K Bothelius a, S Jernelöv b,c, V Kaldo b,d, C Lu e, M-M Stråle e, & M Jansson-Fröjmark b

a Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
b Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
c Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
d Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
e Department of Psychology, Uppsala University, Uppsala, Sweden

Background: Most individuals with longstanding pain experience comorbid sleep problems, and cognitive behavioural therapy for insomnia (CBT-i) has been shown to be effective for this population. However, studies on internet-based CBT-i (ICBT-i) have been sparse.

Aim: The aims of the present study were to examine the effects and feasibility of ICBT-I and to assess putative treatment mechanisms.

Method: Eighty-five participants with insomnia comorbid with chronic pain were randomised to ICBT-i or internet-based applied relaxation, IAR. The treatments were delivered over a period of eight weeks with therapist support provided during the entire period.

Results: Both groups showed a statistically significant improvement in insomnia symptoms after treatment, but there was no statistically significant interaction effect. However, IAR gave a larger improvement than ICBT-i regarding pain-related interference, anxiety severity, and self-rated health directly after treatment. These between-group differences were reduced at follow-up. Decreased sleep-related dysfunctional cognitions and increased sleep-related willingness were shown to be possible treatment-moderating mechanisms. The average number of completed treatment modules was 2.0 out of 8.

Conclusion: Both groups showed improvement in insomnia symptoms after treatment, but there was no difference between the two treatments, and the group differences in secondary outcome measures seen after treatment had diminished at follow-up. One notable finding was a high dropout rate; around a third of the subjects dropped out before finishing any treatment modules. For internet-based insomnia treatments to be a valuable clinical option in chronic pain management, this risk of dropout needs to be addressed.