The Short-Term Efficacy of an Unguided Internet-Based Cognitive-Behavioral Therapy for Insomnia: A Randomized Controlled Trial With a Six-Month Nonrandomized Follow-Up

失眠症 失眠的认知行为疗法 随机对照试验 物理疗法 医学 损耗 认知行为疗法 认知疗法 睡眠起始潜伏期 认知 睡眠开始 临床心理学 精神科 内科学 牙科
作者
Susanne Hagatun,Øystein Vedaa,Tine Nordgreen,Otto R.F. Smith,Ståle Pallesen,Odd E. Havik,Bjørn Bjorvatn,Frances P. Thorndike,Lee M. Ritterband,Børge Sivertsen
出处
期刊:Behavioral Sleep Medicine [Taylor & Francis]
卷期号:17 (2): 137-155 被引量:49
标识
DOI:10.1080/15402002.2017.1301941
摘要

Objective: Insomnia is a major health problem, and the need for effective and accessible treatment is urgent. The aim of the current study was to evaluate the short-term efficacy of an unguided Internet-based cognitive-behavioral treatment program for insomnia (CBTi), called SHUTi (Sleep Healthy Using the Internet). Methods: This study used a parallel arm randomized controlled trial in Norway. Participants were randomly allocated to the SHUTi condition or a Web-based patient education condition. Both groups were assessed before and after the nine-week intervention period (online sleep diaries and questionnaires). The SHUTi participants were reassessed in a six-month nonrandomized follow-up. Primary outcome measures were the Insomnia Severity Index (ISI) and the Bergen Insomnia Scale (BIS). Results: A total of 181 participants were included in the study; SHUTi condition (n = 95), patient education condition (n = 86). Intention-to-treat mixed-model repeated-measures analysis revealed that the SHUTi group had better short-term outcomes compared with the patient education group on most sleep measures. The SHUTi group showed a significant decrease on the primary outcomes, the ISI (dbetween = –1.77, 95% CI = –2.23, –1.31) and the BIS (dbetween = –1.00, 95% CI = –1.32, –.68). Improvements were maintained among the completing SHUTi participants at the six-month nonrandomized follow-up. However, dropout attrition was high. Conclusion: Unguided Internet-based CBTi produced significant short-term improvements in sleep in patients with chronic insomnia. This highlights the benefits of making Internet-delivered CBTi programs available as a standard first-line treatment option in public health services. Nevertheless, the rate of dropout attrition (participants not completing post-assessment) in this trial limits the generalizability of the findings.
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