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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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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“There are numerous published intervention studies that aim to improve physical activity, sedentary, and sleep behaviors [8-11], and although many are effective, few are disseminated to the broader public [12].”
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Digital Delivery of Cognitive Behavioral Therapy for Insomnia
Luik, A. I., van der Zweerde, T., van Straten, A., & Lancee, J. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1041-0 · Cited by 72
Philip, P., Dupuy, L., Morin, C. M., de Sevin, E., Bioulac, S., Taillard, J., Serre, F., Auriacombe, M., & Micoulaud-Franchi, J.-A. (2020) · Journal of Medical Internet Research · doi:10.2196/24268 · Cited by 61
“To our knowledge, no study has focused on insomnia complaints, despite the evidence that digital behavioral therapies are effective to treat insomnia [12-14].”
Self-citationKallestad, H., Scott, J. L., Vedaa, Ø., Lydersen, S., Vethe, D., Morken, G., Stiles, T. C., Sivertsen, B., & Langsrud, K. (2020) · SLEEP · doi:10.1093/sleep/zsab185 · Cited by 64
“We employed a dCBT-I program entitled SHUTi [21] that was created by investigators at the University of Virginia and was translated into Norwegian by the Norwegian Institute of Public Health.”
MethodKuhn, E. R., Miller, K. E., Puran, D., Wielgosz, J., YorkWilliams, S. L., Owen, J. E., Jaworski, B. K., Hallenbeck, H. W., McCaslin, S. E., & Taylor, K. L. (2021) · Behavior Therapy · doi:10.1016/j.beth.2021.11.003 · Cited by 64
Attrition and Adherence in the Online Treatment of Chronic Insomnia
Hebert, E. A., Vincent, N., Lewycky, S. T., & Walsh, K. (2010) · Behavioral Sleep Medicine · doi:10.1080/15402002.2010.487457 · Cited by 64
“This is an important omission, as such programs are rapidly developing (Ritterband et al., 2009; Strom, Pettersson, & Andersson, 2004; Vincent & Lewycky, 2009).”
BackgroundSchlarb, A. A., & Brandhorst (2012) · Nature and Science of Sleep · doi:10.2147/nss.s28337 · Cited by 67
Hagatun, S., Vedaa, Ø., Nordgreen, T., Smith, O. R. F., Pallesen, S., Havik, O. E., Bjorvatn, B., Thorndike, F. P., Ritterband, L. M., & Sivertsen, B. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2017.1301941 · Cited by 61
“The Sleep Healthy Using the Internet (SHUTi) program is an example of a sophisticated online adaptation of CBTi that has shown efficacy (Ritterband et al., 2012; Ritterband et al., 2009; Ritterband et al., 2017).”
BackgroundMethodResultInfluentialSelf-citationHo, F. Y.-Y., Chan, C. S., Lo, W.-Y., & Leung, J. C.-Y. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.062 · Cited by 58
Sweetman, A., Putland, S., Lack, L. C., McEvoy, R. D., Adams, R., Grunstein, R. R., Stocks, N. P., Kaambwa, B., Ryswyk, E. V., Gordon, C. J., et al. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101404 · Cited by 69
Uyumaz, B. E., Feijs, L. M. G., & Hu, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18062929 · Cited by 68
“Published Studies [26,27] [25,28] [29] [22–24,33] [30] [31,32]”
Using Instructional Design Process to Improve Design and Development of Internet Interventions
Hilgart, M. M., Ritterband, L. M., Thorndike, F. P., & Kinzie, M. B. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.1890 · Cited by 61
Self-citationBJORVATN, B., FISKE, E., & PALLESEN, S. (2011) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.2011.00902.x · Cited by 60
“More studies on easily available treatment alternatives are needed (Espie, 2009; Ritterband et al., 2009).”
BackgroundInternet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context
Morris, J., Firkins, A., Millings, A., Möhr, C., Redford, P., & Rowe, A. (2015) · Anxiety Stress & Coping · doi:10.1080/10615806.2015.1058924 · Cited by 60
“…effect size compared to control was moderate, and tallies with studies finding that iCBT can be effective for reducing insomnia in both community (Ritterband et al., 2009; Ström et al., 2004) and patient (Vincent & Lewycky, 2009) populations, with effect sizes ranging from small to moderate…”
BackgroundResultThe Future of Cognitive Behavioral Therapy for Insomnia: What Important Research Remains to Be Done?
Vitiello, M. V., McCurry, S. M., & Rybarczyk, B. D. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21948 · Cited by 59
Rybarczyk, B. D., Lund, H. G., Shamaskin‐Garroway, A., & Mack, L. (2012) · Clinical Gerontologist · doi:10.1080/07317115.2012.731478 · Cited by 60
“Self-help can be delivered via manual, audiotape, videotape (Rybarzcyk & Mack, 2009) and/or internet (Ritterband et al., 2009; Ström, Pettersson, & Anderson, 2004; Vincent & Lewycky, 2009).”
Feasibility of a self‐help treatment for insomnia comorbid with cancer
Savard, J., Villa, J., Simard, S., Ivers, H., & Morin, C. M. (2010) · Psycho-Oncology · doi:10.1002/pon.1818 · Cited by 58
Self-citationMonitoring Progress and Adherence with Positive Airway Pressure Therapy for Obstructive Sleep Apnea
Hwang, D. (2016) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2016.01.008 · Cited by 58
Bjorvatn, B., Jernelöv, S., & Pallesen, S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.639198 · Cited by 57
“The prevalence of OSA is especially high among males, and increases with age (Gabbay and Lavie, 2012) and with increasing weight (Romero-Corral et al., 2010).”
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Effect of Brief Sleep Hygiene Education for Workers of an Information Technology Company
KAKINUMA, M., Takahashi, M., Kato, N., Aratake, Y., Watanabe, M., ISHIKAWA, Y., Kojima, R., Shibaoka, M., & Tanaka, K. (2010) · Industrial Health · doi:10.2486/indhealth.ms1083 · Cited by 54
“A recent internet-based interventional study of insomniacs showed reduced sleep disturbance and arousal during sleep, and improved sleep efficiency 43) .”
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“Such interventions include CBT-I delivered in two sessions (Edinger and Sampson, 2003), an internet-based version of CBT-I (Ritterband et al., 2009) and telephone consultations (Bastien et al.”
Zhou, E. S., & Recklitis, C. J. (2020) · Pediatric Blood & Cancer · doi:10.1002/pbc.28506 · Cited by 52
Evidence-Based Applications of Combination Psychotherapy and Pharmacotherapy for Depression
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Patel, S., Ojo, O., Genc, G., Oravivattanakul, S., Huo, Y., Rasameesoraj, T., Wang, L., Bena, J., Drerup, M., Foldvary-Schaefer, N., et al. (2017) · Journal of Clinical Movement Disorders · doi:10.1186/s40734-017-0062-2 · Cited by 53
“The Cleveland Clinic CCBT-I program [9] consists of sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relaxation training delivered in stages over a 6-week period [10 – 12].”
MethodUse of the Internet and Mobile Media for Delivery of Cognitive Behavioral Insomnia Therapy
Espie, C. A., Hames, P., & McKinstry, B. (2013) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2013.06.001 · Cited by 52
A preliminary study of an online psychoeducational program for hypersexuality
Hardy, S. A., Ruchty, J., Hull, T. D., & Hyde, R. (2010) · Sexual Addiction & Compulsivity · doi:10.1080/10720162.2010.533999 · Cited by 49
“, 2008), eating disorders (Treasure, Claudino, & Zucker, 2010), and insomnia (Ritterband et al., 2009), and for preventing divorce (Braithwaite & Fincham, 2009).”
BackgroundHwang, J., Lee, G. E., Woo, J. H., Kim, S. M., & Kwon, J. Y. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-01514-4 · Cited by 52
Integrative Medicine for Insomnia
Zhou, E. S., Gardiner, P. M., & Bertisch, S. M. (2017) · Medical Clinics of North America · doi:10.1016/j.mcna.2017.04.005 · Cited by 49
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“Recent trends in the literature have explored shortening treatment length (Buysse et al., 2011) and establishing novel treatment delivery methods (Ritterband et al., 2009) as means of more efficiently disseminating CBT-Insomnia.”
MethodTalk and Tools: the best of both worlds in mobile user interfaces for E-coaching
Beun, R. J., Fitrianie, S., Griffioen-Both, F., Spruit, S., Horsch, C., Lancee, J., & Brinkman, W.-P. (2017) · Personal and Ubiquitous Computing · doi:10.1007/s00779-017-1021-5 · Cited by 39
“Also, the research by, for instance, [35, 40, 41], showed promising effects from this type of approaches in the health domain.”
BackgroundEpstein, D. R., Babcock-Parziale, J. L., Haynes, P. L., & Herb, C. A. (2012) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2011.06.0114 · Cited by 47
“study addressed these issues through restricting entry to the Internet program and a careful screening process, including a personal interview [49].”
BackgroundBehavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health
Rybarczyk, B. D., & Mack, L. (2011) · Nature and Science of Sleep · doi:10.2147/nss.s12975 · Cited by 46
Chow, P. I., Ingersoll, K. S., Thorndike, F. P., Lord, H. R., Gonder-Frederick, L. A., Morin, C. M., & Ritterband, L. M. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.11.1140 · Cited by 46
Self-citationWerner‐Seidler, A., Li, S. H., Spanos, S., Johnston, L., O'Dea, B., Torok, M., Ritterband, L., Newby, J. M., Mackinnon, A. J., & Christensen, H. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13795 · Cited by 42
“…briefer than traditional CBT-I packages delivered face-to-face which generally require delivery over at least 6 hr (de Bruin et al., 2014) and briefer than digital adult CBT-I programs (e.g., SHUTi, Sleepio), which require between 3 – 6 hr to complete (Espie et al., 2012; Ritterband et al., 2009).”
BackgroundSelf-citationDigital Cognitive Behavioral Therapy for Insomnia Using a Smartphone Application in China
Zhang, C., Liu, Y., Guo, X., Liu, Y., Shen, Y., & Ma, J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.4866 · Cited by 48
The effects of an anxiety sensitivity intervention on insomnia symptoms
Short, N. A., Allan, N. P., Raines, A. M., & Schmidt, N. B. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.11.004 · Cited by 45
“Previous research has examined brief, portable interventions for insomnia disorder (eg, CBT in a brief, online format; [5]), as well as interventions that target insomnia disorder and related anxiety and arousal (eg, mindfulness-based interventions [6]).”
Gosling, J. A., Glozier, N., Griffiths, K. M., Ritterband, L. M., Thorndike, F. P., Mackinnon, A. J., Hehir, K. K., Bennett, A., Bennett, K., & Christensen, H. M. (2014) · Trials · doi:10.1186/1745-6215-15-56 · Cited by 45
“Australia will be randomised to one of two conditions: SHUTi, an online Cognitive Behavioural Therapy intervention for Insomnia, shown to be effective in decreasing insomnia severity and improving sleep efficiency in two US trials [31,35], or HealthWatch, an attentionmatched control condition used in previous RCTs run…”
MethodSelf-citationZia, S., & Fields, B. G. (2016) · CHEST Journal · doi:10.1016/j.chest.2016.02.670 · Cited by 44
Brooks, A. T., & Wallen, G. R. (2014) · Substance Abuse Research and Treatment · doi:10.4137/sart.s18446 · Cited by 45
Yu, J., Kuhn, E. R., Miller, K. E., & Taylor, K. L. (2018) · Translational Behavioral Medicine · doi:10.1093/tbm/iby014 · Cited by 43
Development of a Just-in-Time Adaptive mHealth Intervention for Insomnia: Usability Study
Pulantara, I. W., Parmanto, B., & Germain, A. (2018) · JMIR Human Factors · doi:10.2196/humanfactors.8905 · Cited by 43
“The results of this intervention are promising [14,15].”
BackgroundAmidi, A., Buskbjerg, C. R., Damholdt, M. F., Dahlgaard, J., Thorndike, F. P., Ritterband, L., & Zachariae, R. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.04.020 · Cited by 41
Self-citationWorking alliance with an avatar: How far can we go with internet interventions?
Heim, E., Rötger, A., Lorenz, N., & Maercker, A. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.01.005 · Cited by 41
“Most surprisingly, two of the most effective interventions were fullyautomated self-help programmes with no additional human support (Espie et al., 2012; Ritterband et al., 2009).”
BackgroundReal-world evidence from users of a behavioral digital therapeutic for chronic insomnia
Ritterband, L. M., Thorndike, F. P., Morin, C. M., Gerwien, R. W., Enman, N. M., Xiong, X. R., Luderer, H. F., Edington, S., Braun, S., & Maricich, Y. A. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104084 · Cited by 44
Self-citationCoulson, N., Smedley, R. M., Bostock, S., Kyle, S. D., Gollancz, R., Luik, A. I., Hames, P., & Espie, C. A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5654 · Cited by 43
“Furthermore, accumulating evidence in recent years suggests that such interventions can provide effective treatment for patients [17-19].”
BackgroundEspie, C. A., Luik, A. I., Cape, J., Drake, C. L., Siriwardena, A. N., Ong, J. C., Gordon, C., Bostock, S., Hames, P., Nisbet, M., et al. (2016) · Trials · doi:10.1186/s13063-016-1364-7 · Cited by 41
“symptoms relative to waitlist groups [32–34].”
Thiboutot, J. P., Sciamanna, C., Falkner, B. E., Kephart, D. K., Stuckey, H. L., Adelman, A., Curry, W. J., & Lehman, E. B. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2298 · Cited by 40
“Although most Web-based studies to date have not shown major health benefits (eg, weight control) [50], some interventions (eg, sleep) have shown benefits [51].”
BackgroundChronic insomnia: Recent advances and innovations in treatment developments and dissemination.
Morin, C. M. (2010) · Canadian Psychology/Psychologie canadienne · doi:10.1037/a0018715 · Cited by 39
“Three studies have documented the potential benefits of treating insomnia via Internet-based programs (Ritterband et al., 2009; Ström, Pettersson, & Andersson, 2004; Vincent & Lewycky, 2009).”
BackgroundSelf-citationPietrzak, R. H., Morgan, C. A., & Southwick, S. M. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.07.002 · Cited by 41
“Emerging research has also demonstrated the efficacy of an Internet-based cognitive -behavioral therapy intervention in treating insomnia [47]; imagery rehearsal therapy [48] and prazosin, an alpha-1 adrenoreceptor antagonist, have also been shown to be promising as treatments for sleep difficulties and trauma-related…”
BackgroundTelemedicine Applications in Sleep Disordered Breathing
Verbraecken, J. A. (2016) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2016.08.007 · Cited by 39
Principles of gamification for Internet interventions
Floryan, M., Ritterband, L. M., & Chow, P. I. (2019) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz041 · Cited by 39
Self-citationToward Data-Driven Digital Therapeutics Analytics: Literature Review and Research Directions
Lee, U., Jung, G., Ma, E.-Y., Kim, J. S., Kim, H., Alikhanov, J., Noh, Y., & Kim, H. (2023) · IEEE/CAA Journal of Automatica Sinica · doi:10.1109/jas.2023.123015 · Cited by 42
“The mental disorders include ADHD [6], depression [40], [41], insomnia [42], panic disorder [43], and substance abuse [4], [45].”
Network meta-analysis examining efficacy of components of cognitive behavioural therapy for insomnia
Steinmetz, L., Simon, L., Feige, B., Riemann, D. W., Johann, A. F., Ell, J., Ebert, D. D., Baumeister, H., Benz, F., & Spiegelhalder, K. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102507 · Cited by 48
Glozier, N., Christensen, H. M., Griffiths, K. M., Hickie, I. B., Naismith, S. L., Biddle, D. J., Øverland, S. N., Thorndike, F. P., & Ritterband, L. M. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418797432 · Cited by 39
“In the first trial of SHUTi (Ritterband et al., 2009), participants not only experienced significant sleep improvement but also demonstrated improvements in comorbid depressive symptoms compared to a wait-list control (Thorndike et al., 2013).”
BackgroundSelf-citationThe Economic Burden of Insomnia at the Workplace. An Opportunity and Time for Intervention?
Sivertsen, B., Lallukka, T. M., & Salo, P. (2011) · SLEEP · doi:10.5665/sleep.1224 · Cited by 38
Pulantara, I. W., Parmanto, B., & Germain, A. (2018) · Journal of Medical Internet Research · doi:10.2196/10124 · Cited by 38
“…programs [32] and online commercial treatment programs such as SHUTi (BeHealth Solutions LLC) [33,34], Sleepio (Sleepio Ltd) [35], and RESTore (CCBT Ltd) [36] have also been shown to be efficacious and typically require anywhere between 5 weeks to several months of patient engagement [25,33,37,38].”
Long-Term Effects of an Unguided Online Cognitive Behavioral Therapy for Chronic Insomnia
Vedaa, Ø., Hagatun, S., Kallestad, H., Pallesen, S., Smith, O. R. F., Thorndike, F. P., Ritterband, L. M., & Sivertsen, B. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7580 · Cited by 36
“The present report adds to the list of studies showing promising effects of treatments that can replicate effects of in-person CBTi, both in terms of individualizing treatment and making the therapeutic concepts accessible for participants through interactive educational tools.(3,4,32,34,35)”
Self-citationThe Insomnia Patient Perspective, A Narrative Review
Cheung, J. M. Y., Bartlett, D. J., Armour, C. L., & Saini, B. (2013) · Behavioral Sleep Medicine · doi:10.1080/15402002.2012.694382 · Cited by 37
“, 2006), Internet-based behavioral interventions (Ritterband et al., 2009) or combining CBT-I with hypnotic therapy (Morin et al.”
BackgroundInfluentialTelemedicine in Sleep-Disordered Breathing
Verbraecken, J. A. (2021) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2021.05.009 · Cited by 39
Sleep locus of control and computerized cognitive-behavioral therapy (cCBT)
Vincent, N., Walsh, K., & Lewycky, S. T. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.006 · Cited by 35
Internet-delivered cognitive-behavioral therapy for insomnia and comorbid symptoms
Hagatun, S., Vedaa, Ø., Harvey, A. G., Nordgreen, T., Smith, O. R. F., Pallesen, S., Havik, O. E., Thorndike, F. P., Ritterband, L. M., & Sivertsen, B. (2018) · Internet Interventions · doi:10.1016/j.invent.2018.02.003 · Cited by 35
“The Sleep Healthy Using the Internet (SHUTi) program is an example of a sophisticated online adaptation of CBTi which have shown significant results (Ritterband et al., 2009; Ritterband et al., 2012).”
BackgroundMethodResultInfluentialSelf-citationOnline assessment of sustained attention following sleep restriction
Sadeh, A., Dan, O., & Bar‐Haim, Y. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2010.02.001 · Cited by 34
“In this era of growing applications for telemedicine in general [26–30], and for sleep disorders in particular [31,32], the ability to assess cognitive function at home or at the clinician’s office with a validated task that is sensitive to sleep loss opens new possibilities for clinical research and for follow-up on…”
Group cognitive behavioural treatment for insomnia in primary care: a randomized controlled trial
Cape, J. D., Leibowitz, J., Whittington, C. J., Espie, C. A., & Pilling, S. (2015) · Psychological Medicine · doi:10.1017/s0033291715002561 · Cited by 34
“These include internetdelivered formats (Ritterband et al. 2009; Espie et al. 2012; van Straten et al. 2013) and short protocolized group treatments delivered by people without * Address for correspondence: Dr J. Cape, Research Department of Clinical, Educational and Health Psychology, University…”
BackgroundMethod“Go! to Sleep”: A Web-Based Therapy for Insomnia
Bernstein, A. M., Allexandre, D., Bena, J., Doyle, J., Gendy, G., Wang, L., Fay, S., Mehra, R., Moul, D. E., Foldvary‐Schaefer, N., et al. (2017) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2016.0208 · Cited by 33
“With an alpha of 0.05, power of 0.80, standard deviation of 4.5, and a conservative 50% drop-out, we needed 56 participants in each of the two study arms to detect a clinically meaningful difference of five points on the ISI.”
InfluentialKrieger, T., Urech, A., Duss, S. B., Blättler, L. T., Schmitt, W. J., Gast, H., Bassetti, C. L., & Berger, T. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.01.045 · Cited by 36
Rybarczyk, B. D., Mack, L., Harris, J. H., & Stepanski, E. J. (2011) · Rehabilitation Psychology · doi:10.1037/a0025577 · Cited by 33
Corkum, P. V., Reid, G. J., Hall, W. A., Godbout, R., Stremler, R., Weiss, S. K., Gruber, R., Witmans, M., Chambers, C. T., Begum, E. A., et al. (2018) · JMIR Research Protocols · doi:10.2196/resprot.8348 · Cited by 33
Persuasive strategies in mobile insomnia therapy: alignment, adaptation, and motivational support
Beun, R. J. (2012) · Personal and Ubiquitous Computing · doi:10.1007/s00779-012-0586-2 · Cited by 32
“In a recent meta-analysis, the effects of self-help for insomnia were found to be small to moderate [42], but Internet-delivered trials have been published with more promising results [34, 45].”
BackgroundForma, F. M., Pratiwadi, R., Moustaid, F. E., Smith, N., Thorndike, F. P., & Velez, F. F. (2022) · Current Medical Research and Opinion · doi:10.1080/03007995.2022.2108616 · Cited by 32
Self-citationThiart, H., Lehr, D., Ebert, D. D., Sieland, B., Berking, M., & Riper, H. M. (2013) · Trials · doi:10.1186/1745-6215-14-169 · Cited by 34
“instrument has been developed by Morin, is validated, also as a web-based measure [56] and frequently used in iCBT-I research (for example, [57]).”
MethodFanning, J. T., Brooks, A. K., Ip, E. H., Nicklas, B. J., & Rejeski, W. J. (2018) · JMIR Research Protocols · doi:10.2196/resprot.9712 · Cited by 31
Babiloni, A. H., Beetz, G., Tang, N. K. Y., Heinzer, R. C., Nijs, J., Martel, M. O., & Lavigne, G. J. (2020) · Pain · doi:10.1097/j.pain.0000000000002124 · Cited by 30
“These issues could be mitigated through the use of internet-based and home-based CBT, which have been implemented with high rates of success and acceptability.(12,15,114,148) Hybrid CBT programs include general sleep and pain education, sleep restriction therapy, stimulus control for sleep and pain, sleep hygiene inst…”
MethodVincent, N., & Walsh, K. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.12.003 · Cited by 29
Bremer, V., Chow, P. I., Funk, B., Thorndike, F. P., & Ritterband, L. M. (2020) · doi:10.2196/preprints.17738 · Cited by 29
“They often feature content that is administered over time as users complete tasks or components of the intervention, typically over several weeks or months [17-20].”
BackgroundSelf-citationInternet-Delivered Cognitive Behavioral Therapy for Insomnia
van der Zweerde, T., Lancee, J., Luik, A. I., & van Straten, A. (2020) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2020.02.001 · Cited by 30
Insomnien – Stand der Forschung
Riemann, D. W., Baglioni, C., Feige, B., & Spiegelhalder, K. (2013) · Der Nervenarzt · doi:10.1007/s00115-013-3892-7 · Cited by 32
Cognitive-Behavioral Therapy for Insomnia
Perlis, M. L., Smith, M. T., Jungquist, C. R., Nowakowski, S., Orff, H. J., & Soeffing, J. P. (2010) · Humana Press eBooks · doi:10.1007/978-1-60327-042-7_22 · Cited by 30
Wang, S., Lan, Y., Liu, Z., Xu, S., & Wu, X. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.07.004 · Cited by 29
Internet-Guided Cognitive Behavioral Therapy for Insomnia Among Patients With Traumatic Brain Injury
Malarkey, M. E., Fu, A. J., Mannan, N., Shaw, O. M., Haight, T. J., Cota, M. R., Jahed, N. C., Werner, J. K., & Brody, D. L. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.20090 · Cited by 26
The Effects of an Internet-Based Imagery Rehearsal Intervention: A Randomized Controlled Trial
Gieselmann, A., Böckermann, M., Sorbi, M. J., & Pietrowsky, R. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000470846 · Cited by 27
Kallestad, H., Vedaa, Ø., Scott, J. L., Morken, G., Pallesen, S., Harvey, A. G., Gehrman, P., Thorndike, F. P., Ritterband, L. M., Stiles, T. C., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-025152 · Cited by 25
“The online version is a fully automated, interactive and tailored web-based program that incorporates the primary tenets of face-to-face CBT-I, including sleep restriction, stimulus control, cognitive restructuring, sleep hygiene and relapse prevention.(20) 22–24 30 Development of SHUTi is grounded in the model for in…”
BackgroundMethodInfluentialSelf-citationLanièpce, A., Lahbairi, N., Cabé, N., Pitel, A., & Rauchs, G. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101435 · Cited by 31
Philip, P., Dupuy, L., Sagaspe, P., de Sevin, É., Auriacombe, M., Taillard, J., Micoulaud‐Franchi, J., & Morin, C. M. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11154387 · Cited by 26
Self-citationMoving from risk to resilience in psychosis research
Thakkar, K. N., McCleery, A., Minor, K. S., Lee, J., Humpston, C. S., Chopik, W. J., Burt, S. A., Pearson, A. L., Ungar, M. T., & Park, S. (2023) · Nature Reviews Psychology · doi:10.1038/s44159-023-00205-9 · Cited by 27
Is it Time to Step Up to Stepped Care with our Cognitive-Behavioral Insomnia Therapies?
Edinger, J. D. (2009) · SLEEP · doi:10.1093/sleep/32.12.1539 · Cited by 26
Nighttime Blood Pressure Dipping in Postmenopausal Women With Coronary Heart Disease
Sherwood, A., Bower, J. K., Routledge, F. S., Blumenthal, J. A., McFetridge-Durdle, J., Newby, L. K., & Hinderliter, A. L. (2012) · American Journal of Hypertension · doi:10.1038/ajh.2012.95 · Cited by 26
Palermo, T. M., Bromberg, M. H., Beals‐Erickson, S. E., Law, E. F., Durkin, L. K., Noel, M. E., & Chen, M. L. (2016) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000140 · Cited by 26
“…on therapy materials from existing CBT-I interventions for adults and adolescents with insomnia (e.g., Clarke et al., 2015; Perlis et al., 2005; Ritterband et al., 2009) and behavioral treatment studies for youth with chronic conditions (e.g., Law, Fisher, Fales, Noel, & Eccleston, 2014;…”
Insomnia (primary) in older people: non-drug treatments.
Alessi, C., & Vitiello, M. V. (2015) · PubMed Central · Cited by 26
Gosling, J. A., Batterham, P. J., Ritterband, L. M., Glozier, N., Thorndike, F. P., Griffiths, K. M., Mackinnon, A. J., & Christensen, H. M. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418772338 · Cited by 26
Self-citationGrierson, A. B., Hobbs, M. J., & Mason, E. C. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.143 · Cited by 25
Internet-based cognitive behaviour therapy for insomnia before and during the COVID-19 pandemic
Mahoney, A., Li, I., Grierson, A. B., Millard, M., Haskelberg, H., & Mason, E. C. (2021) · Australian Psychologist · doi:10.1080/00050067.2021.1979884 · Cited by 24
“iCBT-I under randomised controlled conditions (Espie et al., 2019, 2012; Ritterband et al., 2009; Thiart et al., 2015; Van Straten et al., 2014; Ye et al., 2015) and in routine care and community settings (Grierson et al.”
BackgroundMethodResultParental Concerns About Infant and Toddler Sleep Assessed by a Mobile App
Mindell, J. A. A., Leichman, E. S., Puzino, K., Walters, R. M., & Bhullar, B. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2014.905475 · Cited by 25
“Internet-based interventions, or “information prescriptions,” have been shown to be efficacious for multiple child health concerns, as well as adult insomnia (Ritterband et al., 2003; Ritterband et al., 2009; Stinson, Wilson, Gill, Yamada, & Holt, 2009).”
BackgroundLancee, J., Sorbi, M. J., Eisma, M. C., van Straten, A., & van den Bout, J. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.02.012 · Cited by 25
“This minimal amount of feedback is probably relatively simple to offer via an automated system such as those previously employed in Internetdelivered treatment for insomnia (Espie et al., 2012; Ritterband et al., 2009).”
BackgroundMethodInfluentialBaron, K. G., Duffecy, J. L., Reid, K. J., Begale, M. J., & Caccamo, L. (2018) · JMIR Mental Health · doi:10.2196/mental.8634 · Cited by 25
“Existing technology interventions for sleep have been designed for insomnia [21,22] or treatment adherence in obstructive sleep apnea (eg, MyAir by ResMed Inc).”
BackgroundMiddlemass, J., Davy, Z., Cavanagh, K., Linehan, C., Morgan, K., Lawson, S. W., & Siriwardena, A. N. (2012) · British Journal of General Practice · doi:10.3399/bjgp12x659321 · Cited by 24
Insomnia among cancer caregivers: A proposal for tailored cognitive behavioral therapy.
Shaffer, K. M., Garland, S. N., Mao, J. J. J., & Applebaum, A. J. (2018) · Journal of Psychotherapy Integration · doi:10.1037/int0000105 · Cited by 24
“One Web-based program, SHUTi, has shown strong effects on improving multiple sleep parameters (Ritterband et al., 2009), with effects maintained through a year posttreatment (Ritterband et al., 2017) and preliminary efficacy dem- onstrated among cancer patients (Ritterband et al., 2012).”
Developing and testing an online breastfeeding training among undergraduate nursing students
Cianelli, R., Villegas, N., Azaiza, K., Henderson, S., Hooshmand, M. A., & Peragallo, N. P. (2014) · Clinical Nursing Studies · doi:10.5430/cns.v3n1p82 · Cited by 24
Metadata
- 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 (medical) › 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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