behavior modification CBT Clinical trials Cognitive therapy Cognitive Therapy - methods Confidence intervals Female Group therapy Humans Insomnia Internet Male Medicin och hälsovetenskap Middle Aged Non-inferiority Psychology Psychotherapy Psychotherapy, Group - methods Psykologi Remote Consultation - methods Severity of Illness Index Sleep Initiation and Maintenance Disorders - diagnosis Sleep Initiation and Maintenance Disorders - psychology Sleep Initiation and Maintenance Disorders - therapy Treatment Outcome Psychotherapy Group therapy Internet CBT Insomnia Non-inferiority
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Summary:	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. The study protocol was approved by, and registered with, the regional ethics review board in Linköping, Sweden, registration number 2010/385-31. •We compared guided Internet-delivered therapy for insomnia to group therapy.•Both treatments had large within group effect sizes of Cohen's d 1.8–2.2.•Guided Internet-delivered therapy for insomnia proved non-inferior to group therapy.•Treatments were based on state-of-the-art cognitive behavioral therapy for insomnia.•Follow-up was done post-treatment and after 6 months.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0005-7967 1873-622X 1873-622X
DOI:	10.1016/j.brat.2015.05.002