Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: a non-inferiority internet delivered randomized controlled trial
Open accessAbstract
Background: Insomnia is a highly prevalent sleep disorder frequently comorbid with mental health conditions in nurses. Despite the effectiveness of evidence-based cognitive behavioral therapy for insomnia (CBT-I), there is a critical need for alternative approaches. This study investigated whether internet-delivered mindfulness-based stress reduction (IMBSR) for insomnia could be an alternative to internet-delivered CBT-I (ICBT-I). Objective: The hypothesis was that the IMBSR would be noninferior to the ICBT-I in reducing the severity of insomnia among nurses with insomnia. Additionally, it was expected that ICBT-I would produce a greater reduction in the severity of insomnia and depression than IMBSR. Method: Among 240 screened nurses, 134 with insomnia were randomly allocated (IMBSR, n = 67; ICBT-I, n = 67). The assessment protocol comprised clinical interviews and self-reported outcome measures, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), the 15-item Five Facet Mindfulness Questionnaire (FFMQ), and the Client Satisfaction Questionnaire (CSQ-I). Results: The retention rate was 55% with 77.6% (n = 104) of participants completing the study. At post-intervention, the noninferiority analysis of the ISI score showed that the upper limit of the 95% confidence interval was 4.88 (P = 0.46), surpassing the pre-specified noninferiority margin of 4 points. Analysis of covariance revealed that the ICBT-I group had significantly lower ISI (Cohen’s d = 1.37) and PHQ-9 (Cohen’s d = 0.71) scores than did the IMBSR group. In contrast, the IMBSR group showed a statistically significant increase in the FFMQ-15 score (Cohen’s d = 0.67). Within-group differences showed that both the IMBSR and ICBT-I were effective at reducing insomnia severity and depression severity and improving mindfulness. Conclusion: Overall, nurses demonstrated high levels of satisfaction and adherence to both interventions. The IMBSR significantly reduced insomnia severity and depression, but the findings of this study do not provide strong evidence that the IMBSR is at least as effective as the ICBT-I in reducing insomnia symptoms among nurses with insomnia. The ICBT-I was found to be significantly superior to the IMBSR in reducing insomnia severity, making it a recommended treatment option for nurses with insomnia.
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Noise exposure is linked to delayed sleep onset, more frequent nighttime awakenings, and reduced sleep depth.
“The auditory environment significantly influences sleep quality, with noise exposure linked to delayed sleep onset, more frequent nigh ime awakenings, and reduced sleep depth [53].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [53]
The Background discusses stress disrupting sleep initiation, maintenance, and consolidation, but does not attribute those effects to noise. Searches for noise exposure and the auditory environment found no passage linking them to delayed sleep onset, nighttime awakenings, or reduced sleep depth; page numbers were not available in our copy. (LLM, conf=0.76)
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- Authors
- Guo, W., Nazari, N., & Sadeghi, M.
- Affiliations
- Nanchang University (CN)
- Lorestan University (IR)
- Corresponding author
- Nazari, Nabi
- Venue
- PeerJ
- Publisher
- PeerJ
- Published
- 2024-07-24
- Volume
- 12
- Pages
- e17491
- ISSN
- 2167-8359 (ISSN-L)
- PMC
- PMC11283175
- OpenAlex
- W4400959651
- Cited by
- 15
- References
- 110
- Citations by year
- 2026: 9 · 2025: 6
- FWCI
- 6.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PeerJ (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Jiangxi Province Social Science Planning Youth Foundation Project (No. 21JY45)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- insomnia, cognitive behavioral therapy for insomnia, mindfulness-based stress reduction, nurses, non-inferiority, insomnia severity, depression, mindfulness, sleep disorders, psychiatric comorbidity, client satisfaction, medication adherence, retention, remote treatment delivery, occupational health of nurses
- MeSH terms
- Internet-Based Intervention, Adult, Depression, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Nurses, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Mindfulness
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