SHUTi is unsurpassed in its research and evidence base.  Following are briefs from a 2016 meta-analysis and other top studies.

Internet Psychotherapy works, meta analysis shows.

Efficacy of internet-delivered cognitive behavioral therapy for insomnia – A systematic review and meta analysis of randomized control trials. (2016)

Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. Eleven randomized controlled trials examining a total of 1460 participants were included. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges’s g) ranging from 0.21 to 1.09. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 week follow-up. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.

Zachariae, R, Lyby MS, Ritterband, LM, O’Tolle, MS

NIH-R34 Pilot

The first National Institutes of Health (NIH) funded study evaluated the benefits of using the Internet to deliver cognitive behavioral therapy for insomnia (CBT-I) to adults with chronic insomnia. After 8 weeks, SHUTi users demonstrated greater sleep improvements than wait-list control adults in multiple areas of sleep, including reduced severity of insomnia; increased % of time spent asleep while in bed (sleep efficiency); and decreased time spent awake at night (wake after sleep onset).  There were also numerous secondary benefits for SHUTi users, including reductions in fatigue, depressed mood, and anxiety.In short, participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the wait-list control group did not change.

After SHUTi, 73% of participants no longer met criteria for insomnia
and 61% were still in remission at six-month assessment.

Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L., Magee, J. C., Bailey, E., Saylor, D. K., & Morin, C. M. (2009).Efficacy of an Internet-based behavioral intervention for adults with insomnia. Archives of General Psychiatry, 66, 692-698.

Thorndike, F.P., Ritterband, L.M., Morin, C.A, et al. Randomized Controlled Trial of an Internet Intervention for Adults with Insomnia: Effects on Comorbid Psychological and Fatigue Symptoms (2013). Journal of Clinical Psychology, Vol. 69(10), 1078–1093.

NIH-R01 Study

The current NIH-funded study expands on the R34 trial by including a broader sample, comparing SHUTi to a Patient Education website, and conducting follow-up assessments for one-year to demonstrate potential maintenance of treatment effects. In this new RCT, we will recruit 300 adults with insomnia, including those with comorbid psychological or medical conditions, as part of a 2 (Patient Education vs. SHUTi) X 4 (Pre, Post, 6 and 12 month follow-up) study design. We believe that use of SHUTi will result in greater efficacy compared to the Patient Education website at only a moderate increase in costs, resulting in a greater cost effectiveness ratio. We will also test our model for Internet interventions, and begin to identify user characteristics that may be predictive in determining symptom improvement. Because Internet interventions may ultimately be able to reduce health disparity by increasing access to care for geographically isolated patients, we will collect data regarding the sample’s access to insomnia treatment. Finally, it is important to note that this proposal is consistent with the recommendations made by the 2005 NIH State-of-the-Science for Insomnia Conference Statement calling for increased research on insomnia treatment.

This investigation was covered in JAMA, November 30, 2016.
Click here for the full article.
Click here for the editorial on this study by Andrew Krystal, MD, MS; Aric A. Prather, PhD

Cancer Survivors 

Insomnia is a common complaint among cancer survivors. Fortunately, cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be an effective treatment in this population as well. However, it is rarely implemented given its limited availability. To address this barrier, the University of Virginia Cancer Center funded a grant through the Mary Semmes Scripps Fund for Integrative Medicine to examine the ability of SHUTi, an easily-accessible online CBT-I program, to improve insomnia symptoms in cancer survivors. After using SHUTi, participants in the Internet group showed significant improvements compared to those in the control group in: overall insomnia severity; sleep efficiency; how long it took to fall asleep (sleep onset latency), soundness of sleep, feeling restored upon awakening, and general fatigue.In sum, CBT-I delivered through an interactive, individually-tailored Internet intervention appears to be a viable treatment option for cancer survivors experiencing insomnia.

Visit this page to view the National Cancer Institute’s Research-tested Invention Program rating of SHUTi.

Ritterband, L. M., Bailey, E. T., Thorndike, F. P., Lord, H. R., Farrell-Carnahan, L., & Baum, L. D. (2012). Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psycho-Oncology, 21(7), 695-705.

Insomnia in epilepsy is associated with continuing seizures and worse quality of life.

Insomnia is common in epilepsy, and is associated with short term poor seizure control and worse QOL. Future studies must evaluate cause-and-effect relationships. Assessment of insomnia may be important in the comprehensive care of epilepsy and may influence control of epileptic seizures. http://www.ncbi.nlm.nih.gov/pubmed/26994361   

Quigg M, Gharai S, Ruland J, Schroeder C, Hodges M, Ingersoll KS, Thorndike FP, Yan G, Ritterband LM.  Epilepsy Res. 2016 May;122:91-6. doi: 10.1016/j.eplepsyres.2016.02.014. Epub 2016 Mar 2.

Top peer-reviewed publications related to SHUTi 

  • Internet Psychotherapy works, meta-analysis shows. Efficacy of internet-delivered cognitive behavioral therapy for insomnia – A systematic review and meta-analysis of randomized control trials.
    • February 2016
    • Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. Eleven randomized controlled trials examining a total of 1460 participants were included. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges’s g) ranging from 0.21 to 1.09. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 week follow-up. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.
    • Zachariae, R, Lyby MS, Ritterband, LM, O’Tolle, MS
  • Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial.
    • The Lancet Psychiatry
    • February 2016
    • Online cognitive behaviour therapy for insomnia treatment is a practical and effective way to reduce depression symptoms and could be capable of reducing depression at the population level by use of a fully automatised system with the potential for wide dissemination.
    • Christensen et al.
  • Randomized Controlled Trial of an Internet Intervention for Adults with Insomnia: Effects on Comorbid Psychological and Fatigue Symptoms.
    • Journal of Clinical Psychology
    • 2013
    • Thorndike, F.P., Ritterband, L.M., Gonder-Frederick, L., Lord, H.R., Ingersoll, K. S. & Morin, C. Morin, C.A.
  • Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia.
    • Psycho-Oncology
    • 2012
    • Ritterband, L. M., Bailey, E. T., Thorndike, F. P., Lord, H. R., Farrell-Carnahan, L., & Baum, L. D.
  • Efficacy of an Internet-based behavioral intervention for adults with insomnia.
    • 2009
    • Archives of General Psychiatry
    • Ritterband, L. M., Thorndike, F. P., Gonder-Frederick, L., Magee, J. C., Bailey, E., Saylor, D. K., & Morin, C. M.
  • Development and perceived utility and impact of an Internet intervention for insomnia.
    • 2008
    • Journal of Applied Psychology, 4(2), 32-42.
    • Thorndike, F. P., Saylor, D. K., Bailey, E. T., Gonder-Frederick, L. A., Morin, C. M., Ritterband,

SHUTi Trials

  1. Randomized Controlled Trial (RCT) comparing SHUTi to a waitlist control group, showing that adults using SHUTi improved their sleep and maintained these gains at 6-month follow-up (NIH funded).
  2. RCT evaluating the efficacy of SHUTi in cancer survivors with insomnia. Outcomes were positive and comparable to what was seen in healthy adults with insomnia.  (UVA Cancer Center funded).
  3. A large RCT comparing SHUTi to online patient education over one year (NIH funded). Participants with comorbidities were eligible to participate.
  4. RCT testing whether SHUTi can reduce depression symptoms and subsequently prevent onset of depression in the future in an at-risk sample (Australia).
  5. RCT evaluating whether SHUTi, in combination with depression treatment, can result in better outcomes for depressed men than when depression treatment does not include treatment for insomnia (Australia).
  6. RCT testing a Norwegian version of SHUTi (evaluating issues of internationalization, Norway).
  7. RCT comparing SHUTi with Face-to-Face CBT for insomnia (Norway). Status: Ongoing RCT.
  8. RCT evaluating a Danish version of SHUTi for breast cancer survivors with insomnia. (Denmark).
  9. RCT testing 3 arms (one being SHUTi) in a sample of primary care patients with hypertension (part of study is evaluating its implementation in primary care and use of EMR to identify appropriate patients and communicate with providers about progress of patients in study arms). Status: Ongoing RCT.
  10. RCT evaluating long-term outcomes in a large Norwegian sample who are already part of a large cohort being tracked over time with multiple biomarkers via blood analysis. (Norway). Status: Ongoing RCT.
  11. RCT evaluating an optimized version of SHUTi in older adults. Status: In planning.

The development of the SHUTi program was conducted by the Behavioral Health & Technology program at the University of Virginia and supported by Grant Numbers R34MH70805 and R01MH086758 from the National Institute of Mental Health (NIMH). All of these studies were conducted by the Behavioral Health & Technology program at the University of Virginia.