Internet Based Treatment of Insomnia

By Dr. Gregg D. Jacobs

This study, published in a recent issue of the Journal of Consulting and Clinical Psychology (2004; 72:113-120), was conducted by Dr. Lars Strom and colleagues at the University of Uppsala in Sweden . It assessed the efficacy of cognitive-behavioral therapy (CBT) for sleep-onset and sleep-maintenance insomnia administered via the internet.

Although individuals with insomnia prefer CBT over pharmacotherapy for the treatment of insomnia, and CBT is more effective than pharmacotherapy for insomnia, CBT is often unavailable due to a lack of clinicians with expertise in CBT for insomnia. For this reason, there has been increased interest in empirically evaluating CBT administered in self-help format. Although five studies have now been conducted on self-help CBT for insomnia, and some studies have shown improvements with self-help CBT comparable to therapist administered CBT, none of these studies have employed internet-based self-help CBT for insomnia. However, internet-based self-help treatments have already been shown to be effective for other health problems such as panic disorder.

In this study, the internet was used to evaluate and treat patients with insomnia. 109 subjects enrolled in the study, of which 28 dropped out. The final sample of 81 subjects was randomized to either internet-based CBT or a waiting list control group.

The results showed that the CBT group exhibited greater improvements on measures of sleep latency, total wake time, total sleep time, and sleep efficiency than the control group. However, the control group also showed improvement on these measures, and changes in sleep onset latency were not significantly greater in the CBT group as compared to the control group.

The authors concluded that CBT administered in self-help format via the internet holds promise as a potential treatment for chronic insomnia. Future studies should compare the efficacy of internet-based self-help CBT to book-based self-help CBT as well as clinic-based treatment. The prospect of making CBT more available via the internet is promising.