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“Stepped Care”: A Health Technology Solution for Delivering Cognitive Behavioral Therapy as a First Line Insomnia Treatment
Open accessAbstract
There is a large body of evidence that Cognitive Behavioral Therapy for insomnia (CBT) is an effective treatment for persistent insomnia. However, despite two decades of research it is still not readily available, and there are no immediate signs that this situation is about to change. This paper proposes that a service delivery model, based on "stepped care" principles, would enable this relatively scarce healthcare expertise to be applied in a cost-effective way to achieve optimal development of CBT services and best clinical care. The research evidence on methods of delivering CBT, and the associated clinical leadership roles, is reviewed. On this basis, self-administered CBT is posited as the "entry level" treatment for stepped care, with manualized, small group, CBT delivered by nurses, at the next level. Overall, a hierarchy comprising five levels of CBT stepped care is suggested. Allocation to a particular level should reflect assessed need, which in turn represents increased resource requirement in terms of time, cost and expertise. Stepped care models must also be capable of "referring" people upstream where there is an incomplete therapeutic response to a lower level intervention. Ultimately, the challenge is for CBT to be delivered competently and effectively in diversified formats on a whole population basis. That is, it needs to become "scalable". This will require a robust approach to clinical governance.
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“Non-pharmacological sleep interventions can be successfully delivered in a variety of relatively low-cost formats [28], therefore providing these as a treatment option for people with depression has the potential to be cost-effective.”
From The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials (2019) · cites this paper as [28]
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“To allocate resources where they are needed, the stepped care model has been suggested (Espie, 2009).”
BackgroundEffectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial
Vollert, B., Müller, L. K., Jacobi, C., Trockel, M., & Beintner, I. (2022) · JMIR Mental Health · doi:10.2196/39052 · Cited by 13
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Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?
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BackgroundBarriers in Access to and Delivery of Behavioral Sleep Treatments
Roberts, S., & Ulmer, C. S. (2023) · Current Sleep Medicine Reports · doi:10.1007/s40675-023-00270-9 · Cited by 15
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What more can we learn about sleep education programs in young people?
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BackgroundSato, D., Sutoh, C., Seki, Y., Nagai, E., & Shimizu, E. (2019) · JMIR Formative Research · doi:10.2196/12635 · Cited by 12
“A problem related to CBT is that access to face-to-face CBT is extremely limited in some regions, including Japan, due to human resource and expertise constraints [9-12].”
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MethodPchelina, P. V., Poluektov, M. G., Berger, T., Krieger, T., Duss, S. B., & Bassetti, C. L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00838 · Cited by 12
Expanding Access to CBT-I for Older Adults: Review and Expansion of Recent Recommendations
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“A “stepped care” model proposed by Espie (2009), suggests that behavioral therapies can be delivered by non-psychologists and specialist help is needed only for patients with refractory insomnia.34 Similarly, there is well-supported evidence for pharmacist-led benzodiazepine tapering…”
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“Technology-based interventions can play an important role in integrated mental health stepped-care approaches to treatment (e.g., Espie, 2009; Green and Iverson, 2009), as they address some barriers to care by drawing on convenience, the ability to reach individuals in remote locations and on the…”
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“The delivery of sleep education at a population level is a principal component of the preventative health care model that has previously been adapted to sleep health [33].”
BackgroundSleep and Socioemotional Outcomes Among Sexual and Gender Minority Adolescents: A Longitudinal Study
Wong, M. L., Nagata, J. M., & Barreto, M. (2023) · Archives of Sexual Behavior · doi:10.1007/s10508-023-02732-1 · Cited by 11
“While bedtime, sleep initiation, and sleep maintenance problems, were suggested to be generally modifiable through short-term treatment (Espie, 2009), their roles in the development of socioemotional outcomes in SGMA have rarely been studied (Martin-Storey et al., 2020).”
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“Insomnia has been proposed as a suitable condition for the stepped-care approach (Espie, 2009).”
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“Stepped-care approaches may be ideal for delivering insomnia treatments by capitalizing on the strengths of both digital and clinician-led CBT-I treatment modalities while minimizing their disadvantages [46, 47].”
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Wong, M. L., Zhang, J., Wing, Y. K., & Lau, E. Y. Y. (2016) · Sleep and Biological Rhythms · doi:10.1007/s41105-016-0074-6 · Cited by 10
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BackgroundEnhancing Self-management for Adults With Functional Abdominal Pain
Niesen, C. R., Olson, D. M., Nowdesha, K. D., Tynsky, D. A., Loftus, C. G., & Meiers, S. J. (2018) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000322 · Cited by 10
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“Toward this end, CBT-I self-management apps offer a potentially effective and accessible entry treat-ment in a stepped care approach (Espie, 2009).”
Treatment effect heterogeneity of cognitive behavioral therapy for insomnia – A meta-analysis
Steinmetz, L., Simon, L., Baumeister, H., Spiegelhalder, K., & Terhorst, Y. (2024) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2024.101966 · Cited by 11
Insomnia: A Therapeutic Review for Pharmacists
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“CBT fits well into a stepped-care approach having a range of levels and intensities, and being provided by health professionals with increasing levels of experience (Espie, 2009).”
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Ulmer, C. S., Bosworth, H. B., Zervakis, J., Goodwin, K., Gentry, P., Rose, C., Jeffreys, A. S., Olsen, M. K., Weidenbacher, H. J., Beckham, J. C., et al. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.107060 · Cited by 9
Low-intensity sleep intervention in a youth mental health service: A case series analysis
Rollinson, R., Price, I., Gee, B., Lyons, J., Carroll, B., Wilson, J., & Clarke, T. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246582000051x · Cited by 8
“Espie (2009) has outlined a stepped care model in the implementation of CBTi, suggesting that for many with less complex or chronic insomnia, individual or small group work with a graduate psychologist may be an appropriate level of intervention provided there is recourse to individual therapy with…”
BackgroundCammalleri, A., Perrault, A. A., Hillcoat, A., Carrese‐Chacra, E., Tarelli, L., Patel, R. S., Baltzan, M., Chouchou, F., Dang‐Vu, T. T., Gouin, J., et al. (2024) · Journal of Sport and Exercise Psychology · doi:10.1123/jsep.2023-0139 · Cited by 9
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Effects of a Workplace-Based Sleep Health Program on Sleep in Members of the German Armed Forces
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“However, it should be noted that CPC is not a replacement for the standardized procedure but a complementary approach or initial step toward sleep health, as suggested by the stepped care model in sleep medicine (47).”
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Primary Insomnia: An Overview of Practical Management Using Cognitive Behavioral Techniques
Espie, C. A., & Kyle, S. D. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2009.07.009 · Cited by 8
Garland, S. N. (2021) · Sleep · doi:10.1093/sleep/zsab202 · Cited by 7
Jun, L., Li, X., Wen, Y., & Yongxiang, W. (2024) · Frontiers in Sleep · doi:10.3389/frsle.2024.1323967 · Cited by 7
“…interventions for sleep provide temporary improvements in sleep but are not recommended for addressing chronic sleep problems due to limited effectiveness and the risk of dependence and other potential adverse effects (National Institute for Health Care and Excellence, 2004; Espie, 2009).”
Pchelina, P. V., Poluektov, M. G., Krieger, T., Duss, S. B., & Berger, T. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1301489 · Cited by 8
Insomnia and other sleep disorders in adolescence
Delahoyde, M.-K., Tyack, C., Kugarajah, S., & Joseph, D. (2024) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2021-001229 · Cited by 14
“39 For example, sleep hygiene alone cannot address insomnia, excessive, or erratic sleep, but it provides a solid foundation for the more active components of the intervention, such as sleep restriction and stimulus control.”
Improvement of Insomnia Symptoms following a Single 4-Hour CBT-I Workshop
Okun, M. L., & Glidewell, R. N. (2022) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2036741 · Cited by 7
“…support the notion that modifications in the delivery method and duration of CBT-I can help expand access to CBT-I (Cheung, Jarrin et al., 2019), which is in alignment with a stepped care model for insomnia treatment of providing appropriate levels of treatment to all who seek it (Espie, 2009).”
BackgroundMethodInfluentialBeattie, L., Robb, F. M., Spanswick, M., Henry, A. L., Waxmonsky, J. A., & Gumley, A. I. (2023) · Early Intervention in Psychiatry · doi:10.1111/eip.13388 · Cited by 7
“Digital interventions also permit the delivery of evidence-based interventions at scale, and this is of particular relevance to countries with national healthcare services (Espie, 2009).”
BackgroundCognitive behavioral therapy for the management of poor sleep in insomnia disorder
Kyle, S. D., Miller, C. B., & Espie, C. A. (2014) · ChronoPhysiology and Therapy · doi:10.2147/cpt.s54220 · Cited by 9
“However, the volume of patients seeking treatment for insomnia and the limited number of trained psychologists means that access to therapy is difficult.(31) Stepped care is potentially an extremely useful and cost effective framework for the dissemination of CBT-I.”
InfluentialHunter, M. S., & Melanie Smith in collaboration with the British Menopause Society (2017) · Post Reproductive Health · doi:10.1177/2053369117711636 · Cited by 7
Bravo, A. J., Kelley, M. L., Swinkels, C. M., & Ulmer, C. S. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12624 · Cited by 8
“With regards to treatment, in a stepped care approach (Espie, 2009) the degree of symptomology (both depressive and sleep) would dictate level of care required.”
BackgroundUsefulness of psychoeducational intervention in chronic insomnia: an actigraphic study
Quintiliani, M. I., Imperatori, C., Testani, E., Losurdo, A., Tamburello, S., Contardi, A., Marca, G. D., & Farina, B. (2017) · Journal of Mental Health · doi:10.1080/09638237.2017.1417563 · Cited by 7
Evidence-based psychological therapies for insomnia
Riemann, D. W., & Espie, C. A. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31819-1 · Cited by 7
Stern, É., Brune, S., Mouchabac, S., Dubroc, A., de la Personne, C., & Geoffroy, P. A. (2025) · JMIR Human Factors · doi:10.2196/70193 · Cited by 6
“Digitalization of CBT-i was first proposed in the 1990s, and the first proposal to introduce dCBT-i into the health care system as a preliminary step before in-person orientation was made in 2009 [25].”
Basheti, M. M., Tran, M., WONG, K. K. H., Gordon, C. J., Grunstein, R. R., & Saini, B. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2021.1975718 · Cited by 6
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Clinical governance: An in-depth scientometric analysis
Adduci, A., Perilli, A., Durante, F., de Mattia, E., Cicchetti, A., Ricciardi, W., & de Belvis, A. G. (2023) · International Journal of Healthcare Management · doi:10.1080/20479700.2023.2214963 · Cited by 6
Initial Sleep Time Predicts Success in Manual-Guided Cognitive Behavioral Therapy for Insomnia
Bothelius, K., Kyhle, K., Broman, J., Gordh, T., & Fredrikson, M. (2015) · Behavioral Sleep Medicine · doi:10.1080/15402002.2015.1007995 · Cited by 6
“Researchers (Espie, 2009) have suggested a “stepped care” approach that includes bibliotherapy, Internet-delivered therapy, and nurse-administered treatments as forms of lower steps, and individual CBT and treatment delivered by behavior sleep medicine specialists as examples of higher steps.”
BackgroundNonpharmacologic Approach to Sleep Disorders
Mansel, J. K., & Carey, E. C. (2014) · The Cancer Journal · doi:10.1097/ppo.0000000000000066 · Cited by 6
“A stepped-care approach has been suggested utilizing a self-administered or Internet program initially, followed by referral to a CBT-trained professional if the original intervention proves not to be effective.(58)”
MethodCognitive Behavioral and Psychological Therapies for Chronic Insomnia
Espie, C. A., & Kyle, S. D. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-1703-7.10012-x · Cited by 6
Osborne, J. M., & Blunden, S. L. (2018) · Clinical Medicine Insights Pediatrics · doi:10.1177/1179556518815168 · Cited by 6
“36) for the webinar delivery group, which was statistically significant t(17) = 3.”
BackgroundSánchez-Ortuño, M. M., Pécune, F., Coelho, J., Micoulaud‐Franchi, J., Salles, N., Auriacombe, M., Serre, F., Levavasseur, Y., de Sevin, É., Sagaspe, P., et al. (2024) · JMIR Mental Health · doi:10.2196/51022 · Cited by 7
Reesen, J. E., van de Kamer, F. M., van Keeken, A., Ikelaar, S. L. C., van Oppen, P., Batelaan, N. M., Lancee, J., Someren, E. J. W. V., & van Nassau, F. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06824-1 · Cited by 5
“These recommendations align with the stepped care model, which advocates for delivering interventions that match the specific needs of patients at different levels of care [60].”
Stepped care and digital intervention service model design in the multidisciplinary sleep service
Winter, S., Crocker, S., Rolls, T., Curtin, D., Haratsis, J. M., & Szollosi, I. (2025) · Internet Interventions · doi:10.1016/j.invent.2025.100830 · Cited by 5
“This model often leverages digital, group, and trainee-led interventions as entry points, allowing for flexible, cost-effective care delivery that can be escalated if necessary (Espie, 2009; Darden et al., 2021; Espie et al., 2007).”
Matsuda, E., & Kikutani, M. (2022) · SAGE Open · doi:10.1177/21582440221086610 · Cited by 7
“This has been preventing the treatment to achieve high volume of patient care in the last few decades (Espie, 2009).”
BackgroundInsomnia is associated to depressive symptoms in patients with chronic heart failure
Johansson, P., & Broström, A. (2013) · Open Journal of Nursing · doi:10.4236/ojn.2013.31005 · Cited by 5
“CBT studies in HF populations are missing but in other populations face to face CBT interventions have been successfully [38,39].”
BackgroundSelf‐care strategies to facilitate sleep in patients with heart disease—A qualitative study
Johansson, A., Karlsson, J., Brödje, K., & Edéll‐Gustafsson, U. (2012) · International Journal of Nursing Practice · doi:10.1111/j.1440-172x.2011.01997.x · Cited by 5
Baglioni, C., Spiegelhalder, K., Nissen, C., Hirscher, V., Frase, L., Feige, B., Unbehaun, T., & Riemann, D. W. (2013) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-013-0602-4 · Cited by 5
Group cognitive–behavioral therapy in insomnia: a cross-sectional case-controlled study
Mao, H., Ji, Y., Xu, Y., Tang, G., Yu, Z., Xu, L.-L., Shen, C., & Wang, W. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s149610 · Cited by 5
“Furthermore, the contradiction of high demand of CBT and its short supply hampers its dissemination in treating insomnia.(16,17) Up to date, pharmacotherapy remains one of the common treatment necessities for insomnia.”
BackgroundMethodChronobiology and Treatment in Depression
Geoffroy, P. A., & Yeim, S. (2017) · Springer eBooks · doi:10.1007/978-981-10-6577-4_9 · Cited by 5
Kognitive Verhaltenstherapie bei Insomnie
Weinhold, S. L., & Göder, R. (2022) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-022-00341-z · Cited by 5
“nach [11]), sortiert nach Zugänglichkeit.”
One-week inpatient cognitive behavioral therapy for insomnia: a retrospective study
Cai, Q., Li, M., Li, G., Xu, X., Li, C., & Li, Q. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1440026 · Cited by 4
PRO: CBT-I for insomnia treatment can be delivered by a range of healthcare providers
Espie, C. A., Grandner, M. A., & Drake, C. L. (2025) · SLEEP · doi:10.1093/sleep/zsaf124 · Cited by 4
Meneo, D., Baldi, E., Benz, F., & Fabris, M. A. (2025) · Cogent Mental Health · doi:10.1080/28324765.2025.2541697 · Cited by 6
Daily physical activity and sleep in veterans: the role of insomnia severity
Robinson, S. A., Reilly, E. D., Petrakis, B. A., Wiener, R. S., Castaneda‐Sceppa, C., & Quigley, K. S. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00260-8 · Cited by 7
“While cognitive behavioral therapy for insomnia (CBTI) is the first-line treatment for chronic insomnia (Qaseem et al., 2016), it can be timeand resource-intensive (Espie, 2009).”
BackgroundInfluentialSullan, M. J., Kinney, A. R., Stearns‐Yoder, K. A., Reis, D. J., Saldyt, E. G., Forster, J. E., Cogan, C. M., Bahraini, N. H., & Brenner, L. A. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107525 · Cited by 4
Carson, E., Dhillon, H. M., Vardy, J. L., Brown, C. S. B., Nunes-Zlotkowski, K. F., Della‐Fiorentina, S. A., Khan, S. N., Parsonson, A. O., Roncoloato, F., Pearson, A., et al. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08554-8 · Cited by 4
“This approach may be more cost-effective, and a more appropriate use of scarce resources, addressing the high demand and short supply of CBT-I [46].”
BackgroundSkoglund, H., Sivertsen, B., Kallestad, H., & Vedaa, Ø. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.06.026 · Cited by 4
A scoping review of self-help cognitive behavioural therapy for insomnia
Lake, R., Tucker, R. E., Murphy, A. L., Pencer, A. H., Kruglova, K., & Gardner, D. M. (2024) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2024.102021 · Cited by 4
Ramos, S. A. T., & Muñoz, M. D. C. L. (2011) · Revista Colombiana de Psiquiatría · doi:10.1016/s0034-7450(14)60126-8 · Cited by 4
“Por otro lado, conforme con lo encontrado en otras revisiones (58,59), la TCC resultó ser una intervención efectiva para el manejo del insomnio primario y una de las más utilizadas en los últimos tiempos; al compararla con el tratamiento farmacológico, demostró su eicacia a largo plazo, así como su capacidad para opti…”
BackgroundInsomnie und Hypersomnie bei Kindern und Jugendlichen mit psychiatrischen Störungen
Alfer, D., Lehmkuhl, G., & Bender, S. (2019) · Praxis der Kinderpsychologie und Kinderpsychiatrie · doi:10.13109/prkk.2019.68.2.110 · Cited by 4
Chen, H., Hsu, N., Pan, P., Kuo, P., Chien, M., & Chou, P. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s324928 · Cited by 4
“However, the different modules may demand various levels of professions, time, and labor, by which the accessibility and availability are determined.(36) Accordingly, the heterogeneity of poor sleep quality not only leads to inadequate diagnosis and treatment but may also incur overtreatment or inappropriate use of hy…”
BackgroundReffi, A. N., & Cheng, P. (2023) · SLEEP · doi:10.1093/sleep/zsad064 · Cited by 4
Browne, A., Cahalan, R., & O’Sullivan, K. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305931 · Cited by 6
&You: Design of a Sensor-Based Wearable Device for Use in Cognitive Behavioral Therapy
McEuen, A., Proffitt, J., Camba, J. D., & Kwon, E. (2016) · Advances in intelligent systems and computing · doi:10.1007/978-3-319-41652-6_24 · Cited by 4
Barnes, G. L., Lawrence, V. C., Khondoker, M. R., Stewart, R. J., & Brown, J. S. L. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2017.1301942 · Cited by 4
“, 2012) when delivered as part of the original stepped-care model (Espie, 2009).”
BackgroundInfluentialTorabi, A. A., Ilali, E. S., Emadian, S. O., & Mousavinasab, N. (2019) · Journal of Gerontology · doi:10.29252/joge.4.2.9 · Cited by 4
“Iranian Journal of Nursing Research 2013; 8 (29): 19-25 (Persian).”
BackgroundFuture Directions in Insomnia Diagnosis and Treatment
Baglioni, C., Spiegelhalder, K., Nissen, C., & Riemann, D. W. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-378610-4.00212-6 · Cited by 4
Cheung, J. M. Y., Ritterband, L. M., Chen, S., Ivers, H., & Morin, C. M. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70127 · Cited by 3
Rollinson, R., Cole, A., Gee, B., Tofan, I., Graham, A., Hatton, J., Lyons, J., Reeve, S., Wilson, J., Beardsworth, K., et al. (2024) · Early Intervention in Psychiatry · doi:10.1111/eip.13534 · Cited by 3
“The transdiagnostic nature of a sleep intervention, together with the use of either non-expert practitioners as in the current study or digital interventions as used by Mathews et al. (2022), widens the potential for positive impact even further (Espie, 2009).”
Application of stepped care model in cancer patients: a scoping review
Pan, Y., Zhang, L., & Tian, X. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-09086-x · Cited by 5
“On the one hand, it improves the allocation of health resources and expands the scope of care services, while on the other hand, it can provide personalized care support according to the intervention outcome, presenting a “pyramid”-like model [9].”
Bjorvatn, B., Lundetræ, R. S., Vedaa, Ø., Pallesen, S., & Evanger, L. N. (2025) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2025.2525423 · Cited by 2
“…are striving to reduce their prescriptions [22,23]. effective and scientifically documented self-help therapies have therefore been called for [1,13,24]. there are no other scientifically tested self-help books for insomnia in Norwegian, but a swedish self-help book has shown good effects among…”
InfluentialManaging the trajectory of insomnia: from public health to relapse prevention
Ellis, J. G., Alfonso‐Miller, P., Cheng, P., Bastien, C., Altena, E., & Grandner, M. A. (2025) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2025.100540 · Cited by 4
Xu, Z., & Anderson, K. N. (2019) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x19000242 · Cited by 3
“Use of a similar stepped care model to treat insomnia using digital CBTi (dCBTi) is particularly attractive (Christensen et al., 2016; Espie, 2009) as access to secondary care sleep services can be variable.”
MethodJudge, D. J., Miller, C. B., Bartlett, D. J., Jomaa, I., Wong, K. K., Saini, B., Semsarian, C. R., Espie, C. A., Kyle, S. D., Grunstein, R. R., et al. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13699 · Cited by 3
“, 2021) and may be more readily deployable as a manualised treatment in a primary care setting as part of a “stepped care approach” (Espie, 2009).”
Background
Metadata
- Authors
- Espie, C. A.
- Affiliations
- Southern General Hospital (GB)
- Corresponding author
- Espie, Colin A.
- ORCID
- Espie, Colin A.
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-12
- Volume
- 32
- Issue
- 12
- Pages
- 1549-1558
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2786038
- OpenAlex
- W1215988363
- Cited by
- 422
- References
- 61
- Citations by year
- 2026: 17 · 2025: 22 · 2024: 32 · 2023: 28 · 2022: 35 · 2021: 28 · 2020: 21 · 2019: 29 · 2018: 26 · 2017: 22 · 2016: 19 · 2015: 39 · 2014: 29 · 2013: 29 · 2012: 18
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Funders
- Wellcome Trust
- Cancer Research UK
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- stepped care, cognitive behavioral therapy for insomnia, insomnia treatment, service delivery models, manualized intervention, referral, scalability, clinical governance, cost-effectiveness
- MeSH terms
- Humans, Sleep Initiation and Maintenance Disorders, Patient Care Management, Cognitive Behavioral Therapy, Biomedical Technology
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