{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:26:01Z","timestamp":1790756761087,"version":"4.1.0"},"reference-count":80,"publisher":"JMIR Publications Inc.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sleep complaints are among the most prevalent health concerns, especially among workers, which may lead to adverse effects on health and work. Internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) offers the opportunity to deliver effective solutions on a large scale. The efficacy of iCBT-I for clinical samples has been demonstrated in recent meta-analyses, and there is evidence that iCBT-I is effective in the working population with severe sleep complaints. However, to date, there is limited evidence from randomized controlled trials that iCBT-I could also be an effective tool for universal prevention among the general working population regardless of symptom severity. Although increasing evidence suggests that negatively toned cognitive activity may be a key factor for the development and maintenance of insomnia, little is known about how iCBT-I improves sleep by reducing presleep cognitive activity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to examine the efficacy of a self-help internet-delivered recovery training, based on principles of iCBT-I tailored to the work-life domain, among the general working population. General and work-related cognitive activities were investigated as potential mediators of the intervention\u2019s effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A sample of 177 workers were randomized to receive either the iCBT-I (n=88) or controls (n=89). The intervention is a Web-based training consisting of six 1-week modules. As the training was self-help, participants received nothing but technical support via email. Web-based self-report assessments were scheduled at baseline, at 8 weeks, and at 6 months following randomization. The primary outcome was insomnia severity. Secondary outcomes included measures of mental health and work-related health and cognitive activity. In an exploratory analysis, general and work-related cognitive activities, measured as worry and work-related rumination, were investigated as mediators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis of the linear mixed effects model showed that, relative to controls, participants who received iCBT-I reported significantly lower insomnia severity scores at postintervention (between-group mean difference \u22124.36; 95% CI \u22125.59 to \u2212 3.03; Cohen d=0.97) and at 6-month follow-up (between-group difference: \u22123.64; 95% CI \u22124.89 to \u22122.39; Cohen d=0.86). The overall test of group-by-time interaction was significant (P&lt;.001). Significant differences, with small-to-large effect sizes, were also detected for cognitive activity and for mental and work-related health, but not for absenteeism. Mediation analysis demonstrated that work-related rumination (indirect effect: a1b1=\u22120.80; SE=0.34; 95% boot CI \u22121.59 to \u22120.25) and worry (indirect effect: a2b2=\u22120.37; SE=0.19; 95% boot CI \u22120.85 to \u22120.09) mediate the intervention\u2019s effect on sleep.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A self-help Web-based recovery training, grounded in the principles of iCBT-I, can be effective in the general working population, both short and long term. Work-related rumination may be a particularly crucial mediator of the intervention\u2019s effect, suggesting that tailoring interventions to the workplace, including components to reduce the work-related cognitive activity, might be important when designing recovery interventions for workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>German Clinical Trials Register DRKS00007142; https:\/\/www.drks.de\/DRKS00007142<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/13346","type":"journal-article","created":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T11:49:44Z","timestamp":1569498584000},"page":"e13346","source":"Crossref","is-referenced-by-count":51,"title":["Efficacy of a Self-Help Web-Based Recovery Training in Improving Sleep in Workers: Randomized Controlled Trial in the General Working Population"],"prefix":"10.2196","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2991-6034","authenticated-orcid":false,"given":"Doerte","family":"Behrendt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-0146","authenticated-orcid":false,"given":"David Daniel","family":"Ebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4133-3464","authenticated-orcid":false,"given":"Kai","family":"Spiegelhalder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5560-3605","authenticated-orcid":false,"given":"Dirk","family":"Lehr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2020,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.26"},{"key":"ref2","author":"Storm, A","year":"2017","journal-title":"DAK- Health Report 2017: Analysis of data on work disability. 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