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The aim of this study was to determine the feasibility and preliminary efficacy of online-delivered paradoxical intention therapy (PI) among adults with insomnia symptoms and high sleep effort. A two-arm randomised controlled trial was conducted. Twenty-six adults (18-54 years) were randomly allocated to receive either PI (n= 13) or sleep hygiene instructions (n= 13). PI sessions were delivered via the Internet across two hour-long sessions over two weeks whereas sleep hygiene instructions sessions were one-off. Participants completed 5 consecutive days of wrist actigraphy and sleep diary, the Glasgow Sleep Effort Scale (GSES), Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire (PHQ-9) at baseline, post-intervention (2 weeks) and follow-up (1 month). Thirtyfive adults of the 46 recruited (76%) presented with insomnia symptoms and high sleep effort. The randomised participants who persisted with the study (n= 24) showed good adherence (85%-100%) throughout the intervention and follow-up periods. Significant reductions were observed on the GSES indicating the role of PI in reducing sleep effort. Findings also show that PI significantly improved self-reported sleep parameters (sleep onset latency, wake after sleep onset, sleep efficiency), and sleep quality measured by PSQI, yielding moderate to large effect sizes. Preliminary findings indicate that PI is a feasible, standalone psychological intervention for insomnia symptoms that can be administered successfully via the Internet. Future trials are needed to address the sustained efficacy of online PI
