A randomized controlled trial comparing guided internet-based multi-component treatment and internet-based guided sleep restriction treatment to care as usual in insomnia

Tobias Krieger; Antoine Urech; Simone B Duss; Larissa Blättler; Wolfgang Schmitt; Heidemarie Gast; Claudio Bassetti; Thomas Berger

doi:10.1016/j.sleep.2019.01.045

A randomized controlled trial comparing guided internet-based multi-component treatment and internet-based guided sleep restriction treatment to care as usual in insomnia

Sleep Med. 2019 Oct:62:43-52. doi: 10.1016/j.sleep.2019.01.045. Epub 2019 Feb 22.

Authors

Tobias Krieger¹, Antoine Urech², Simone B Duss³, Larissa Blättler⁴, Wolfgang Schmitt⁵, Heidemarie Gast³, Claudio Bassetti³, Thomas Berger⁴

Affiliations

¹ Institute for Psychology, University of Bern, Bern, Switzerland. Electronic address: tobias.krieger@psy.unibe.ch.
² Institute for Psychology, University of Bern, Bern, Switzerland; Neurorehabilitation Dept. of Neurology, Hospital and University of Bern, Riggisberg, Switzerland.
³ Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland.
⁴ Institute for Psychology, University of Bern, Bern, Switzerland.
⁵ Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland; University Hospital of Psychiatry and Psychotherapy Bern, Switzerland.

PMID: 31541851
DOI: 10.1016/j.sleep.2019.01.045

Abstract

Background: Internet-based cognitive behavioral treatment (iCBT-I) for insomnia comprising different sleep-related cognitive and behavioral interventional components has shown some promise. However, it is not known which components are necessary for a good treatment outcome.

Method: People suffering from insomnia (N = 104) without any other comorbid psychiatric disorders were randomized (2:2:1) to two guided internet-based self-help interventions for insomnia [multi-component cognitive behavioral self-help intervention (MCT); sleep restriction intervention for insomnia (SRT)], and care as usual [CAU]. In all three conditions, additional care or treatment was allowed. The primary outcome was insomnia severity measured with the insomnia severity index (ISI) at eight weeks. Furthermore, the two active conditions were compared regarding sleep efficacy from daily diary data over the eight weeks, and other measures from the daily protocols. Secondary outcomes included sleep quality, depressive symptoms, dysfunctional beliefs, and quality of life at post-treatment (eight weeks) and follow-up (six months after randomization).

Results: Both conditions were more effective than CAU at post-treatment, with medium to large between-group effect sizes on the primary outcome (ISI; MCT: Cohen's d = -1.15; SRT: d = -0.68) and small to medium between-group effect sizes for secondary outcomes. Treatment gains were maintained at six-month follow-up. Active conditions did not differ from each other on all measures from pre to post, except for dysfunctional beliefs about sleep, and sleep protocol data throughout the intervention. Participants in MCT were significantly more satisfied with the intervention than participants in SRT.

Conclusions: Results of the present study indicate that CAU + MCT and CAU + SRT are both effective compared to CAU. There were no statistical differences regarding efficacy between the two active conditions, but participants in MCT reported to be more satisfied with the intervention.

Keywords: Cognitive behavioral treatment; Insomnia; Internet-based intervention; Online intervention; Sleep restriction.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Behavioral Therapy / instrumentation*
Culture
Depression / epidemiology
Depression / psychology
Female
Humans
Internet-Based Intervention / statistics & numerical data*
Internet-Based Intervention / trends*
Male
Middle Aged
Patient Satisfaction / statistics & numerical data
Quality of Life
Severity of Illness Index
Sleep
Sleep Initiation and Maintenance Disorders / psychology
Sleep Initiation and Maintenance Disorders / therapy*
Treatment Outcome