Efficacy of an Internet-based behavioral intervention for adults with insomnia
Open accessAbstract
CONTEXT: Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability of one of the most effective insomnia treatments, cognitive behavioral therapy, is significantly limited. The Internet may be a key conduit for delivering this intervention. OBJECTIVE: To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia. DESIGN, SETTING, AND PARTICIPANTS: Forty-five adults were randomly assigned to an Internet intervention (n = 22) or wait-list control group (n = 23). Forty-four eligible participants (mean [SD] age, 44.86 [11.03] years; 34 women) who had a history of sleep difficulties longer than 10 years on average (mean [SD], 10.59 [8.89] years) were included in the analyses. INTERVENTION: The Internet intervention is based on well-established face-to-face cognitive behavioral therapy incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention. MAIN OUTCOME MEASURES: The Insomnia Severity Index and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset and sleep efficiency. RESULTS: Intention-to-treat analyses showed that scores on the Insomnia Severity Index significantly improved from 15.73 (95% confidence interval [CI], 14.07 to 17.39) to 6.59 (95% CI, 4.73 to 8.45) for the Internet group but did not change for the control group (16.27 [95% CI, 14.61 to 17.94] to 15.50 [95% CI, 13.64 to 17.36]) (F(1,42) = 29.64; P < .001). The Internet group maintained their gains at the 6-month follow-up. Internet participants also achieved significant decreases in wake after sleep onset (55% [95% CI, 34% to 76%]) and increases in sleep efficiency (16% [95% CI, 9% to 22%]) compared with the nonsignificant control group changes of wake after sleep onset (8% [95% CI, -17% to 33%) and sleep efficiency (3%; 95% CI, -4% to 9%). CONCLUSIONS: Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not have a significant change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00328250.
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Outcomes of web-based interventions vary widely, from virtually no effect to effect sizes similar to face-to-face interventions.
“However, within this growing number of studies, the range of outcomes can vary from virtually no effect to effect sizes that are similar to face-to-face interventions.”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
Attrition and non-adherence in standalone web-based interventions range widely, from over 95% for standalone depression sites, modest for many anxiety sites, to minimal for insomnia, depending on disorder and sampling/screening.
“Attrition and non-adherence can also range widely, from extremely high (>95% for standalone depression sites), modest (many anxiety sites), to minimal (insomnia), depending on the disorder and how participants were sampled or screened.”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
Standalone web-based interventions produce a wide range of outcomes: small or nonsignificant for many depression and substance abuse sites, moderate for some anxiety disorders, and fairly large for insomnia.
“Standalone interventions have produced a wide range of outcomes, from small or nonsignificant (e.g. many depression sites, substance abuse) to moderate (some anxiety disorders) to fairly large (insomnia) (14, 15, 18, 25).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
Web-based interventions have demonstrated efficacy for depression, anxiety disorders, alcohol and substance abuse, and insomnia.
“The efficacy of web-based intervention has been demonstrated by a large number of trials for a number of mental health problems, including depression, anxiety disorders, alcohol and substance abuse, and insomnia (14–18).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [18]
Initial results of CCBT for somatic problems are promising, but many of the trials have been relatively small.
“Although initial results are promising, further work is needed because many of the trials have been relatively small [44-47].”
From Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress (2012) · cites this paper as [45]
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Ritterband, L. M., Bailey, E. T., Thorndike, F. P., Lord, H. R., Farrell‐Carnahan, L., & Baum, L. D. (2012) · Psycho-Oncology · doi:10.1002/pon.1969 · Cited by 296 · see citing works
“Specifically, Sleep Healthy Using The Internet (SHUTi, pronounced ‘Shut-Eye’), an individually tailored, interactive intervention based on CBT-I, has been shown to significantly improve sleep in adults with primary insomnia [39].”
BackgroundResultSelf-citationRogers, M. A., Lemmen, K., Kramer, R., Mann, J., & Chopra, V. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7111 · Cited by 259 · see citing works
“Of these studies, there were 268 unique RCTs that were self-help Internet-based interventions; and of the 268 studies, there were 57 trials demonstrating a health benefit with a functional website [77-138].”
BackgroundUsing evidence-based internet interventions to reduce health disparities worldwide.
Muñoz, R. F. (2010) · Journal of Medical Internet Research · doi:10.2196/jmir.1463 · Cited by 242 · see citing works
“More recent reports continue to show empirical support for the effectiveness of Internet interventions [15,16] and their potential for both prevention and treatment [17,18].”
BackgroundComputerised Cognitive Behavioural Therapy for Insomnia: A Systematic Review and Meta-Analysis
Cheng, S. K., & Dizon, J. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000335379 · Cited by 241 · see citing works
Sivertsen, B., Lallukka, T. M., Salo, P., Pallesen, S., Hysing, M., Krokstad, S., & Øverland, S. N. (2013) · Journal of Sleep Research · doi:10.1111/jsr.12102 · Cited by 251 · see citing works
“the SLEEPIO andSHUTi-programs (Espie et al., 2012; Ritterband et al., 2009), points to an important future direction for improving public dissemination and the implementation of efficacious and cost-effective insomnia treatments.”
Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline.
(2018) · Europe PMC (PubMed Central) · Cited by 250 · see citing works
Self-help cognitive-behavioral therapy for insomnia: A meta-analysis of randomized controlled trials
Ho, F. Y., Chung, K., Yeung, W., Ng, T. H., Kwan, K.-S., Yung, K.-P., & Cheng, S. K. W. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.06.010 · Cited by 239 · see citing works
“14 Ritterband et al., 2009 [51] USA/NA 44.9 (NR)/77.3% DSM-IV, insomnia 3 nights per week for 6 mo 2-parallel arms (SH, WL) Nil 9 wk 6 mo 45 (22/23) Internet/CT, SC, SHy and SR WL ISI, SD SH significantly >WL in ISI.”
BackgroundInfluentialPredictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea
Mehrtash, M., Bakker, J. P., & Ayas, N. (2019) · Lung · doi:10.1007/s00408-018-00193-1 · Cited by 231 · see citing works
“OSA patients that suffer from insomnia have worse sleep related functional outcomes, health-related quality of life, and mental health outcomes [52].”
BackgroundCLINICAL PRACTICE. Insomnia Disorder.
Winkelman, J. (2015) · New England Journal of Medicine · doi:10.1056/nejmcp1412740 · Cited by 153 · see citing works
Zachariae, R., Amidi, A., Damholdt, M. F., Clausen, C. D. R., Dahlgaard, J., Lord, H., Thorndike, F. P., & Ritterband, L. M. (2018) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/djx293 · Cited by 212 · see citing works
“SHUTi (25), a fully automated interactive iCBT-I based on well-established face-to-face CBT-I (26), was adapted into Danish.”
BackgroundMethodSelf-citationMurawski, B., Wade, L., Plotnikoff, R. C., Lubans, D. R., & Duncan, M. J. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2017.12.003 · Cited by 225 · see citing works
“Technology- or web-based interventions therefore may be useful in providing the necessary reach to effectively improve various indicators of sleep health [18,19].”
BackgroundWeb-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress
Murray, E. (2012) · Medicine 2.0 · doi:10.2196/med20.1741 · Cited by 219 · see citing works
“Although initial results are promising, further work is needed because many of the trials have been relatively small [44-47].”
ResultEstablishing Guidelines for Executing and Reporting Internet Intervention Research
Proudfoot, J., Klein, B., Barak, A., Carlbring, P., Cuijpers, P., Lange, A., Ritterband, L., & Andersson, G. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.573807 · Cited by 202 · see citing works
Self-citationSleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers
Troxel, W., Shih, R. A., Pedersen, E. R., Geyer, L., Fisher, M., Griffin, B. A., Haas, A. C., Kurz, J., & Steinberg, P. S. (2015) · Rand health quarterly · doi:10.7249/rhq-05-02-19 · Cited by 195 · see citing works
“Evaluations of some of these programs have shown evidence of efficacy in reducing symptoms of insomnia and comorbid disorders (Espie et al., 2012; Thorndike, Ritterband, Gonder‐Frederick, et al., 2013; Ritterband et al., 2009).”
BackgroundBlom, K., Jernelöv, S., Kraepelien, M., Bergdahl, M. O., Jungmarker, K., Ankartjärn, L., Lindefors, N., & Kaldo, V. (2015) · SLEEP · doi:10.5665/sleep.4412 · Cited by 197 · see citing works
Validation of the insomnia severity index as a web-based measure
Thorndike, F. P., Ritterband, L. M., Saylor, D. K., Magee, J. C., Gonder-Frederick, L. A., & Morin, C. M. (2011) · Behavioral Sleep Medicine · doi:10.1080/15402002.2011.606766 · Cited by 186 · see citing works
“…were enrolled in the parent randomized controlled trial (RCT) to assess the effectiveness of an Internet intervention called Sleep Healthy Using the Internet (SHUTi), designed to deliver cognitive behavioral therapy for insomnia (for the main results from the trial, see Ritterband et al., 2009).”
BackgroundMethodSelf-citationYe, Y.-Y., Zhang, Y.-F., Chen, J., Liu, J., Li, X.-J., Liu, Y.-Z., Lang, Y., Lin, L., Yang, X.-J., & Jiang, X.-J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0142258 · Cited by 186 · see citing works
“As an independent factor, time should be considered a critical aspect in the assessment of therapeutic efficacy [49].”
BackgroundCheng, P., Luik, A. I., Fellman-Couture, C., Peterson, E. L., Joseph, C. L. M., Tallent, G., Tran, K. M., Ahmedani, B. K., Roehrs, T., Roth, T. G., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718001113 · Cited by 183 · see citing works
Thiart, H., Lehr, D., Ebert, D. D., Berking, M., & Riper, H. (2015) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.3478 · Cited by 168 · see citing works
“Both factors are supposed to foster accountability and trust and by that, adherence, (66) and both we share with the studies of Ritterband on iCBT-I (44, 67), which also reported high adherence rates.”
Lancee, J., van Straten, A., Nexhmedin Morina, B., Kaldo, V., & Kamphuis, J. H. (2015) · SLEEP · doi:10.5665/sleep.5344 · Cited by 173 · see citing works
Ebert, D. D., Berking, M., Thiart, H., Riper, H., Laferton, J. A. C., Cuijpers, P., Sieland, B., & Lehr, D. (2015) · Health Psychology · doi:10.1037/hea0000277 · Cited by 161 · see citing works
Felder, J. N., Epel, E. S., Neuhaus, J. M., Krystal, A. D., & Prather, A. A. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.4491 · Cited by 173 · see citing works
Blom, K., Tillgren, H. T., Wiklund, T., Danlycke, E., Forssén, M., Söderström, A., Johansson, R., Hesser, H., Jernelöv, S., Lindefors, N., et al. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.05.002 · Cited by 172 · see citing works
“Most of the previous group- or Internet-delivered therapy studies did not use ISI as primary outcome measure, but when comparing sleep diary data at post-assessment, guided ICBT in this study did well compared to other guided and un-guided Internettreatments (Lancee, van den Bout, van Straten, & Spoormaker, 2012; Ritt…”
ResultHermes, E. D., Lyon, A. R., Schueller, S. M., & Glass, J. E. (2019) · Journal of Medical Internet Research · doi:10.2196/11752 · Cited by 149 · see citing works
Realizing the Potential of Behavioral Intervention Technologies
Schueller, S. M., Muñoz, R. F., & Mohr, D. C. (2013) · Current Directions in Psychological Science · doi:10.1177/0963721413495872 · Cited by 152 · see citing works
“, 2010), insomnia (Ritterband et al., 2009), diet (Resnicow et al.”
BackgroundHorsch, C. H., Lancee, J., Griffioen-Both, F., Spruit, S., Fitrianie, S., Neerincx, M. A., Beun, R. J., & Brinkman, W.-P. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6524 · Cited by 164 · see citing works
Efficacy of an internet-based intervention for infant and toddler sleep disturbances
Mindell, J. A., Du Mond, C. E., Sadeh, A., Telofski, L. S., Kulkarni, N., & Gunn, E. (2011) · Sleep · doi:10.1093/sleep/34.4.451 · Cited by 161 · see citing works
Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review
Luik, A. I., Kyle, S. D., & Espie, C. A. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0065-4 · Cited by 156 · see citing works
“However, for studies whereby the dCBT intervention did not address sleepmedication use or tapering specifically, there tended to be an absence of treatment effects on sleep medication use [12, 17, 19].”
BackgroundUnderstanding and Treating Insomnia
Bootzin, R. R., & Epstein, D. R. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091516 · Cited by 150 · see citing works
“One Internet program that had strong results in improving sleep provides interesting data for how to handle this issue of match between the program and the patient (Ritterband et al. 2009).”
BackgroundBrasure, M., Fuchs, E. L., MacDonald, R. H., Nelson, V. A., Koffel, E., Olson, C. M., Khawaja, I. S., Diem, S. J., Carlyle, M. H., Wilt, T. J., et al. (2016) · Annals of Internal Medicine · doi:10.7326/m15-1782 · Cited by 148 · see citing works
“Ritterband et al, 2009 (80) Vincent et al, 2009 (93) Subtotal”
BackgroundGeraghty, A. W. A., Torres, L. D., Leykin, Y., Pérez‐Stable, E. J., & Muñoz, R. F. (2012) · Health Promotion International · doi:10.1093/heapro/das029 · Cited by 139 · see citing works
“, 2001), and improve insomnia (Ritterband et al., 2009).”
Hasan, F., Tu, Y.-K., Yang, C.-M., James Gordon, C., Wu, D., Lee, H.-C., Yuliana, L. T., Herawati, L., Chen, T.-J., & Chiu, H.-Y. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101567 · Cited by 137 · see citing works
Lancee, J., van den Bout, J., van Straten, A., & Spoormaker, V. I. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.09.012 · Cited by 131 · see citing works
Kaldo, V., Jernelöv, S., Blom, K., Ljótsson, B., Brodin, M., Jörgensen, M., Kraepelien, M., Rück, C., & Lindefors, N. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.06.001 · Cited by 132 · see citing works
“Several studies with no therapist support, or with automated feedback only, have presented positive results (Lancee, van den Bout, van Straten, & Spoormaker, 2012; Ritterband et al., 2009; Ritterband et al., 2012), in one case also when compared to a non-guided internet-based placebo condition (Espie et al.”
BackgroundResultInfluentialAshworth, D. K., Sletten, T. L., Junge, M., Simpson, K., Clarke, D., Cunnington, D., & Rajaratnam, S. M. W. (2015) · Journal of Counseling Psychology · doi:10.1037/cou0000059 · Cited by 131 · see citing works
Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial
van Straten, A., Emmelkamp, J., de Wit, J., Lancee, J., Andersson, G., Someren, E. J. W. V., & Cuijpers, P. J. (2013) · Psychological Medicine · doi:10.1017/s0033291713002249 · Cited by 131 · see citing works
“Other studies on Internet-delivered CBT (Suzuki et al. 2008; Ritterband et al. 2009; Vincent & Lewycky, 2009; Espie et al. 2012; Lancee et al. 2012) have concluded that this treatment has positive effects, although the interventions in these studies were provided without personal guidance or…”
BackgroundInfluentialIs Chronic Insomnia a Precursor to Major Depression? Epidemiological and Biological Findings
Baglioni, C., & Riemann, D. W. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0308-5 · Cited by 131 · see citing works
Simon, L., Steinmetz, L., Feige, B., Benz, F., Spiegelhalder, K., & Baumeister, H. (2023) · Scientific Reports · doi:10.1038/s41598-023-28853-0 · Cited by 135 · see citing works
Fragmented Sleep, Fragmented Mind
der Kloet, D. V. H., Merckelbach, H. L. G. J., Giesbrecht, T., & Lynn, S. J. (2012) · Perspectives on Psychological Science · doi:10.1177/1745691612437597 · Cited by 130 · see citing works
“Although sleep diaries represent a core assessment component in studies on sleep problems, polysomnography would be preferred to confirm objective changes in sleep (Ritterband et al., 2009).”
BackgroundGothe, N. P., Ehlers, D. K., Salerno, E. A., Fanning, J., Kramer, A. F., & McAuley, E. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2019.1690493 · Cited by 125 · see citing works
“For instance, Ritterband and colleagues have demonstrated the efficacy of automated, internet-delivered cognitive behavioral therapy for insomnia across several randomized controlled trials (Ritterband et al., 2009, 2017).”
BackgroundKlein, B., Mitchell, J., Abbott, J.-A., Shandley, K. A., Austin, D., Gilson, K., Kiropoulos, L. A., Cannard, G., & Redman, T. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.04.005 · Cited by 124 · see citing works
Klein, B., Meyer, D., Austin, D. W., & Kyrios, M. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1918 · Cited by 118 · see citing works
“e-Therapy programs can be broadly categorized as being self-help or therapist-assisted, and hundreds have been evaluated across a range of mental health disorders and symptoms, including panic disorder (eg, [13,14], SAD (eg, [15]), PTSD and symptoms (eg, [8,16,17]), anxiety prevention (eg, [18,19]), depression and dep…”
BackgroundVedaa, Ø., Kallestad, H., Scott, J. L., Smith, O. R. F., Pallesen, S., Morken, G., Langsrud, K., Gehrman, P., Thorndike, F. P., Ritterband, L. M., et al. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(20)30135-7 · Cited by 118 · see citing works
Self-citationYe, Y.-Y., Chen, N.-K., Chen, J., Liu, J., Lin, L., Liu, Y.-Z., Lang, Y., Li, X.-J., Yang, X.-J., & Jiang, X.-J. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-010707 · Cited by 115 · see citing works
Zhou, E. S., Ritterband, L. M., Bethea, T. N., Robles, Y., Heeren, T., & Rosenberg, L. A. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2022.0653 · Cited by 111 · see citing works
Self-citationTrockel, M., Manber, R., Chang, V., Thurston, A., & Tailor, C. B. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.1072 · Cited by 108 · see citing works
Fanning, J. T., Porter, G. C., Awick, E. A., Ehlers, D. K., Roberts, S. A., Cooke, G. E., Burzynska, A. Z., Voss, M. W., Kramer, A. F., & McAuley, E. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9788-9 · Cited by 107 · see citing works
“For instance, Ritterband et al. (2009) adapted core concepts from cognitive behavioral therapy for insomnia for delivery via the internet.”
Insomnia and Sleep-Related Breathing Disorders
Wickwire, E. M., & Collop, N. A. (2010) · CHEST Journal · doi:10.1378/chest.09-1485 · Cited by 108 · see citing works
Lancee, J., van den Bout, J., Sorbi, M. J., & van Straten, A. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.09.004 · Cited by 104 · see citing works
“…internet-delivered CBT-I (Lancee, van den Bout, van Straten, & Spoormaker, 2012), and other authors have found even more pronounced effects for internet-delivered treatment with either automated (Espie et al., 2012; Ritterband et al., 2009) or human-delivered support (Van Straten et al., 2013).”
BackgroundHolmqvist, M., Vincent, N., & Walsh, K. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2013.10.013 · Cited by 103 · see citing works
“Research shows that web-based programs improve sleep quality (SQ), daytime fatigue, and overall severity of insomnia relative to nontreatment control groups [7,9]; however, many of such interventions have yet to be compared to active treatments.”
BackgroundPregnancy-specific anxiety: which women are highest and what are the alcohol-related risks?
Arch, J. J. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.07.010 · Cited by 105 · see citing works
“[50]), results should be replicated in clinic samples.”
BackgroundBarney, L. J., Griffiths, K. M., & Banfield, M. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-88 · Cited by 102 · see citing works
“It is known that self-help strategies such as limiting stimulants, undertaking physical exercise during the day or early evening, keeping to a regular sleep routine and other cognitive and behavioural strategies (refer to [26]) can be effective in reducing sleep problems and depressive symptoms among people with insom…”
BackgroundRandomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia
Arnedt, J. T., Cuddihy, L. J., Swanson, L. M., Pickett, S. M., Aikens, J. E., & Chervin, R. D. (2013) · SLEEP · doi:10.5665/sleep.2448 · Cited by 98 · see citing works
Glozier, N., Moullaali, T. J., Sivertsen, B., Kim, D., Mead, G. E., Jan, S., Li, Q., & Hackett, M. L. (2017) · Cerebrovascular Diseases Extra · doi:10.1159/000455751 · Cited by 96 · see citing works
de Bruin, E. J., Oort, F. J., Bögels, S. M., & Meijer, A. M. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2013.784703 · Cited by 95 · see citing works
“Third, Lancee, Van den Bout, Van Straten, and Spoormaker (2012) showed improvement on most sleep measures, insomnia symptoms, depression, and anxiety in 216 adults with chronic insomnia after online self-help CBT–i. Fourth, Ritterband et al. (2009) revealed improvement in the Insomnia Severity Index and primary sleep…”
BackgroundResultThorndike, F. P., Ritterband, L. M., Gonder-Frederick, L. A., Lord, H. R., Ingersoll, K. S., & Morin, C. M. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.22032 · Cited by 95 · see citing works
“To briefly summarize the findings from the primary trial, SHUTi was found to be efficacious in improving sleep, including insomnia severity, wake after sleep onset (WASO), and sleep efficiency (SE; Ritterband et al., 2009).”
BackgroundMethodInfluentialSelf-citationLancee, J., Eisma, M. C., van Straten, A., & Kamphuis, J. H. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1026386 · Cited by 93 · see citing works
“However, the effects appeared somewhat smaller than effects in a couple of recent studies (Espie, Kyle, Williams, et al., 2012; Lancee et al., 2012; Ritterband et al., 2009; van Straten et al., 2014), as well as in a recent study using the same treatment program (e.g., posttest within-group Cohen’s…”
New developments in cognitive behavioral therapy as the first-line treatment of insomnia
Siebern, A. T., & Manber (2011) · Psychology Research and Behavior Management · doi:10.2147/prbm.s10041 · Cited by 91 · see citing works
Lorenz, N., Heim, E., Rötger, A., Birrer, E., & Maercker, A. R. A. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000486 · Cited by 90 · see citing works
We know CBT-I works, now what?
Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D. A., Bastien, C., Drummond, S. P. A., & Perlis, M. L. (2022) · Faculty Reviews · doi:10.12703/r/11-4 · Cited by 91 · see citing works
Sleep to Lower Elevated Blood Pressure: A Randomized Controlled Trial (SLEPT)
McGrath, E. R., Espie, C. A., Power, A., Murphy, A. W., Newell, J., Kelly, C., Duffy, N., Gunning, P., Gibson, I., Bostock, S., et al. (2016) · American Journal of Hypertension · doi:10.1093/ajh/hpw132 · Cited by 88 · see citing works
Wagley, J. N., Rybarczyk, B., Nay, W. T., Danish, S., & Lund, H. G. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21927 · Cited by 85 · see citing works
Taylor, D. J., Peterson, A. L., Pruiksma, K. E., Young‐McCaughan, S., Nicholson, K. L., & Mintz, J. (2017) · SLEEP · doi:10.1093/sleep/zsx075 · Cited by 87 · see citing works
Batterham, P. J., Christensen, H. M., Mackinnon, A. J., Gosling, J. A., Thorndike, F. P., Ritterband, L. M., Glozier, N., & Griffiths, K. M. (2017) · BJPsych Open · doi:10.1192/bjpo.bp.117.005231 · Cited by 85 · see citing works
Self-citationHo, F. Y., Chung, K., Yeung, W., Ng, T. H., & Cheng, S. K.-W. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.10.002 · Cited by 86 · see citing works
“Participants were recruited from the community to imitate “realworld” setting, while in previous studies (Jernel€ ov et al., 2012; Ritterband et al., 2009), individuals with medical and psychiatric comorbidities were excluded.”
MethodDigital therapeutics in the clinic
Phan, P., Mitragotri, S., & Zhao, Z. (2023) · Bioengineering & Translational Medicine · doi:10.1002/btm2.10536 · Cited by 90 · see citing works
“Under its clinical trial name SHUTi (Sleep Healthy Using the Internet), the application was found to improve the insomnia severity index and sleep efficiency.(50,51) However, Somryst”
MethodMindell, J. A., Du Mond, C. E., Sadeh, A., Telofski, L. S., Kulkarni, N., & Gunn, E. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.1320 · Cited by 85 · see citing works
Sleep and Productivity Benefits of Digital Cognitive Behavioral Therapy for Insomnia
Bostock, S., Luik, A. I., & Espie, C. A. (2016) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000778 · Cited by 84 · see citing works
Liar! Liar! Identifying eligibility fraud by applicants in digital health research
Glazer, J. V., MacDonnell, K., Frederick, C., Ingersoll, K. S., & Ritterband, L. M. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100401 · Cited by 82 · see citing works
Self-citationSleep America: Managing the crisis of adult chronic insomnia and associated conditions
Kraus, S. S., & Rabin, L. A. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.05.014 · Cited by 79 · see citing works
“For example, Ritterband et al. (2009) demonstrated that the core components of CBT-I delivered via the internet were effective in producing improved sleep parameters relative to non-treatment controls.”
BackgroundThe Delivery of Behavioral Sleep Medicine to College Students
Kloss, J. D., Nash, C. O., Horsey, S. E., & Taylor, D. J. (2010) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2010.09.023 · Cited by 78 · see citing works
Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups
Horsch, C. H. G., Lancee, J., Beun, R. J., Neerincx, M. A., & Brinkman, W. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4115 · Cited by 80 · see citing works
“ISI, ≥8 N/A 34/10 22 Intervention Ritterband [39]”
Lintvedt, O., Griffiths, K. M., Eisemann, M. R., & Waterloo, K. K. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2422 · Cited by 74 · see citing works
“There is now sufficient evidence to suggest that Internet interventions can be effective in the prevention and treatment of depression [39,18,40,41].”
BackgroundBaglioni, C., Spiegelhalder, K., Nissen, C., & Riemann, D. W. (2011) · The EPMA Journal · doi:10.1007/s13167-011-0079-9 · Cited by 73 · see citing works
“All the three studies available up to date [51, 53, 54] found that online CBT-I is efficacious.”
BackgroundCognitive‐Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis
Smitherman, T. A., Kuka, A. J., Calhoun, A. H., Walters, A. B. P., Davis-Martin, R. E., Ambrose, C. E., Rains, J. C., & Houle, T. T. (2018) · Headache The Journal of Head and Face Pain · doi:10.1111/head.13313 · Cited by 72 · see citing works
“In conjunction with evidence of efficacy across various comorbid conditions, advances have been made in condensing the traditional CBTi protocol into cost-efficient delivery formats using as few as 2 treatment sessions,(15,16) group administration,(17) and delivery via the internet.(18,19) These developments offer pro…”
BackgroundInsomnia Patients' Help-Seeking Experiences
Cheung, J. M. Y., Bartlett, D. J., Armour, C. L., Glozier, N., & Saini, B. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2013.764529 · Cited by 68 · see citing works
“Most found out about specialist help for insomnia serendipitously through the Internet, hospitals, or health department services (e.g., Medicare).”
BackgroundInfluentialEthical and legal considerations for internet-based psychotherapy
Dever Fitzgerald, T., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010) · Cognitive Behaviour Therapy · doi:10.1080/16506071003636046 · Cited by 69 · see citing works
“Internetbased programs for smoking cessation, tinnitus, problem drinking, and insomnia also exist (e.g. Bewick et al., 2008; Cobb et al., 2005; Kaldo et al., 2008; Ritterband et al., 2009; Strom, Pettersson, & Andersson, 2004).”
BackgroundMethodInfluential
- Authors
- Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., Magee, J. C., Bailey, E. T., Saylor, D. K., & Morin, C. M.
- Affiliations
- University of Virginia Health System (US)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2009-07-01
- Volume
- 66
- Issue
- 7
- Pages
- 692
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3723339
- OpenAlex
- W2126133436
- Cited by
- 482
- References
- 52
- Citations by year
- 2026: 19 · 2025: 18 · 2024: 25 · 2023: 28 · 2022: 28 · 2021: 26 · 2020: 23 · 2019: 24 · 2018: 31 · 2017: 31 · 2016: 30 · 2015: 44 · 2014: 28 · 2013: 33 · 2012: 33
- FWCI
- 39.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34 MH70805, R34MH070805)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- insomnia, online intervention, cognitive behavioral therapy, sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, relapse prevention, insomnia severity, wake after sleep onset, sleep efficiency, treatment efficacy, maintenance of treatment gains, waitlist control, follow-up outcomes, Insomnia Severity Index, sleep diary, cost-effectiveness, acceptability
- MeSH terms
- Adult, Feasibility Studies, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Education as Topic, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Self Efficacy, Internet
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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