Logging on for Better Sleep: RCT of the Effectiveness of Online Treatment for Insomnia
Open accessAbstract
STUDY OBJECTIVES: Despite effective cognitive behavioral treatments for chronic insomnia, such treatments are underutilized. This study evaluated the impact of a 5-week, online treatment for insomnia. DESIGN: This was a randomized controlled trial with online treatment and waiting list control conditions. PARTICIPANTS: Participants were 118 adults with chronic insomnia. SETTING: Participants received online treatment from their homes. INTERVENTION: Online treatment consisted of psychoeducation, sleep hygiene, and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, and help with medication tapering. MEASUREMENT AND RESULTS: From pre- to post-treatment, there was a 33% attrition rate, and attrition was related to referral status (i.e., dropouts were more likely to have been referred for treatment rather than recruited from the community). Using a mixed model analysis of variance procedure (ANOVA), results showed that online treatment produced statistically significant improvements in the primary end points of sleep quality, insomnia severity, and daytime fatigue. Online treatment also produced significant changes in process variables of pre-sleep cognitive arousal and dysfunctional beliefs about sleep. CONCLUSIONS: Implications of these findings are that identification of who most benefits from online treatment is a worthy area of future study.
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The Restore program, a six-session Internet-based self-administered therapy for insomnia, has demonstrated efficacy in a controlled trial of 118 people with chronic insomnia.
“The program has shown efficacy in a controlled trial involving 118 persons with chronic insomnia (20).”
From Implementing computer-based psychotherapy among veterans in outpatient treatment for substance use disorders (2016) · cites this paper as [20]
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“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.”
BackgroundSelf-citationas the Sleep Disturbance Expert Panel on behalf of the Cancer Journey Advisory Group of the Canadian Partnership Against Cancer, Howell, D., Oliver, T. K., Keller-Olaman, S., Davidson, J. R., Garland, S. N., Samuels, C. H., Savard, J., Harris, C. A., Aubin, M., et al. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1823-6 · Cited by 100 · see citing works
“evidence; these included reviews, information summaries, consensus statements, or guidelines that offered best practice advice, but were not necessarily cancer-focused or evidencebased [13,16,34–59].”
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
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“…den Berg, Schoones, & Vliet-Vlieland, 2007), including insomnia (Cheng & Dizon, 2012; Espie et al., 2012; Lancee, van den Bout, van Straten, & Spoormaker, 2012; Ritterband et al., 2009; Ritterband et al., 2011; Ström, Pettersson, & Andersson, 2004; Suzuki et al., 2008; Vincent & Lewycky, 2009).”
BackgroundInfluentialFostering Innovation in Symptom Management among Hemodialysis Patients
Flythe, J. E., Hilliard, T. S., Lumby, E., Castillo, G., Orazi, J., Abdel‐Rahman, E. M., Pai, A. B., Rivara, M. B., Peter, W. L. S., Weisbord, S. D., et al. (2018) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.07670618 · Cited by 93 · see citing works
“It has been shown to improve sleep latency, efficiency, and quality in nondialysis populations (21,22).”
BackgroundNew developments in cognitive behavioral therapy as the first-line treatment of insomnia
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Sleep and Productivity Benefits of Digital Cognitive Behavioral Therapy for Insomnia
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“Research in pain management has found that a patient accepting their condition can itself lead to positive outcomes [28], and (computerised) CBT has been shown to be effective for patients with anxiety disorders and for patients with insomnia [29-31].”
BackgroundSleep Disturbance and Affective Comorbidity Among Episodic Migraineurs
Walters, A. B., Hamer, J. D., & Smitherman, T. A. (2013) · Headache The Journal of Head and Face Pain · doi:10.1111/head.12168 · Cited by 82 · see citing works
The Delivery of Behavioral Sleep Medicine to College Students
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Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups
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“N/A N/A 79/39 59 Intervention Vincent [41]”
Kinnucan, J. A. R., Rubin, D. T., & Ali, T. (2013) · Europe PMC (PubMed Central) · Cited by 73 · see citing works
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“All the three studies available up to date [51, 53, 54] found that online CBT-I is efficacious.”
BackgroundCasault, L., Savard, J., Ivers, H., & Savard, M. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.02.003 · Cited by 65 · see citing works
Digital Delivery of Cognitive Behavioral Therapy for Insomnia
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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 · see citing works
“This is an important omission, as such programs are rapidly developing (Ritterband et al., 2009; Strom, Pettersson, & Andersson, 2004; Vincent & Lewycky, 2009).”
BackgroundSelf-citationStepped Care for Insomnia: An Evaluation of Implementation in Routine Practice
Vincent, N., & Walsh, K. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.2484 · Cited by 63 · see citing works
Self-citationSchlarb, A. A., & Brandhorst (2012) · Nature and Science of Sleep · doi:10.2147/nss.s28337 · Cited by 63 · see citing works
“36 In recent years, a growing number of studies have shown that the Internet can be effectively used for the assessment and treatment of various medical and behavioral problems 37–41 as well as adult sleep disorders, 42,43 especially insomnia.”
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Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context
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“25 (a medium ES), which was selected because although studies have shown that iCBT can yield large effect sizes, these tend to be found with clinical populations (Titov, 2009; Vincent and Lewycky, 2009), or”
BackgroundResultInfluentialRybarczyk, B. D., Lund, H. G., Shamaskin‐Garroway, A., & Mack, L. (2012) · Clinical Gerontologist · doi:10.1080/07317115.2012.731478 · Cited by 58 · see citing works
“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).”
Garland, S. N., Zhou, E. S., Gonzalez, B. D., & Rodriguez, N. (2016) · Current Sleep Medicine Reports · doi:10.1007/s40675-016-0050-3 · Cited by 57 · see citing works
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Theadom, A., Barker-Collo, S. L., Jones, K., Dudley, M., Vincent, N., & Feigin, V. L. (2017) · Clinical Rehabilitation · doi:10.1177/0269215517736671 · Cited by 56 · see citing works
Self-citationLiving with persistent insomnia after cancer: A qualitative analysis of impact and management
Reynolds‐Cowie, P., & Fleming, L. (2021) · British Journal of Health Psychology · doi:10.1111/bjhp.12446 · Cited by 53 · see citing works
“…administered using a range of delivery methods, including groups (Jansson & Linton, 2005; Verbeek, Konings, & Aldenkamp, 2006), telephone (Bastien, Morin, Ouellet, Blais, & Bouchard, 2004), online (Espie et al., 2013; Vincent & Lewycky, 2009), and self-help manuals (Mimeault & Morin, 1999).”
Mind-body interventions for the treatment of insomnia: a review
Kozasa, E. H., Hachul, H., Monson, C., Pinto, L. R., Garcia, M. C., Mello, L. E., & Tufik, S. (2010) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462010000400018 · Cited by 53 · see citing works
Mechanisms of cognitive behavioural therapy for insomnia
Altena, E., Ellis, J. G., Camart, N., Guichard, K., & Bastien, C. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13860 · Cited by 52 · see citing works
“More specifically, Vincent and Lewycky (2009) found that reduced pre-sleep cognitive hyperar-ousal mediated the effect of computerised CBT on self-reported sleep data, as compared with a control condition that consisted of improving sleep schedule consistency only.”
BackgroundMethodPatel, 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 · see citing works
“%) suggesting that community based recruitment may have higher levels of pre-treatment motivation or more comfortable with technology [15].”
BackgroundUse 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 50 · see citing works
Practical Guideline for Fatigue Management in Inflammatory Bowel Disease
Kreijne, J. E., Lie, M. R. K. L., Vogelaar, L., & van der Woude, C. J. (2015) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjv168 · Cited by 47 · see citing works
Talk 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 · see citing works
“Also, the research by, for instance, [35, 40, 41], showed promising effects from this type of approaches in the health domain.”
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 45 · see citing works
Harrold, E. C., Idris, A. F., Keegan, N. M., Corrigan, L., Teo, M. Y., O'Donnell, M. J., Lim, S. T., Duff, E., O’Donnell, D. M., Kennedy, M. J., et al. (2020) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2020.7611 · Cited by 44 · see citing works
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Espie, 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 · see citing works
Adherence to Cognitive Behavior Therapy for Insomnia
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Cognitive-Behavioral Therapy for Insomnia in Patients With Cancer
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“Based on information from Page et al., 2006; Schutte-Rodin et al., 2008. sources consider insomnia to be chronic if it lasts more than one month (Yamamoto, 2010).”
BackgroundMethodInfluentialNetwork 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 40 · see citing works
The 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 35 · see citing works
“While this theoretical model of help-seeking behavior derives from a mental health perspective, it is equally relevant to insomnia patients who are potentially facing a similar situation given the comparable rates of treatment seeking as those with mental health issues (Vincent & Lewycky, 2009).”
BackgroundPerceptions of Heavy-Drinking College Students About a Sleep and Alcohol Health Intervention
Fucito, L. M., DeMartini, K. S., Hanrahan, T. H., Whittemore, R., Yaggi, H. K., & Redeker, N. S. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2014.919919 · Cited by 37 · see citing works
“…that results in medium to large improvements in insomnia symptoms (Edinger, Wohlgemuth, Radtke, Marsh, & Quillian, 2001; Morin et al., 2009) and is effective in brief (Edinger & Sampson, 2003) and computerbased formats (e.g., SHUTiTM, RESTORETM; Ritterband et al., 2009; Vincent & Lewycky, 2009).”
BackgroundSleep 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 33 · see citing works
Self-citationTreating Insomnia: A Review of Patient Perceptions Toward Treatment
Cheung, J. M. Y., Bartlett, D. J., Armour, C. L., & Saini, B. (2015) · Behavioral Sleep Medicine · doi:10.1080/15402002.2014.981818 · Cited by 34 · see citing works
“…researchers noted higher attrition rates among those who have been passively referred by their clinician to participate in the study compared to research volunteers who make a conscious decision to participate (Davidson, Aime, Ivers, & Morin, 2009; Stepanski et al., 1989; Vincent & Lewycky, 2009).”
Background“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 · see citing works
“We were unable to directly compare our attrition and login rates to other reported studies given the varying measures of adherence.(14) Baseline age, gender, or insomnia severity were not associated with drop-out, but intervention-group participants were less likely to return the questionnaires, possibly due to fatigu…”
InfluentialRybarczyk, B. D., Mack, L., Harris, J. H., & Stepanski, E. J. (2011) · Rehabilitation Psychology · doi:10.1037/a0025577 · Cited by 33 · see citing works
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 32 · see citing works
Persuasive strategies in mobile insomnia therapy: alignment, adaptation, and motivational support
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“Relaxation training was selected as a high-demand control because it too is amenable to online delivery and focuses on similar outcomes (Beatty & Lambert, 2013; Devineni & Blanchard, 2005; Vincent & Lewycky, 2009).”
BackgroundVincent, N., & Walsh, K. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.12.003 · Cited by 29 · see citing works
Self-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 · see citing works
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“adherence to sleep restriction (45–50%) and stimulus control (32–35%) across four chemotherapy treatments was lower than some studies of primary insomnia [28, 38] and similar to others [39, 40].”
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 · see citing works
Is it Time to Step Up to Stepped Care with our Cognitive-Behavioral Insomnia Therapies?
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Insomnia (primary) in older people: non-drug treatments.
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“…effect of Internetdelivered CBT-I in comparison with a wait-list control group, which means that it is highly unlikely that current effects are exclusively due to time effects (Espie et al., 2012; Lancee et al., 2012; Ritterband et al., 2009; van Straten et al., in press; Vincent & Lewycky, 2009).”
BackgroundInfluentialComputer-based self-help therapy: A qualitative analysis of attrition
Hermes, E. D. A., Merrel, J. D., Clayton, A. R., Morris, C., & Rowe, M. (2016) · Health Informatics Journal · doi:10.1177/1460458216683536 · Cited by 25 · see citing works
“25 In our prior study, RESTORE was implemented using a strategy consisting of face-to-face provider and patient education sessions, on-site Internet access, and clinician telephone support.”
MethodMiddlemass, 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 · see citing works
Aji, M., Glozier, N., Bartlett, D. J., Grunstein, R. R., Calvo, R. A., Marshall, N. S., White, D. P., & Gordon, C. J. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2021.1967157 · Cited by 24 · see citing works
“…similar efficacy to face-to-face interventions with large treatment effects on the Insomnia Severity Index (ISI) (Hedge’s g = 1.09) and moderate effects on sleep-wake parameters such as wake after sleep onset (WASO) (g = 0.45) and sleep onset latency (SOL) (g = 0.41) (Zachariae et al., 2016).”
BackgroundInfluentialTucker, R. M., Contreras, D. A., Carlson, B. R., Carter, A., & Drake, C. L. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s304035 · Cited by 24 · see citing works
- Authors
- Vincent, N., & Lewycky, S.
- Affiliations
- University of Manitoba (CA)
- Corresponding author
- Vincent, Norah
- ORCID
- Vincent, Norah
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06
- Volume
- 32
- Issue
- 6
- Pages
- 807-815
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2690569
- OpenAlex
- W1534297593
- Cited by
- 206
- References
- 54
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 3 · 2023: 16 · 2022: 8 · 2021: 7 · 2020: 12 · 2019: 8 · 2018: 6 · 2017: 18 · 2016: 17 · 2015: 20 · 2014: 12 · 2013: 21 · 2012: 13
- FWCI
- 19.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- chronic insomnia, online therapy, internet-based cognitive behavioral therapy, sleep hygiene, stimulus control, sleep restriction, relaxation training, cognitive therapy, medication tapering, treatment discontinuation, referral status, sleep quality, daytime fatigue, dysfunctional beliefs about sleep
- MeSH terms
- Adult, Circadian Rhythm, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Education as Topic, Relaxation Therapy, Therapy, Computer-Assisted, Health Behavior, Comorbidity, Cognitive Behavioral Therapy, Internet
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