June 3, 2009 A study in the June 1 issue of the journal SLEEP demonstrates that online cognitive behavioral therapy (CBT) for chronic insomnia significantly improves insomnia severity, daytime fatigue, and sleep quality. Online treatment also reduces erroneous beliefs about sleep and pre-sleep mental arousal.
Results indicate that 81 percent of treated participants (30 of 37) reported at least mild improvement in their sleep after completing the five-week program, including 35 percent (13 of 37) who rated themselves as much or very much improved. Thirty percent of treatment group completers were receiving an additional hour of sleep at the end of the program. Those who received treatment also developed healthier attitudes about sleep and were less likely to report having an overactive mind at bedtime.
According to principal investigator Norah Vincent, PhD, psychologist at the University of Manitoba in Winnipeg, Canada, the researchers were surprised by the significant results in the absence of any ongoing support from a clinician. The treatment program consisted of psychoeducation about insomnia, information concerning sleep hygiene, stimulus control instruction, relaxation training, sleep restriction and cognitive therapy.
"Although each segment of the CBT program is important, the cognitive therapy module was the most positively rated," said Vincent. "The cognitive therapy section was designed to help individuals to develop realistic expectations about sleep and the impact of sleep on next-day functioning while teaching a variety of strategies for coping with an overactive mind and worries."
The study involved118 adults with chronic insomnia who were referred to a teaching hospital behavioral medicine sleep clinic or who had responded to a newspaper advertisement. Those included in the study were required to have high-speed Internet access and a home computer, as well as an insomnia complaint with daytime impairment occurring more than four nights a week for six months or longer.
Participants were randomly assigned to a treatment or wait-list group; those on the wait list were informed that they would receive access to treatment once their follow-up data was received, and they were asked to refrain from treatment-seeking during the course of the study. Individuals receiving treatment engaged in online CBT from home for five weeks with no clinician interaction. The online treatment used audiovisual clips as the main teaching component, downloadable mp3 files for relaxation training and PDF files for psychoeducation and cognitive therapy. Findings were based on self-reported data gathered from a post-treatment questionnaire packet and sleep diaries.
There was a 33-percent drop-out rate, and physician-referred participants were significantly more likely to drop out than community-recruited participants. According to the authors, the rate of attrition for North American in-person psychotherapy is 22 percent.
Vincent said that most individuals could potentially benefit from online CBT for chronic insomnia, as the program has been used successfully by people ranging in age from 18 to 80 years. The researchers speculate that the program also could help teenagers.
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- Norah Vincent, Samantha Lewycky. Logging on for Better Sleep: RCT of the Effectiveness of Online Treatment for Insomnia. SLEEP, 2009; 32 (06): 807-815 [link]
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