{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:06:07Z","timestamp":1782846367279,"version":"3.54.5"},"reference-count":43,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Internet-based interventions for insomnia show promise, but understanding the process variables, such as knowledge acquisition and psychological acceptance, is crucial for enhancing digital adherence and clinical effectiveness.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate the feasibility, adherence, and preliminary clinical signals of 2 therapist-assisted interventions\u2014internet-delivered cognitive behavioral therapy (iCBT) and internet-delivered acceptance and commitment therapy (iACT)\u2014for insomnia in a primary care setting.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a pilot randomized controlled trial. Adults seeking help for insomnia (n=18) were recruited via primary care and randomized to either a 5-module iCBT or iACT program delivered via a secure digital platform with weekly therapist feedback. Blinding of participants and therapists was not possible due to the nature of the interventions. Primary outcomes included the Insomnia Severity Index; secondary outcomes included the 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder, and WHO Disability Assessment Schedule. A novel sleep knowledge test was used as a process variable. The data were analyzed using split-plot analyses of variance (intention-to-treat or last observation carried forward and complete case analysis) and nonparametric Friedman and Kruskal-Wallis tests.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 18 participants were randomized (iCBT: n=9; iACT: n=9). High attrition was observed, with only 33.3% (n=3) of iCBT and 55.6% (n=5) of iACT participants completing all modules. The iACT group demonstrated a significant within-group reduction in insomnia severity (\n P<\/jats:italic>\n =.01, Friedman test), whereas iCBT results were nonsignificant (\n P<\/jats:italic>\n =.10, Friedman test). No significant between-group differences were found for any clinical or process variables. Participants rated both treatments as credible (Credibility\/Expectancy Questionnaire scores remained stable), though qualitative feedback indicated a need for more flexible, less burdensome content.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This pilot study demonstrates that while internet-delivered insomnia treatments are feasible and credible in primary care, high attrition remains a significant barrier. Preliminary signals suggest that iACT may be a viable alternative to iCBT, potentially offering better adherence. Larger, fully powered pilot randomized controlled trials (estimated N=404) with refined recruitment and automated retention strategies are required to determine definitive comparative efficacy and the mediating role of sleep knowledge and acceptance.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/81285","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:42:31Z","timestamp":1779396151000},"page":"e81285-e81285","source":"Crossref","is-referenced-by-count":0,"title":["Conceptualizing Acceptance and Knowledge as Process Variables in Internet-Delivered and Therapist-Supported Cognitive Behavioral Therapy and Acceptance and Commitment Therapy in Primary Care for Insomnia: Pilot Feasibility and Process-Oriented Randomized Controlled Trial"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7530-3039","authenticated-orcid":false,"given":"Anna Caroline","family":"Larsson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0633-8104","authenticated-orcid":false,"given":"Susanna","family":"Jernel\u00f6v","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6443-5279","authenticated-orcid":false,"given":"Viktor","family":"Kaldo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6681-0554","authenticated-orcid":false,"given":"Kerstin","family":"Blom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2428-4004","authenticated-orcid":false,"given":"Sandra","family":"Weineland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. 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