TY  - JOUR
AU  - Sato, Daisuke
AU  - Sekizawa, Yoichi
AU  - Sutoh, Chihiro
AU  - Hirano, Yoshiyuki
AU  - Okawa, Sho
AU  - Hirose, Motohisa
AU  - Takemura, Ryo
AU  - Shimizu, Eiji
PY  - 2022
DA  - 2022/2/9
TI  - Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy and the Three Good Things Exercise for Insomnia: 3-Arm Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e28747
VL  - 24
IS  - 2
KW  - insomnia
KW  - internet-based treatment
KW  - cognitive behavioral therapy
KW  - positive psychology
KW  - randomized controlled trial
KW  - mobile phone
AB  - Background: The treatment of insomnia with sleep medication causes problems such as long-term use, dependence, and significant economic losses, including medical expenses. Evidence-based lifestyle guidance is required to improve insomnia symptoms not only in person but also in easy-to-use web-based formats. Objective: This study aims to clarify whether unguided internet-based cognitive behavioral therapy (ICBT) or the Three Good Things (TGT) exercise, both administered as self-help internet interventions without email support, could improve insomnia symptoms compared with a waiting list control (WLC) group. Methods: A 4-week program was implemented, and participants were randomly allocated to 1 of the 3 groups. The primary outcome measure was the Pittsburgh Sleep Questionnaire (PSQI) score at 4 weeks compared with baseline. Results: Of the 21,394 individuals invited to participate, 312 (1.46%) met the eligibility criteria and were randomly assigned to 1 of the 3 groups. Of these 312 individuals, 270 (86.5%; ICBT 79/270, 29.3%; TGT 88/270, 32.6%; and WLC 103/270, 38.1%) completed a postintervention survey at 4 and 8 weeks. The adjusted mean changes of the primary outcome measure (PSQI) in the ICBT (−1.56, 95% CI −2.52 to −0.59; P<.001) and TGT (−1.15, 95% CI −2.08 to −0.23; P=.002) groups at 4 weeks from baseline showed a significant improvement compared with the WLC group. The adjusted mean changes in the secondary outcome measures of sleep onset latency, total sleep time, Athens Insomnia Scale score, and Patient Health Questionnaire-9 score at 4 weeks from baseline, as well as in the PSQI at 8 weeks from baseline, showed significant improvement for ICBT. Moreover, total sleep time, Athens Insomnia Scale, and Patient Health Questionnaire-9 scores at 4 weeks from baseline showed a significant improvement in the TGT group compared with the WLC group. Conclusions: A total of 4 weeks of unguided ICBT and TGT exercises improved insomnia. Trial Registration: University Hospital Medical Information Network Clinical Trial Registry UMIN000034927; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000039814 
SN  - 1438-8871
UR  - https://www.jmir.org/2022/2/e28747
UR  - https://doi.org/10.2196/28747
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35138259
DO  - 10.2196/28747
ID  - info:doi/10.2196/28747
ER  -