Psychological Medicine

Original Articles

Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

A. van Stratena1a2 c1, J. Emmelkampa1a2, J. de Wita1a2, J. Lanceea3, G. Anderssona4a5, E. J. W. van Somerena6a7 and P. Cuijpersa1a2

a1 Department of Clinical Psychology, VU University Amsterdam, The Netherlands

a2 EMGO Institute for Health and Care Research, The Netherlands

a3 University of Amsterdam (UvA), Department of Clinical Psychology, The Netherlands

a4 Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden

a5 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

a6 Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands

a7 Departments of Integrative Neurophysiology and Medical Psychology, Centre for Neurogenomics and Cognitive Research, VU University and Medical Centre, Amsterdam, The Netherlands


Background Insomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).

Method A total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).

Results Almost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.

Conclusions This study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.

(Received October 10 2012)

(Revised July 07 2013)

(Accepted August 05 2013)

(Online publication September 04 2013)

Key words

  • Behaviour therapy;
  • cognitive therapy;
  • Internet;
  • sleep disorders;
  • sleep initiation and maintenance disorders


c1 Address for correspondence: A. van Straten, Ph.D., VU University, FPP, Department of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: