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Randomized Controlled Trial to Test the Efficacy of an Unguided Online Intervention with Automated Feedback for the Treatment of Insomnia

Published online by Cambridge University Press:  06 September 2018

Noah Lorenz Open the ORCID record for Noah Lorenz [Opens in a new window] ,
Eva Heim ,
Alexander Roetger ,
Eva Birrer  and
Andreas Maercker
Noah Lorenz*
Affiliation:
Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
Eva Heim
Affiliation:
Department of Psychology, University of Zurich, Switzerland
Alexander Roetger
Affiliation:
Department of Psychology, University of Zurich, Switzerland
Eva Birrer
Affiliation:
Seeklinik Brunnen, Gersauerstrasse 8, 6440 Brunnen, Switzerland
Andreas Maercker
Affiliation:
Department of Psychology, University of Zurich, Switzerland
*
Correspondence to Noah Lorenz, Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany. E-mail: [email protected]
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Abstract

Background: Insomnia has become a major public health concern. Aims: The study examined the efficacy of a web-based unguided self-help programme with automated feedback. The programme was based on cognitive behaviour therapy for insomnia (CBT-I). The investigation particularly focused on factors that contribute to the maintenance of insomnia and tested whether treatment effects were stable over a period of 12 months. Method: Fifty-six participants were randomly assigned either to web-based CBT-I or to the waiting-list control group. Included measures assessed insomnia severity, sleep-related cognitions, safety behaviours, depression, anxiety and somatization. In the intervention group, a sleep diary was used to assess sleep continuity parameters, sleep quality and daytime performance. Results: Large between- and within-group effect sizes (d = 1.79, d = 1.59) for insomnia severity were found. The treatment group effect remained stable over the period of 12 months. Further, sleep-related cognitions, safety behaviours, depression and somatization significantly decreased in the treatment group compared with the control group. On all sleep diary parameters, medium to large effects were revealed within the treatment group. Anxiety did not decrease significantly from pre- to post-assessment. For all measures except somatization and anxiety significant within-group effects were found at 12-month follow-up assessment indicating long-lasting effects. Conclusions: This study adds evidence to the literature on unguided online interventions for insomnia, and indicates that online CBT-I can have substantial long-term effects on relevant sleep-related outcome parameters. Moreover, the results indicate that sleep-related cognitions and safety behaviour can be successfully altered with an unguided CBT-I intervention.

Keywords

insomniainternetrandomized controlled trialcognitive behavioural therapyvirtual coachsafety behaviourscognition
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 3 , May 2019 , pp. 287 - 302
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U. et al. (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135, 10–19. http://doi.org/10.1016/j.jad.2011.01.011Google Scholar
Baglioni, C., Spiegelhalder, K., Lombardo, C. and Riemann, D. (2010). Sleep and emotions: a focus on insomnia. Sleep Medicine Reviews, 14, 227–238. http://doi.org/10.1016/j.smrv.2009.10.007Google Scholar
Barak, A., Hen, L., Boniel-Nissim, M. and Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109–160. http://doi.org/10.1080/15228830802094429Google Scholar
Bastien, C., Vallières, A. and Morin, C. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307. http://doi.org/doi:10.1016/S1389-9457(00)00065-4Google Scholar
Beck, A., Steer, R. and Brown, G. (1996). Beck Depression Inventory-II. San Antonio, 12–15. http://doi.org/10.1037/t00742-000Google Scholar
Beunckens, C., Molenberghs, G. and Kenward, M. G. (2005). Direct likelihood analysis versus simple forms of imputation for missing data in randomized clinical trials. Clinical Trials, 2, 379–386. http://doi.org/10.1191/1740774505cn119oaGoogle Scholar
Blom, K., Tarkian Tillgren, H., Wiklund, T., Danlycke, E., Forssén, M., Söderström, A. et al. (2015). Internet- vs group-delivered cognitive behavior therapy for insomnia: a randomized controlled non-inferiority trial. Behaviour Research and Therapy, 70, 47–55. http://doi.org/10.1016/j.brat.2015.05.002Google Scholar
Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L. and Morin, C. M. (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29, 1155–1173. http://doi.org/10.1093/sleep/29.9.1155Google Scholar
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L. and Morin, C. M. (2012). The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep, 35, 287–302. http://doi.org/10.5665/sleep.1642Google Scholar
Derogatis, L. (2001). BSI 18, Brief Symptom Inventory 18: Administration, scoring and procedures manual. NCS Pearson, Incorporated.Google Scholar
Espie, C. A. (2002). Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53, 215–243. http://doi.org/10.1146/annurev.psych.53.100901.135243Google Scholar
Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P. and Brown, J. S. L. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35, 769–781. http://doi.org/10.5665/sleep.1872Google Scholar
Faul, F., Erdfelder, E., Buchner, A. and Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.Google Scholar
Fernandez-Mendoza, J. and Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15, 418. http://doi.org/10.1007/s11920-013-0418-8Google Scholar
Harvey, A. G. (2002). A cognitive model of insomnia. Journal of Cognitive Psychotherapy, 18, 281–288. http://doi.org/10.1891/jcop.18.3.281.65649Google Scholar
Harvey, A. G., Sharpley, A. L., Ree, M. J., Stinson, K. and Clark, D. M. (2007). An open trial of cognitive therapy for chronic insomnia. Behaviour Research and Therapy, 45, 2491–2501. http://doi.org/10.1016/j.brat.2007.04.007Google Scholar
Irwin, M. R., Cole, J. C. and Nicassio, P. M. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25, 3–14. http://doi.org/10.1037/0278-6133.25.1.3Google Scholar
Jansson-Fröjmark, M. and Lindblom, K. (2008). A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. Journal of Psychosomatic Research, 64, 443–449. http://doi.org/10.1016/j.jpsychores.2007.10.016Google Scholar
Katz, D. A. and McHorney, C. A. (2002). The relationship between insomnia and health-related quality of life in patients with chronic illness. Journal of Family Practice, 51, 229–235.Google Scholar
Kripke, D. F., Garfinkel, L., Wingard, D. L., Klauber, M. R. and Marler, M. R. (2002). Mortality associated with sleep duration and insomnia. Archives of General Psychiatry, 59, 131–136. http://doi.org/10.1001/archpsyc.59.2.131Google Scholar
Lancee, J., Eisma, M. C., van Straten, A. and Kamphuis, J. H. (2015). Sleep-related safety behaviors and dysfunctional beliefs mediate the efficacy of online CBT for insomnia: a randomized controlled trial. Cognitive Behaviour Therapy, 44. http://doi.org/10.1080/16506073.2015.1026386Google Scholar
Lancee, J., van den Bout, J., van Straten, A. and Spoormaker, V. I. (2012). Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial. Behaviour Research and Therapy, 50, 22–29. http://doi.org/10.1016/j.brat.2011.09.012Google Scholar
Lancee, J., van Straten, A., Morina, N., Kaldo, V. and Kamphuis, J. H. (2016). Guided online or face-to-face cognitive behavioral treatment for insomnia: a randomized wait-list controlled trial. Sleep, 39, 183–191. http://doi.org/10.5665/sleep.5344Google Scholar
Léger, D., Guilleminault, C., Bader, G., Lévy, E. and Paillard, M. (2002). Medical and socio-professional impact of insomnia. Sleep, 25, 621–625. http://doi.org/10.1093/sleep/25.6.621Google Scholar
Liendl, S. and Hoffmann, R. M. (1999). Compliance-probleme bei der bearbeitung von abend-morgen-protokollen - Entwicklung einer kurzversion der standardprotokolle der DGSM. Somnologie, 3, 73–77. http://doi.org/10.1007/s11818-999-0013-8Google Scholar
Lundh, L. G. and Broman, J. E. (2000). Insomnia as an interaction between sleep-interfering and sleep-interpreting processes. Journal of Psychosomatic Research, 49, 299–310. http://doi.org/10.1016/S0022-3999(00)00150-1Google Scholar
Morin, C. M. (2006). Cognitive-behavioral therapy of insomnia. Sleep Medicine Clinics, 1, 375–386. http://doi.org/10.1016/j.jsmc.2006.06.008Google Scholar
Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A. and Lichstein, K. L. (2006a). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep, 29, 1398–1414.Google Scholar
Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P. and Merette, C. (2006b). Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7, 123–130. http://doi.org/10.1016/j.sleep.2005.08.008Google Scholar
Morin, C. M., Stone, J., Trinkle, D., Mercer, J. and Remsberg, S. (1993). Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychology and Aging, 8, 463–467. http://doi.org/10.1037/0882-7974.8.3.463Google Scholar
Morin, C. M., Vallieres, A., Guay, B., Ivers, H., Savard, J., Merette, C. et al. (2009). Cognitive behavioral therapy alone and with medication for persistent insomnia [2]. Journal of the American Medical Association, 301, 2005–1015. http://doi.org/10.1001/jama.2009.1282Google Scholar
Morris, S. B. (2008). Estimating effect sizes from pretest-posttest-control group designs. Organizational Research Methods, 11, 364–386. http://doi.org/10.1177/1094428106291059Google Scholar
Ohayon, M. M. (2011). Epidemiological overview of sleep disorders in the general population. Sleep Medicine Research, 2, 1–9. http://doi.org/sGoogle Scholar
Pigeon, W. R., Pinquart, M. and Conner, K. (2012). Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. Journal of Clinical Psychiatry, 73, e1160–e1167. http://doi.org/10.4088/JCP.11r07586Google Scholar
Ree, M. J. and Harvey, A. G. (2004). Investigating safety behaviours in insomnia: the development of the Sleep-related Behaviours Questionnaire (SRBQ). Behaviour Change, 21, 26–36. http://doi.org/10.1375/bech.21.1.26.35971Google Scholar
Riemann, D. and Perlis, M. L. (2009). The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews. http://doi.org/10.1016/j.smrv.2008.06.001Google Scholar
Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L. A., Magee, J. C., Bailey, E. T., Saylor, D. K. and Morin, C. M. (2009). Efficacy of an internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry, 66, 692–698. http://doi.org/10.1016/S8756-3452(09)79335-1Google Scholar
Ritterband, L. M., Thorndike, F. P., Ingersoll, K. S., Lord, H. R., Gonder-Frederick, L., Frederick, C. et al. (2017). Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year follow-up. JAMA Psychiatry, 74, 68. http://doi.org/10.1001/jamapsychiatry.2016.3249Google Scholar
Roth, T. and Roehrs, T. (2003). Insomnia: epidemiology, characteristics, and consequences. Clinical Cornerstone, 5, 5–15. http://doi.org/10.1016/S1098-3597(03)90031-7Google Scholar
Spiegelhalder, K., Regen, W., Feige, B., Holz, J., Piosczyk, H., Baglioni, C. et al. (2012). Increased EEG sigma and beta power during NREM sleep in primary insomnia. Biological Psychology, 91, 329–333. http://doi.org/10.1016/j.biopsycho.2012.08.009Google Scholar
Sterne, J. A. C., White, I. R., Carlin, J. B., Spratt, M., Royston, P., Kenward, M. G. et al. (2009). Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ, 338, b2393–b2393. http://doi.org/10.1136/bmj.b2393Google Scholar
Tang, N. and Harvey, A. (2004). Correcting distorted perception of sleep in insomnia: a novel behavioural experiment? Behaviour Research and Therapy, 42, 27–39. http://doi.org/10.1016/S0005-7967(03)00068-8Google Scholar
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W. and Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine, 163, 191–204. http://doi.org/10.7326/M14-2841Google Scholar
Van Straten, A., Van Der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C. M. and Lancee, J. (2017). Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis. Sleep Medicine Reviews. http://doi.org/10.1016/j.smrv.2017.02.001Google Scholar
Zachariae, R., Lyby, M. S., Ritterband, L. M. and O'Toole, M. S. (2016). Efficacy of internet-delivered cognitive-behavioral therapy for insomnia – a systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 30, 1–10. http://doi.org/10.1016/j.smrv.2015.10.004Google Scholar
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