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Title: Efficacy of a theory-based cognitive behavioral technique app-based intervention for patients with insomnia : randomized controlled trial
Authors: Majd, NR
Brostrom, A
Ulander, M
Lin, C 
Griffiths, MD
Imani, V
Ahorsu, DK 
Ohayon, MM
Pakpour, AH
Issue Date: 2020
Source: Journal of medical Internet research, 1 Apr. 2020, v. 22, no. 4, e15841, p. 1-17
Abstract: Background: Sleep hygiene is important for maintaining good sleep and reducing insomnia. Objective: This study examined the long-term efficacy of a theory-based app (including cognitive behavioral therapy [CBT], theory of planned behavior [TPB], health action process approach [HAPA], and control theory [CT]) on sleep hygiene among insomnia patients.
Methods: The study was a 2-arm single-blind parallel-group randomized controlled trial (RCT). Insomnia patients were randomly assigned to a treatment group that used an app for 6 weeks (ie, CBT for insomnia [CBT-I], n=156) or a control group that received only patient education (PE, n=156) through the app. Outcomes were assessed at baseline and 1 month, 3 months, and 6 months postintervention. Primary outcomes were sleep hygiene, insomnia, and sleep quality. Secondary outcomes included attitudes toward sleep hygiene behavior, perceived behavioral control, behavioral intention, action and coping planning, self-monitoring, behavioral automaticity, and anxiety and depression. Linear mixed models were used to evaluate the magnitude of changes in outcomes between the two groups and across time.
Results: Sleep hygiene was improved in the CBT-I group compared with the PE group (P=.02 at 1 month, P=.04 at 3 months, and P=.02 at 6 months) as were sleep quality and severity of insomnia. Mediation analyses suggested that perceived behavioral control on sleep hygiene as specified by TPB along with self-regulatory processes from HAPA and CT mediated the effect of the intervention on outcomes.
Conclusions: Health care providers might consider using a CBT-I app to improve sleep among insomnia patients.
Keywords: App-based intervention
Cognitive behavioral therapy, insomnia
Sleep hygiene
Theory of planned behavior
Publisher: JMIR Publications, Inc.
Journal: Journal of medical Internet research 
ISSN: 1439-4456
EISSN: 1438-8871
DOI: 10.2196/15841
Rights: ©Nilofar Rajabi Majd, Anders Broström, Martin Ulander, Chung-Ying Lin, Mark D Griffiths, Vida Imani, Daniel Kwasi Ahorsu, Maurice M Ohayon, Amir H Pakpour. Originally published in the Journal of Medical Internet Research (, 01.04.2020.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
The following publication Rajabi Majd N, Broström A, Ulander M, Lin CY, Griffiths MD, Imani V, Ahorsu DK, Ohayon MM, Pakpour AH. Efficacy of a Theory-Based Cognitive Behavioral Technique App-Based Intervention for Patients With Insomnia: Randomized Controlled Trial. J Med Internet Res 2020;22(4):e15841 is available at
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