MedicalResearch.com Interview with:
Lee M. Ritterband, Ph.D.
Professor, Department of Psychiatry and Neurobehavioral Sciences
Director, Center for Behavioral Health and Technology
University of Virginia School of Medicine
Ivy Foundational Translational Research Building
Charlottesville, VA 22903
MedicalResearch.com: What is the background for this study?
Response: Cognitive behavioral therapy for insomnia, a non-pharmacological intervention, is the first line recommendation for adults with chronic insomnia (see recommendations made earlier this year from the American College of Physicians). Access to CBT-I, however, is limited by numerous barriers, including a limited supply of behavioral medicine providers. One way to help improve access to this effective treatment is to develop and evaluate additional delivery methods of CBT-I, including Internet-delivered CBT-I.
This study was designed to evaluate the efficacy of an Internet-delivered CBT-I program (SHUTi: Sleep Healthy Using The Internet) over the short-term (9-weeks) and long-term (1-year).
MedicalResearch.com: What are the main findings?
Response: Adults with insomnia who were randomized to receive SHUTi, a fully automated, tailored intervention for insomnia, experienced significant and clinically meaningful improvements in their sleep compared to those who were randomized to receive online patient education. At one-year follow-up, 70% of SHUTi users were deemed “treatment responders” and 57% were in “treatment remission” (no insomnia).
MedicalResearch.com: What should readers take away from your report?
Response: Achieving a meaningful treatment response, or even remission, from insomnia through a fully automated Internet-delivered program has important public health implications for the millions of people who suffer from this prevalent and costly problem. This Internet intervention without human support resulted in outcomes that are similar to outcomes reported in trials that include face-to-face CBT for insomnia. This gives us an easily accessible, convenient, and low cost method to help the millions of people who suffer from sleep problems. To be clear, we are not trying to replace face-to-face CBT for insomnia, but rather expand access and work to find additional ways to meet the needs of the 30 million Americans who have insomnia.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: In multiple research trials, we are seeing that Internet-delivered CBT-I can improve insomnia and have a lasting benefit, even among those with severe symptoms and a chronic condition. Research is needed, though, to determine who might be best suited for online CBT-I. This study shows that even people with medical and psychiatric comorbidities did well with the online program for insomnia. However, what other characteristics might make a difference? Will age or comfort with technology predict who will do well with one approach versus another?
MedicalResearch.com: Is there anything else you would like to add?
Response: One additional point to note is that participants in this study were more typical of people in the “real world” with about half having other health or mental health concerns in addition to insomnia. Often people with comorbid conditions are excluded from these types of trials, but by including them, we were able to see that people with insomnia and a medical or psychiatric comorbidity still benefitted from the automated program. This provides additional information about who can do well with this type of program.
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Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C, Quigg MS, Cohn WF, Morin CM. Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-upA Randomized Clinical Trial . JAMA Psychiatry. Published online November 30, 2016. doi:10.1001/jamapsychiatry.2016.3249
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