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January 2017

Should Internet Cognitive Behavioral Therapy for Insomnia Be the Primary Treatment Option for Insomnia?Toward Getting More SHUTi

Author Affiliations
  • 1Department of Psychiatry, University of California, San Francisco
  • 2Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
JAMA Psychiatry. 2017;74(1):15-16. doi:10.1001/jamapsychiatry.2016.3431

Insomnia is a prevalent, often debilitating, sleep disorder with significant consequences for physical health and well-being. With as many as 50% of adults reporting insomnia symptoms at least intermittently and up to 20% of adults meeting diagnostic criteria for insomnia disorder, there is an acute need for effective interventions.1 Treatments established to be safe and efficacious for this condition include a variety of different medications and cognitive behavioral therapy for insomnia (CBT-I), which focuses on improving homeostatic sleep drive, standardizing circadian rhythm, breaking any conditioned arousal associated with the nighttime environment, and reorienting maladaptive cognitions about sleep and one’s ability to cope effectively after a night of poor sleep. Of these, CBT-I has advantages in terms of risks and sustained efficacy.2 Unfortunately, clinicians who have the necessary expertise in delivering CBT-I are scarce, which has led many researchers, as well as entrepreneurs, to leverage technology to deliver CBT-I to individuals who are unable or unwilling to meet with a clinician or who prefer the convenience and potentially lower cost of an internet-based treatment.

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