Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Efficacy of Web-Based CBT for Insomnia

JAMA Psychiatry; ePub 2016 Nov 30; Ritterband, et al

Effective behavioral treatments for insomnia may be achieved with internet-delivered cognitive behavior therapy for insomnia (CBT-I), a recent study found. This randomized clinical trial included 303 adults (mean age 43.38 years; 71.9% female) with chronic insomnia and compared the Internet CBT-I with internet patient education at baseline, 9 weeks, 6 months, and 1 year. Primary sleep outcomes were self-reported online ratings of insomnia severity and online sleep diary-derived values for sleep-onset latency and wake after sleep onset, collected prospectively for 10 days at each assessment period. Researchers found:

  • 151 participants were randomized to the Sleep Healthy Using the Internet (SHUTi) group and 152 to the online patient education group.
  • Results of the 3 primary sleep outcomes showed that the overall group×time interaction was significant for all variables, favoring the SHUTI group, sleep-onset latency, and wake after sleep onset.
  • Within-group effect sizes demonstrated improvements from baseline to postassessment for SHUTi participants.
  • Treatment effects were maintained at 1-year follow-up, with 56.6% achieving remission status and 69.7% deemed treatment responders at 1 year.


Ritterband LM, Thorndike FP, Ingersoll KS, et al. Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year follow-up. A randomized clinical trial. [Published online ahead of print November 30, 2016]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.3249.


Chronic insomnia is defined as having symptoms that cause clinically significant functional distress or impairment and present for at least 3 nights per week for at least 3 months.1 According to these stringent criteria, approximately 10% of the population suffers from insomnia. A recent ACP guideline, based on a vigorous evidence review, recommends CBT tailored for insomnia (CBT-I) as the initial treatment for insomnia. The problem with implementing this recommendation is that it is hard to find therapists that do CBT-I, but this study shows that CBT-I can be made available through an automated, web-based program. The program, SHUTi, leads patients through one 25-45 minute session a week for 6 weeks. With proven short and long-term efficacy, this is an excellent option for patients. —Neil Skolnik, MD

  1. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133.