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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 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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“In recent years, computerized treatments for insomnia have emerged to treat this chronic problem (Ritterband et al., 2009; Strom, Pettersson, & Andersson, 2004; Suzuki et al., 2008; Vincent & Lewycky, 2009).”
BackgroundInfluentialSelf-citationPsychological and Behavioral Treatments for Insomnia I
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“50 Conversely, an Internet-based treatment intervention found that while the treatment group showed improvement on the Dysfunctional Beliefs and Attitudes about Sleep Scale, 51 few significant differences between the treatment and control groups were seen in improvements in sleep.”
Making Space for the Quality Care
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“48,65,66 However, the initial validation of the MFI-20 found inadequate internal consistency on some subscales in certain samples (range: .53–.93).”
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“The included studies were published between 2004 and 2021 and were conducted in the United States (11/37, 30%) [26,39,53,54,56,58,69,72,73,78], the Netherlands (6/37, 16%) [37,64,66,67,79,80], Australia (3/37, 8%) [35,57,61], Japan (3/37, 8%) [13,75,77], Sweden (3/37, 8%) [36,55,76], the United Kingdom (3/37, 8%) [12,…”
BackgroundMethodInfluentialOnline Delivery of Cognitive Behavioral Therapy-Insomnia
Drerup, M. L., & Ahmed, S. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.02.001 · Cited by 16
Psychological and Behavioral Treatments for Insomnia II
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“Alternate forms of CBT-I, such as group treatment, Internet-based treatment [29, 30], telephone consultation [31], and brief versions [32, 33] attest to its robust efficacy and potential for dissemination [34].”
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
“While some studies suggest that guided interventions are more effective than unguided ones [53,62], the latter may still yield large and sustainable effects compared with a waitlist or active control condition [63-68].”
Nazem, S., Barnes, S. M., Forster, J. E., Hostetter, T. A., Monteith, L. L., Kramer, E. B., Gaeddert, L. A., & Brenner, L. A. (2023) · JMIR Mental Health · doi:10.2196/50516 · Cited by 15
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“One has been a large-scale dissemination effort by the US Veterans Administration to train clinicians to deliver CBT-I [73] with preliminary evidence of the effectiveness of these clinicians now available [74].”
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Nazem, S., Sun, S., Barnes, S. M., Monteith, L. L., Hostetter, T. A., Forster, J. E., Brenner, L. A., Galfalvy, H., & Haghighi, F. G. (2024) · Translational Behavioral Medicine · doi:10.1093/tbm/ibae032 · Cited by 12
“In spite of this, only a small percentage of individuals with insomnia disorder receive treatment for their symptoms [46] due to a lack of trained clinicians and overreliance on in-person models of delivering care.”
Sato, D., Sutoh, C., Seki, Y., Nagai, E., & Shimizu, E. (2019) · JMIR Formative Research · doi:10.2196/12635 · Cited by 12
“Accumulating evidence in recent years suggests that internet-based, computerized CBT for insomnia can be an effective treatment [13-15], and attention has turned to internet-based CBT for insomnia as an alternative to face-to-face CBT [16].”
Corbett, T. K., Walsh, J. C., Groarke, A., Moss-Morris, R. E., & McGuire, B. E. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011485 · Cited by 11
The Use of Digital Health Technologies to Manage Insomnia in Military Populations
Cavanagh, R., Mackey, R., Bridges, L., Gleason, A., Ciulla, R., Micheel, L., Bradshaw, D. H., Armstrong, C. M., & Hoyt, T. (2019) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-019-00114-w · Cited by 16
Rask, M. T., Frostholm, L., Hansen, S. H., Petersen, M. W., Ørnbøl, E., & Rosendal, M. (2023) · Health Psychology Review · doi:10.1080/17437199.2022.2163917 · Cited by 14
“Module 3 presented relaxation training and provided MP3 fi les for paced breathing, progressive muscle relaxation, imagery-induced relaxation and selfhypnosis (Vincent and Lewycky, 2009).”
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“…online CBT programs for PTBIF, suggesting that further investigation was warranted given the evidence base in other populations (Trauer et al., 2015; Castell et al., 2011; van den Akker et al., 2016; Fernie et al., 2015; van Kessel et al., 2008; Vincent & Lewycky, 2009; Ritterband et al., 2017).”
Keuppens, L., Marten, F., Baeyens, D., Boyer, B. E., Danckaerts, M., & der Oord, S. V. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2023.12.001 · Cited by 16
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Beaulac, J., Vincent, N., & Walsh, K. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2013.845780 · Cited by 10
“The duration of insomnia among those who did make contact was much more brief (i.e., 5 years) relative to samples of individuals that proceed through typical sleep clinics in this region (Vincent & Lewycky, 2009).”
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“This high attrition rate is consistent with Vincent and Lewycky (2009), who reported a higher attrition rate for their physician referred (47”
BackgroundResultControl and coping in chronic insomnia: A daily diary study
Vincent, N., Walsh, K., & Chiang, D. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.02.004 · Cited by 10
Self-citationNew models of care for psychology in Canada's health services.
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Dekker, K., Benjamins, J. S., van Straten, A., Hofman, W. F., & Someren, E. J. W. V. (2015) · Trials · doi:10.1186/s13063-015-0790-2 · Cited by 9
“This saves a lot of time for a therapist and subsequently may help to solve the discrepancy between care needed and care available [33, 34], thus allowing for large-scale implementation.”
Alldredge, C. T., Snyder, M., Stork, S. R., & Elkins, G. R. (2023) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2023.2278720 · Cited by 7
“The reduction in both pre-sleep arousal and sleep onset latency observed in the present study is consistent with the hyperarousal model of sleep disturbance (Riemann et al., 2010) and previous research findings (Rosen et al., 2000; Vincent & Lewycky, 2009; Wu et al., 2006).”
ResultCognitive 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
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“Consistent with previous studies (Lancee et al., 2019; Vincent & Lewycky, 2009), our findings demonstrated that CBT-I effectively reduced pre-sleep arousal, a commonly reported barrier to initiating and maintaining sleep and a significant risk factor for insomnia and sleep disturbance.”
Kakazu, V. A., Assis, M., Bacelar, A., Bezerra, A. G., Ciutti, G. L. R., Conway, S. G., Galduróz, J. C. F., Drager, L. F., Khoury, M. P., Leite, I. P. A., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1600767 · Cited by 5
Psychological and Behavioral Treatments for Insomnia II
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Cognitive Behavioral Treatment as a Digital Therapeutic for Insomnia
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Psychophysiological Mechanisms of CBT‐I
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“In adults, ICBT-I improves sleep quality and has a positive effect on insomnia severity, daytime sleepiness and co-morbid depression and anxiety (Kaldo et al., 2015; Strom et al., 2004; Vincent & Lewycky, 2009; Ye et al., 2015).”
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Hofman, W. F., & Kumar, A. (2010) · UvA-DARE (University of Amsterdam) · Cited by 4
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“…and engineers have been working on developing more accessible and affordable therapy solutions that can also lessen the burden of clinicians, such as internet-or mobile-based computerised therapy tools (Str¨om et al., 2004; Ritterband et al., 2009; Vincent and Lewycky, 2009; Lancee et al., 2012).”
BackgroundCognitive-Behavioral Therapy for Insomnia and Nightmares in PTSD
Belleville, G., & Dubé‐Frenette, M. (2015) · Springer eBooks · doi:10.1007/978-3-319-08613-2_38-1 · Cited by 2
Inzet POH ggz bij chronisch slaapmiddelengebruik
van de Ven, G., Meulepas, M. A., Gorgels, W. J. M. J., Verbeek, I., & Laurant, M. G. H. (2011) · Huisarts en Wetenschap · doi:10.1007/s12445-011-0318-2 · Cited by 2
Treating Sleep Disorders with an ACT-Based Behavior Change Support System
Langrial, S. U., B, H. O.-K. A., Lappalainen, P., & Lappalainen, R. I. (2017) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-5225-3241-5.ch003 · Cited by 2
“For example, Vincent and Lewycky (2009) evaluated the effect of an online intervention for insomnia.”
BackgroundDigital Therapies for Insomnia
Jackson, M. L., Meaklim, H., & Mason, E. C. (2023) · Springer eBooks · doi:10.1007/978-3-031-10698-9_6 · Cited by 2
Melton, B. F., Bigham, L. E., Wilson, C., & Buman, M. P. (2017) · International Journal of Kinesiology in Higher Education · doi:10.1080/24711616.2017.1282763 · Cited by 2
“Such results are important to consider as tracking physical activity, sleep, and nutrition have long been used to help modify health behaviors (Bridges-Arzaga, Magoc, & Tomaka, 2011; Intille, Lester, Sallis, & Duncan, 2012; Sternfeld et al., 2011; Vincent & Lewycky, 2009).”
BackgroundAssessment and Management of Insomnia
Huntley, E. D., & Arnedt, J. T. (2015) · Springer eBooks · doi:10.1007/978-3-319-18054-0_10 · Cited by 2
Is it time to get some SHUT-i?
Ellis, J. G., Seed, J. A., Bastien, C., & Grandner, M. A. (2017) · Annals of Translational Medicine · doi:10.21037/atm.2017.04.28 · Cited by 2
Worry and Other Mental Health Problems
Jansson‐Fröjmark, M., Bilevicius, E., El-Gabalawy, R. M., & Asmundson, G. J. G. (2020) · Wiley eBooks · doi:10.1002/9781119189909.ch5 · Cited by 4
Application of online cognitive-behavioral therapy for insomnia among individuals with epilepsy
Alimoradi, Z., Griffiths, M. D., & Pakpour, A. H. (2023) · Handbook of Cognitive Behavioral Therapy by Disorder · doi:10.1016/b978-0-323-85726-0.00027-2 · Cited by 1
Matsuura, J. T., Keller, N. S., Lustik, M. B., Campbell, C. E., & Grills, C. E. (2023) · Frontiers in Sleep · doi:10.3389/frsle.2023.1268967 · Cited by 1
Self-help Treatment for Insomnia☆
Vallières, A., Bertrand, M., Ouellet, M., & Morin, C. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.05407-9 · Cited by 1
No Need to Count Sheep: Investigating an Online Insomnia Intervention among Older Adults
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“Vincent and Lewycky (2009) also explored an online self-help treatment for insomnia.”
BackgroundCognitive-Behavioral Therapy for Insomnia
Hall, D. L., Gorman, M. J., Finkelstein‐Fox, L., Wieman, S. T., Mizrach, H. R., & Park, E. R. (2023) · Current clinical psychiatry · doi:10.1007/978-3-031-29368-9_22 · Cited by 1
Bidirectional Relationships Between Sleep, Insomnia, and Depression
Berger, C., & Riemann, D. W. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199796816.003.0020 · Cited by 1
Daytime functioning and quality of life in chronic insomnia: a multi-method, multi-level approach
Kyle, S. D. (2010) · Enlighten: Theses (The University of Glasgow) · Cited by 1
Cognitive-Behavioral Self-Help Treatment for Nightmares and Insomnia
Lancee, J. (2011) · Utrecht University Repository (Utrecht University) · Cited by 1
Garland, S. N. (2012) · Libraries and Cultural Resources (University of Calgary) · doi:10.5072/prism/27123 · Cited by 1
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Insomnia: an essential treatment target in psychotherapy for anxiety disorders
Belleville, G. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.03.003
“Finally, psychologists should keep in mind that there are several cost-effective ways to deliver CBT-I, including via as few as two therapy sessions [19], via the Internet [20], and as a self-help treatment with minimal supervision [21].”
BackgroundEfficacia di un trattamento cognitivo comportamentale online per l'insonnia: risultati preliminari
Baglioni, C., Battagliese, G., D'Elia, F., Lombardo, C., Riemann, D. W., & Violani, C. (2013) · QUADERNI DI PSICOTERAPIA COGNITIVA · doi:10.3280/qpc2013-032002
Kozasa, E. H., Hachul, H., Monson, C., de Araújo, L. E., Mello, M., & Tufik, S. B. (2010)
Árangur hugrænnar atferlismeðferðar við svefnleysi sem veitt er á netinu
Friðgeirsdóttir, G., Jóhannsson, G., Ellertsson, S., & Björnsdóttir, E. (2015) · Hirsla (Landspítali University Hospital)
Internetbasierte Selbsthilfeprogramme bei Insomnie
Johann, A. F., Hertenstein, E., Riemann, D. W., & Spiegelhalder, K. (2015) · Schlaf · doi:10.1055/s-0038-1626126
van Straten, A., Blom, K., Lancee, J., & Kaldo, V. (2016) · Springer eBooks · doi:10.1007/978-3-319-06083-5_8
kazamia, N. (2015) · Queen Margaret University Publications Repository (Queen Margaret University)
Cognitive-Behavioral Therapy for Insomnia and Nightmares in PTSD
Belleville, G., & Dubé‐Frenette, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-08359-9_38
Online-Schlafberatung für Schichtarbeitende
Peter, L., Reindl, R., Zauter, S., & Richter, K. (2018) · Schlaf · doi:10.1055/s-0038-1677344
Examining the sleep hygiene behaviors of migraineurs in a university setting
Walters, A. B. (2011)
Kanady, J. C., Luik, A. I., & Espie, C. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00027-x
Advances in Cardiac Psychology: Computerized Therapies
Kuhl, E. A. (2012) · Springer eBooks · doi:10.1007/978-1-4419-5650-7_16
Philip, P., Dupuy, L., Sagaspe, P., de Sevin, É., Auriacombe, M., Taillard, J., Micoulaud‐Franchi, J., & Morin, C. M. (2022) · doi:10.2196/preprints.36992
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Atzmon, O., Crowther, M. E., Quin, N., Cassera, L., Wellecke, C., Pinnington, D. M., & Bei, B. (2025) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2501704
“This contradicts prior literature indicating a strong adherence to relaxation exercises among adults with chronic insomnia (McChargue et al., 2012; Vincent & Lewycky, 2009), with one study identifying it as the strategy deemed most beneficial by participants (Harvey et al., 2002).”
Cognitive Behavioral Therapies for Insomnia
Morin, C. M., & Kyle, S. D. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197602751.013.19
Spiropoulos, A., Vincent, N., Tomfohr‐Madsen, L. M., Brost, A., Schmidtler, H., MacKinnon, A., & Kopala‐Sibley, D. C. (2026) · Trials · doi:10.1186/s13063-026-09542-5
“The present trial uses return2sleep [23], which is a web-based, six-session, self-guided CBT-I intervention.”
Self-citationHuang, Y., Yuan, L., Zhu, Y., Chen, M., & Zheng, H. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.105017
Metadata
- 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 (medical) › 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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