Guided Online or Face to Face Cognitive Behavioral Treatment for Insomnia: A Randomized Wait List Controlled Trial.
STUDY OBJECTIVES To compare the efficacy of guided online and individual face to face cognitive behavioral treatment for insomnia (CBT I) to a wait list condition. METHODS A randomized controlled trial comparing three conditions: guided online; face to face; wait list. Posttest measurements were administered to all conditions, along with 3 and 6 mo follow up assessments to the online and face to face conditions. Ninety media recruited participants meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) criteria for insomnia were randomly allocated to either guided online CBT I (n 30) individual face to face CBT I (n 30) or wait list (n 30) RESULTS At post assessment, the online (Cohen d 1.2) and face to face (Cohen d 2.3) intervention groups showed significantly larger treatment effects than the wait list group on insomnia severity (insomnia severity index) Large treatment effects were also found for the sleep diary estimates (except for total sleep time) and anxiety and depression measures (for depression only in the face to face condition) Face to face treatment yielded a statistically larger treatment effect (Cohen d 0.9) on insomnia severity than the online condition at all time points. In addition, a moderate differential effect size favoring face to face treatment emerged at the 3 and 6 mo follow up on all sleep diary estimates. Face to face treatment further outperformed online treatment on depression and anxiety outcomes. CONCLUSIONS These data show superior performance of face to face treatment relative to online treatment. Yet, our results also suggest that online treatment may offer a potentially cost effective alternative to and complement face to face treatment. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT01955850. COMMENTARY A commentary on this article appears in this issue on page 13.
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