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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).
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).
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.
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.
A prospective study of 47 married women who met RDC for major depressive disorder investigated the relationship between the social support provided by the husbands and the post-hospital symptom course of the women. Separate taped semistructured interviews were held with the patient and husband at the time of admission. Six months later, symptom course was rated using the LIFE psychiatric status schedule. Only 51 % of the sample recovered in the six months. Few demographic or clinical factors were related to symptom course. Recovery was predicted by the depressed woman's ratings of the current marital relationship and by the husband's rating of the pre-morbid relationship but not by the husband's level of expressed criticism or his ratings of the current relationship.
In a 2-year study of conjugal bereavement, 26 of 99 women remained highly distressed throughout the course of the study. Of the remaining 73 women, 30 never gave evidence of ‘high distress’. Deficits in social support, health and financial problems correlate with enduring ‘high distress’. Personality traits consonant with a socially acceptable and expected ‘widow role’ were found to differentiate the women with enduring ‘low distress’.
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