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Guided internet cognitive behavioral therapy for insomnia compared to a control treatment - a randomized trial
Open accessAbstract
AIM: To evaluate if internet-delivered Cognitive Behavioral Therapy for insomnia (ICBT-i) with brief therapist support outperforms an active control treatment. METHOD: Adults diagnosed with insomnia were recruited via media (n = 148) and randomized to either eight weeks of ICBT-i or an active internet-based control treatment. Primary outcome was the insomnia severity index (ISI) assessed before and after treatment, with follow-ups after 6 and 12 months. Secondary outcomes were use of sleep medication, sleep parameters (sleep diary), perceived stress, and a screening of negative treatment effects. Hierarchical Linear Mixed Models were used for intent-to-treat analyses and handling of missing data. RESULTS: ICBT-i was significantly more effective than the control treatment in reducing ISI (Cohen's d = 0.85), sleep medication, sleep efficiency, sleep latency, and sleep quality at post-treatment. The positive effects were sustained. However, after 12 months the difference was no longer significant due to a continuous decrease in ISI among controls, possibly due to their significantly higher utilization of insomnia relevant care after treatment. Forty-six negative effects were reported but did not differ between interventions. CONCLUSIONS: Supported ICBT-i is more effective than an active control treatment in reducing insomnia severity and treatment gains remain stable one year after treatment.
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“Furthermore, the numbers of messages sent between the therapists and the participants were at a similar level as those reported by Kaldo et al. (2015) and Blom et al. (2015a).”
From Feasibility and preliminary efficacy of guided internet-delivered cognitive behavioral therapy for insomnia after the loss of a child to cancer: Randomized controlled trial (2021) · cites this paper as Kaldo et al. (2015)
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“a) 18 years or older, b) Insomnia diagnosis according to the research criteria from American Academy of Sleep Medicine (Edinger et al., 2004), assessed in a structured diagnostic interview, c) Insomnia at a clinical level defined as more than 10 points on ISI according to Morin (1993), d) Ability to read and write in…”
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Morin, C. M., & Jarrin, D. C. (2022) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2022.03.003 · Cited by 907
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MethodHedman, E., Ljótsson, B., & Lindefors, N. (2012) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/erp.12.67 · Cited by 672
Self-citationWilson, S., Nutt, D., Alford, C., Argyropoulos, S., Baldwin, D., Bateson, A., Britton, T., Crowe, C., Dijk, D.-J., Espie, C., et al. (2010) · Journal of Psychopharmacology · doi:10.1177/0269881110379307 · Cited by 634
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“…the importance of reducing sleep medications has been stressed (Ritterband et al., 2009; Van Straten et al., 2013), previous studies have seldom included use of sleep medication as an outcome, and some studies that did measure it showed no decrease (Espie et al., 2012; Van Straten et al., 2013).”
BackgroundResultInfluentialEfficacy of an Internet-based behavioral intervention for adults with insomnia
Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., Magee, J. C., Bailey, E. T., Saylor, D. K., & Morin, C. M. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.66 · Cited by 482 · cited 6×
“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.”
BackgroundResultInfluentialRiemann, D., & Perlis, M. L. (2009) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2008.06.001 · Cited by 477 · cited 1×
“In comparison, although data on possible negative effects of treatment are lacking, psychological treatment for insomnia in the form of cognitive behavioral therapy (CBT) has strong evidence (Riemann & Perlis, 2009) with sustained improvements.”
ResultNegative effects from psychological treatments: a perspective
Barlow, D. H. (2010) · American Psychologist · doi:10.1037/a0015643 · Cited by 426 · cited 1×
“In general, the reporting of negative treatment effects, or adverse events, has been a neglected aspect of psychological treatments so far (Barlow, 2010), and this is also true for both CBT and ICBT.”
BackgroundACCOUNTING FOR DROPOUT BIAS USING MIXED-EFFECTS MODELS
Mallinckrodt, C. H., Clark, W. S., & David, S. R. (2001) · Journal of Biopharmaceutical Statistics · doi:10.1081/bip-100104194 · Cited by 398 · cited 1×
“c) Insomnia at a clinical level defined as more than 10 points on ISI according to Morin (1993), d) Ability to read and write in Swedish and no foreseeable practical problems to participate in the study, e) No comorbid sleep disorders primarily requiring other treatment (e.”
BackgroundConsensus statement on defining and measuring negative effects of internet interventions
Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., Ljótsson, B., Kaldo, V., Titov, N., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.001 · Cited by 371
Self-citationInternet-Based Treatment for Insomnia: A Controlled Evaluation.
Ström, L., Pettersson, R., & Andersson, G. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.1.113 · Cited by 311
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Handling drop‐out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches
Lane, P. (2008) · Pharmaceutical Statistics · doi:10.1002/pst.267 · Cited by 262 · cited 2×
“, last observation carried forward) in most missing data situations (Lane, 2008; Mallinckrodt, Clark, & David, 2001).”
BackgroundMethodPersistent Insomnia is a Predictor of Hypertension in Japanese Male Workers
Suka, M., Yoshida, K., & Sugimori, H. (2003) · Journal of Occupational Health · doi:10.1539/joh.45.344 · Cited by 247
Morin, C. M., & Jarrin, D. C. (2013) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2013.05.002 · Cited by 216
Kyle, S. D., Miller, C. B., Rogers, Z., Siriwardena, A. N., Macmahon, K., & Espie, C. A. (2014) · SLEEP · doi:10.5665/sleep.3386 · Cited by 205
Blom, 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
Self-citationRelaxation and sleep compression for late-life insomnia: A placebo-controlled trial.
Lichstein, K. L., Riedel, B. W., Wilson, N. M., Lester, K. W., & Aguillard, R. N. (2001) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.69.2.227 · Cited by 193
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 · cited 1×
“The psychometric properties of ISI are adequate and it is sensitive to change (Bastien, Vallieres, et al., 2001), also when web-based (Thorndike et al., 2011).”
MethodSelf-help therapy for insomnia: a meta-analysis
van Straten, A., & Cuijpers, P. (2009) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2008.04.006 · Cited by 185 · cited 2×
“However, treatment access is low since qualified CBT-therapists are rare (Larsson, Kaldo, & Broberg, 2009) and expensive (van Straten & Cuijpers, 2008).”
BackgroundRelaxation and sleep compression for late-life insomnia: A placebo-controlled trial.
Lichstein, K. L., Riedel, B. W., Wilson, N. M., et al. (2001) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.69.2.227 · Cited by 152
Insomniacs' reported use of CBT components and relationship to long-term clinical outcome
Harvey, L., Inglis, S. J., & Espie, C. A. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00004-3 · Cited by 133
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
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
Jernelöv, S., Lekander, M., Blom, K., Rydh, S., Ljótsson, B., Axelsson, J., & Kaldo, V. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-5 · Cited by 127
Self-citationHedman, E., Ljótsson, B., Blom, K., El Alaoui, S., Kraepelien, M., Rück, C., Andersson, G., Svanborg, C., Lindefors, N., & Kaldo, V. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2818 · Cited by 75 · cited 1×
“…in this study, especially on the web-based questionnaires (including ISI) at long term follow-ups (Lancee et al., 2012), the recommendations by Hedman et al. (2013) were followed by including an interview version of the primary measure to be administered at all assessment-points before and…”
BackgroundSelf-citationLarsson, B., Kaldo, V., & Broberg, A. (2009) · Journal of Psychotherapy Integration · doi:10.1037/a0015446 · Cited by 38
Self-citationInvolving clients in treatment methods: a neglected interaction in the therapeutic relationship
Kaldo, V., Ramnerö, J., & Jernelöv, S. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000039 · Cited by 27
Self-citationAlexandru, B. V., Balázsi, R., Lupu, V., & Vasile, B. Ş. (2009) · Journal of Evidence-Based Psychotherapies · Cited by 16
Flagged first, then by citations
Research works printed but not linked: 2
- Bastien, 2001, Validation of the insomnia severity index as an outcome measure for insomnia research, Sleep Medicine, 2, 297, 10.1016/S1389-9457(00)00065-4 · DOI · Paper page
- Morin, 2009, vol. 301, 2005
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The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023
Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., Bassetti, C. L. A., Bastien, C., Berzina, N., Bjorvatn, B., Dikeos, D., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14035 · Cited by 834
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Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis
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Metadata
- Authors
- Kaldo, V., Jernelöv, S., Blom, K., Ljótsson, B., Brodin, M., Jörgensen, M., Kraepelien, M., Rück, C., & Lindefors, N.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Kaldo, Viktor
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 71
- Pages
- 90-100
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1771931246
- Cited by
- 132
- References
- 48
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 11 · 2023: 11 · 2022: 13 · 2021: 14 · 2020: 24 · 2019: 15 · 2018: 5 · 2017: 7 · 2016: 14 · 2015: 4
- FWCI
- 14.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Söderström-Königska Foundation (SLS-156621)
- AFA Sickness Insurance Research Fund (2999/09-721)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- insomnia, internet-based cognitive behavioral therapy, Insomnia Severity Index, therapist support, sleep medication use, sleep efficiency, sleep latency, sleep quality, perceived stress, treatment effects, long-term treatment outcomes
- MeSH terms
- Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Compliance, Professional-Patient Relations, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Patient Satisfaction, Outcome Assessment, Health Care, Internet
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