Comparative Efficacy of Onsite, Digital, and Other Settings for Cognitive Behavioral Therapy for Insomnia: a Systematic Review and Network Meta-analysis

Overview

Journal Sci Rep

Specialty Science

Date 2023 Feb 2

PMID 36732610

Authors

Laura Simon

Lisa Steinmetz

Bernd Feige

Fee Benz

Kai Spiegelhalder

Harald Baumeister

Affiliations

Soon will be listed here.

Abstract

Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity. A systematic review and frequentist network meta-analysis of available CBT-I settings was performed. PsycINFO, PsycARTICLES, MEDLINE, PubMed, and CINAHL were searched for randomized controlled trials (RCTs) investigating any CBT-I settings in adults with insomnia disorder. The systematic literature search (3851 references) resulted in 52 RCTs. For the primary outcome insomnia severity, all examined CBT-I settings except smartphone-delivered CBT-I yielded significant effects when compared to WL. Large standardized mean differences were found for individual onsite CBT-I (- 1.27;95%CI - 1.70, - 0.84), group-delivered CBT-I (- 1.00;95%CI - 1.42. - 0.59), telehealth (- 1.28;95%CI - 2.06, - 0.50), and guided bibliotherapy (- 0.99;95%CI - 1.67, - 0.32). Both guided iCBT-I (- 0.71;95%CI - 1.18, - 0.24) and unguided iCBT-I (- 0.78;95%CI - 1.18, - 0.38) yielded medium effect sizes. The results underline that health care systems should intensify their efforts to provide synchronously-delivered CBT-I (individual onsite, group-delivered, and telehealth), and particularly individual onsite CBT-I, given its solid evidence base. Medium to large effect sizes for iCBT-I and guided bibliotherapy indicate that self-help settings may be a viable alternative when synchronously-delivered CBT-I is not available.

Citing Articles

Systematic review and meta-analysis on fully automated digital cognitive behavioral therapy for insomnia.

Hwang J, Lee G, Woo J, Kim S, Kwon J NPJ Digit Med. 2025; 8(1):157.

PMID: 40075149 PMC: 11903857. DOI: 10.1038/s41746-025-01514-4.

Do the effects of internet-delivered cognitive-behavioral therapy (i-CBT) last after a year and beyond? A meta-analysis of 154 randomized controlled trials (RCTs).

Zainal N, Soh C, Van Doren N, Benjet C Clin Psychol Rev. 2024; 114:102518.

PMID: 39579466 PMC: 11849760. DOI: 10.1016/j.cpr.2024.102518.

Internet-based cognitive behavioural therapy for insomnia comorbid with chronic benign pain - A randomized controlled trial.

Bothelius K, Jernelov S, Kaldo V, Lu C, Strale M, Jansson-Frojmark M Internet Interv. 2024; 38:100781.

PMID: 39498476 PMC: 11533069. DOI: 10.1016/j.invent.2024.100781.

Internet-delivered cognitive behaviour therapy for affective disorders, anxiety disorders and somatic conditions: An updated systematic umbrella review.

Kall A, Biliunaite I, Andersson G Digit Health. 2024; 10:20552076241287643.

PMID: 39381818 PMC: 11459498. DOI: 10.1177/20552076241287643.

Impact of real-world implementation of evidence-based insomnia treatment within a large payor-provider health system: initial provider and patient-level outcomes.

Karlin B, Anderson R, Rung J, Drury-Gworek C, Barrett T Sleep Adv. 2024; 5(1):zpae053.

PMID: 39372543 PMC: 11450627. DOI: 10.1093/sleepadvances/zpae053.

References

Edinger J, Arnedt J, Bertisch S, Carney C, Harrington J, Lichstein K . Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2020; 17(2):263-298. PMC: 7853211. DOI: 10.5664/jcsm.8988. View

Edinger J, Olsen M, Stechuchak K, Means M, Lineberger M, Kirby A . Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009; 32(4):499-510. PMC: 2663864. DOI: 10.1093/sleep/32.4.499. View

Lopez R, Evangelista E, Barateau L, Chenini S, Bosco A, Billiard M . French Language Online Cognitive Behavioral Therapy for Insomnia Disorder: A Randomized Controlled Trial. Front Neurol. 2019; 10:1273. PMC: 6906191. DOI: 10.3389/fneur.2019.01273. View

Condon H, Maurer L, Kyle S . Reporting of adverse events in cognitive behavioural therapy for insomnia: A systematic examination of randomised controlled trials. Sleep Med Rev. 2021; 56:101412. DOI: 10.1016/j.smrv.2020.101412. View

Forsell E, Jernelov S, Blom K, Kraepelien M, Svanborg C, Andersson G . Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients. Am J Psychiatry. 2019; 176(4):315-323. DOI: 10.1176/appi.ajp.2018.18060699. View

Koffel E, Bramoweth A, Ulmer C . Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med. 2018; 33(6):955-962. PMC: 5975165. DOI: 10.1007/s11606-018-4390-1. View

Ho F, Chan C, Lo W, Leung J . The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials. J Affect Disord. 2020; 265:287-304. DOI: 10.1016/j.jad.2020.01.062. View

Kyle S, Miller C, Rogers Z, Siriwardena A, Macmahon K, Espie C . Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. Sleep. 2014; 37(2):229-37. PMC: 3900612. DOI: 10.5665/sleep.3386. View

Krieger T, Urech A, Duss S, Blattler L, Schmitt W, Gast H . A randomized controlled trial comparing guided internet-based multi-component treatment and internet-based guided sleep restriction treatment to care as usual in insomnia. Sleep Med. 2019; 62:43-52. DOI: 10.1016/j.sleep.2019.01.045. View

10.

Shochat T, Umphress J, Israel A, Ancoli-Israel S . Insomnia in primary care patients. Sleep. 1999; 22 Suppl 2:S359-65. View

11.

Alessi C, Martin J, Fiorentino L, Fung C, Dzierzewski J, Rodriguez Tapia J . Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial. J Am Geriatr Soc. 2016; 64(9):1830-8. PMC: 5351772. DOI: 10.1111/jgs.14304. View

12.

Shim M, Mahaffey B, Bleidistel M, Gonzalez A . A scoping review of human-support factors in the context of Internet-based psychological interventions (IPIs) for depression and anxiety disorders. Clin Psychol Rev. 2017; 57:129-140. DOI: 10.1016/j.cpr.2017.09.003. View

13.

Lorenz N, Heim E, Roetger A, Birrer E, Maercker A . Randomized Controlled Trial to Test the Efficacy of an Unguided Online Intervention with Automated Feedback for the Treatment of Insomnia. Behav Cogn Psychother. 2018; 47(3):287-302. DOI: 10.1017/S1352465818000486. View

14.

Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E . Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014; 13(3):288-95. PMC: 4219070. DOI: 10.1002/wps.20151. View

15.

Saleem M, Kuhne L, De Santis K, Christianson L, Brand T, Busse H . Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review. JMIR Ment Health. 2021; 8(12):e30000. PMC: 8726056. DOI: 10.2196/30000. View

16.

Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini G . Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol. 2012; 21(1):57-64. DOI: 10.1177/2047487312460020. View

17.

Zachariae R, Lyby M, Ritterband L, OToole M . Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2015; 30:1-10. DOI: 10.1016/j.smrv.2015.10.004. View

18.

Strom L, Pettersson R, Andersson G . Internet-based treatment for insomnia: a controlled evaluation. J Consult Clin Psychol. 2004; 72(1):113-20. DOI: 10.1037/0022-006X.72.1.113. View

19.

Lancee J, Eisma M, van Straten A, Kamphuis J . Sleep-Related Safety Behaviors and Dysfunctional Beliefs Mediate the Efficacy of Online CBT for Insomnia: A Randomized Controlled Trial. Cogn Behav Ther. 2015; 44(5):406-22. DOI: 10.1080/16506073.2015.1026386. View

20.

Juni P, Witschi A, Bloch R, Egger M . The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999; 282(11):1054-60. DOI: 10.1001/jama.282.11.1054. View