Cognitive Behavior Therapy for Insomnia Delivered by a Therapist or on the Internet

Cognitive Behavior Therapy for Insomnia Delivered by a Therapist or on the Internet: a Randomized Controlled Noninferiority Trial

Background: Insomnia is a highly prevalent and disabling disorder where Cognitive Behavior Therapy for Insomnia (CBT-I) is established as the best available treatment. Still, only a negligible number of patients with insomnia receive this treatment. One potential way of improving the dissemination of CBT-I is by using online adaptations of CBT-I. This is a new method for delivering CBT-I and it is not known how effective online treatment is compared to face-to-face CBT-I. This trial's purpose is to compare face-to-face CBT-I with online CBT-I. Because of the great advantage of online treatment in both availability and cost, the trial is designed as a noninferiority trial.

Aim: To test if online CBT-I is noninferior in reducing insomnia complaints compared with CBT-I as delivered face-to-face by a therapist.

Inclusion Criteria:

• meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnostic criteria for insomnia disorder

Exclusion Criteria:

• a condition that renders the patient incapable of understanding the treatment (e.g. actively psychotic, mental retardation, dementia or others
• an ongoing substance abuse problem
• other organic sleep disturbances or circadian sleep disturbance
• an ongoing medical condition where treatment of insomnia is not indicated (e.g. an attack phase of multiple sclerosis)
• working night shifts and being unable to discontinue this work pattern
• not being sufficiently fluent in Norwegian to understand the assessments or treatment
• not having the necessary computer skills needed to log on to the web based program