July 7, 2009 — The estimated one-third of adults who suffer from insomnia could soon find effective treatment without ever leaving their homes. Researchers at the University of Virginia Health System have developed a unique Internet-based intervention, based on well-established face-to-face cognitive behavioral therapy techniques, that has shown remarkable results in improving patients' sleep.
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In the pilot study, Lee M. Ritterband, an associate professor of psychiatry and neurobehavioral sciences at the U.Va. School of Medicine, and colleagues evaluated the effectiveness of the Internet intervention among 44 adults who had a history of sleep difficulties lasting more than 10 years on average. Half were randomly assigned to a control group and half received the Internet intervention, called SHUTi.
"All 44 patients were in the moderate severity range for insomnia when we began our study," Ritterband said. "After completing our study, 73 percent of those who used our system reported no severity of insomnia, whereas all patients who didn't use the system continued to have the same level of moderate severity."
Furthermore, Ritterband reports that all patients with improved sleep after using the Internet intervention maintained these improvements six months after the study's completion. The study, supported by a grant from the National Institute of Mental Health, National Institutes of Health, appears in the July issue of Archives of General Psychiatry.
The highly interactive nine-week program uses text, graphics, animations, vignettes, quizzes and games to present behavioral, educational and cognitive techniques for improving sleep.
For instance, patients were advised to avoid reading and watching television in the bedroom, stop daytime napping and change unhelpful beliefs and thoughts (including worries about the consequences of insomnia) that may exacerbate sleep difficulties.
"Our program is unique in that it engages the user and tailors the treatment to an individual's particular needs," Ritterband said. "These interactive components make it like no other online intervention for insomnia out there right now."
Participants completed daily sleep diaries before and after the intervention and also rated their symptoms on the seven-item Insomnia Severity Index, which produces a score from zero (no symptoms) to 28 (severe insomnia). Among individuals who received the intervention, scores on the index improved from 15.73 to 6.59, whereas scores did not change for the control group. These gains were maintained at a six-month follow-up assessment.
"One of the exciting pieces of Internet-based interventions is to be able to provide treatment to people who otherwise might not get treatment," Ritterband said.
Cognitive behavioral therapy – a psychological treatment focusing on the behaviors and dysfunctional thoughts that contribute to sleep problems – is one of the most effective treatments for insomnia.
"Unfortunately, availability of cognitive behavioral therapy is severely limited for many reasons, including lack of trained clinicians, poor geographical distribution of knowledgeable professionals, expense and inaccessibility to treatment and clinicians," Ritterband said.
"An Internet intervention has the potential of meeting the large unmet treatment needs of the population with insomnia by providing effective treatment through the Web. An effective and inexpensive Internet intervention would expand treatment options for large numbers of adults with insomnia, especially those whose geographical location prohibits access to relevant care, and could be a substantive first-line treatment choice."