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Volume 15 No. 01
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Accepted Papers

Scientific Investigations

Long-Term Effects of an Unguided Online Cognitive Behavioral Therapy for Chronic Insomnia

Øystein Vedaa, PhD1,2,3; Susanne Hagatun, PhD3,4; Håvard Kallestad, PhD1,2; Ståle Pallesen, PhD5,6; Otto R.F. Smith, PhD3; Frances P. Thorndike, PhD7; Lee M. Ritterband, PhD8; Børge Sivertsen, PhD1,3,9
1Norwegian University of Science and Technology, Department of Mental Health, Faculty of Medicine and Health Sciences, Trondheim, Norway; 2St. Olavs University Hospital, Division of Mental Health Care, Department of Østmarka, Trondheim, Norway; 3Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; 4Department of Clinical Psychology, University of Bergen, Bergen, Norway; 5Department of Psychosocial Science, University of Bergen, Bergen, Norway; 6Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway; 7BeHealth Solutions, Charlottesville, Virginia; 8Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, Virginia; 9Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway

Study Objectives:

The aim of this study was to test the efficacy of fully automated Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) 18 months after the intervention period on sleep, daytime functioning, and beliefs about sleep for adults with chronic insomnia.


Participants in this study had participated in a randomized controlled trial comparing the efficacy of unguided Internet CBT-I with web-based patient education. Participants who had received Internet CBT-I (n = 95) completed online questionnaires and online sleep diaries 18 months after the intervention period. We used linear mixed models to study changes from baseline to postassessment and to 18-month follow-up, and a separate mixed-models analysis to study changes from postassessment to 18-month follow-up.


Mean age of the participants was 45.5 years (standard deviation = 12.6) and 64% were females. Sixty-six participants (70%) completed the 18-month follow-up assessment. There were significant improvements from baseline to 18-month follow-up on the Insomnia Severity Index (ISI) (Cohen d = 2.04 [95% confidence interval (CI) 1.66–2.42]) and the Bergen Insomnia Scale (BIS) (d = 1.64 [95% CI 1.30–1.98]), levels of daytime fatigue (d = 0.85 [95% CI 0.59–1.11]), psychological distress (d = 0.51 [95% CI 0.29–0.73]), and beliefs about sleep (d = 1.44 [95% CI 1.15–1.73]). Moderate to large effect size improvements were also shown on the diary-derived sleep variables. All improvements from baseline to postassessment were essentially maintained to 18-month follow-up.


Unguided Internet CBT-I appears to have sustained effects on sleep, daytime functioning, and beliefs about sleep up to 18 months after the intervention period.

Clinical Trial Registration:

This study presents long-term follow-up data of a previous clinical trial. Registry:, Title: Internet-based Treatment for Insomnia in Norway, Identifier: NCT02261272, URL:


Vedaa Ø, Hagatun S, Kallestad H, Pallesen S, Smith OR, Thorndike FP, Ritterband LM, Sivertsen B. Long-term effects of an unguided online cognitive behavioral therapy for chronic insomnia. J Clin Sleep Med. 2019;15(1):101–110.

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