Tobias Krieger1, Antoine Urech2, Simone B Duss3, Larissa Blättler4, Wolfgang Schmitt5, Heidemarie Gast3, Claudio Bassetti3, Thomas Berger4. 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.
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.
RCT Entities:
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.
Authors: Simon D Kyle; Claire Madigan; Nargis Begum; Lucy Abel; Stephanie Armstrong; Paul Aveyard; Peter Bower; Emma Ogburn; Aloysius Siriwardena; Ly-Mee Yu; Colin A Espie Journal: BMJ Open Date: 2020-03-04 Impact factor: 2.692