Computerised Cognitive Behavioural Therapy for Insomnia: A Systematic Review and Meta-Analysis

Clinical Psychology Service, Kwai Chung Hospital, Hong Kong, SAR, China.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 05/2012; 81(4):206-16. DOI: 10.1159/000335379
Source: PubMed


Computerised cognitive behavioural therapy (CCBT) is an innovative mode of delivering services to patients with psychological disorders. The present paper uses a meta-analysis to systematically review and evaluate the effectiveness of CCBT for insomnia (CCBT-I).
A comprehensive search was conducted on 7 databases including MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Library, Social Sciences Citation Index and PubMed (up to March 2011). Search terms covered 3 concepts: (1) [internet, web, online, computer-aided, computer-assisted, computer-guided, computerized OR computerised] AND (2) [CBT, cognitive therapy, behavio(u)ral therapy OR behavio(u)r therapy] AND (3) [insomnia, sleep disorders OR sleeping problem].
533 potentially relevant papers were identified, and 6 randomised controlled trials (RCTs) that met the selection criteria were included in the review and analysis. Two RCTs were done by the same group of investigators (Ritterband and colleagues) using the same internet programmes. Post-treatment mean differences between groups showed that the effects of CCBT-I on sleep quality, sleep efficiency, the number of awakenings, sleep onset latency and the Insomnia Severity Index were significant, ranging from small to large effect sizes. However, effects on wake time after sleep onset, total sleep time and time in bed were non-significant. On average, the number needed to treat was 3.59. The treatment adherence rate for CCBT-I was high (78%).
The results lend support to CCBT as a mildly to moderately effective self-help therapy in the short run for insomnia. CCBT-I can be an acceptable form of low-intensity treatment in the stepped care model for insomnia.


Available from: Sammy Cheng, Jul 01, 2014
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    • "Reviews and meta-analyses have supported the efficacy of CBT-I for improving sleep in the treatment of primary insomnia [2] and insomnia comorbid with medical (e.g., chronic pain, cancer) or psychiatric (e.g., posttraumatic stress disorder, depression) conditions [3] when measured by validated self-report measures and sleep diaries. Further, CBT-I has been demonstrated effective when delivered in individual, group [4], self-help [5], or computerized formats [6]. "
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    ABSTRACT: This review examined the efficacy of cognitive behavior therapy for insomnia (CBT-I) in people diagnosed with cancer. Studies were identified through November 2014 using multiple databases, clinical trial records, and bibliography searches. Inclusion was limited to RCTs of CBT-I conducted in individuals with a cancer diagnosis who had clinically relevant insomnia. The primary outcome variable was sleep efficiency (SE) as measured by sleep diary. Eight studies including data from 752 cancer survivors met inclusion criteria. CBT-I resulted in a 15.5% improvement in SE relative to control conditions (6.1%) from pre-to post-intervention, with a medium effect size (ES: d = 0.53). Overall, sleep latency was reduced by 22 minutes with an ES of d = 0.43, compared to a reduction of 8 minutes in the control conditions. Wake after sleep onset was reduced by 30 minutes with an ES of d = 0.41, compared to 13 minutes in the control conditions. Large effect sizes were observed for self-reported insomnia severity (d = 0.77) for those patients who received CBT-I, representing a clinically relevant 8 point reduction. Effects were durable up to 6 months. The quality of the evidence supports a strong recommendation for the use of CBT-I among cancer survivors.
    Sleep Medicine Reviews 07/2015; 27:20-28. DOI:10.1016/j.smrv.2015.07.001 · 8.51 Impact Factor
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    • "The efficacy of CBT-I in people with mental health disorders has been established (Edinger et al., 2009). A literature review and meta-analysis reported that a computerized self-directed CBT package was mildly to moderately effective in a group of adults with insomnia, including participants with comorbid anxiety or depression (Cheng and Dizon, 2012). Similarly, a recent review found that 'CBT-I is highly effective in improving sleep in patients with comorbid psychiatric disorders' (Taylor and Pruiksma, 2014). "
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    ABSTRACT: Given the longstanding controversy about hypnosedative use, we aimed to investigate the attitudes of prescribing psychiatrists and service users towards long-term use of hypnosedative medication, and their perceptions of barriers to evidence-based nonmedication alternatives. Qualitative data from focus groups in Aotearoa/NZ were analysed thematically. A novel research design involved a service user researcher contributing throughout the research design and process. Service users and psychiatrists met to discuss each other's views, initially separately, and subsequently together. Analysis of the data identified four key themes: the challenge, for both parties, of sleep disturbance among service users with mental health problems; the conceptual and ethical conflicts for service users and psychiatrists in managing this challenge; the significant barriers to service users accessing evidence-based nonmedication alternatives; and the initial sense of disempowerment, shared by both service users and psychiatrists, which was transformed during the research process. Our results raise questions about the relevance of the existing guidelines for this group of service users, highlight the resource and time pressures that discourage participants from embarking on withdrawal regimes and education programmes on alternatives, highlight the lack of knowledge about alternatives and reflect the complex interaction between sleep and mental health problems, which poses a significant dilemma for service users and psychiatrists.
    International clinical psychopharmacology 04/2015; 30(4). DOI:10.1097/YIC.0000000000000073 · 2.46 Impact Factor
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    • "Only studies providing four or more treatment sessions were included, as a duration of four sessions has been shown to effectively treat insomnia and may be the optimal dose for durable response to treatment [36e38]. An excellent meta-analysis of computerized CBT-I has recently been published [29], so only studies involving delivery of face-to-face (individual or group) therapy were included. Additionally, only studies conducted in adults, using standardized diagnostic criteria for insomnia, were included to reduce study heterogeneity due to variation in the sample beyond their comorbidity. "
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    ABSTRACT: s u m m a r y Cognitive behavioral therapy for insomnia (CBT-I) is effective for treatment of primary insomnia. There has been no synthesis of studies quantifying this effect on insomnia comorbid with medical and psy-chiatric disorders using rigorous selection criteria. The objective of this study was to quantify the effect of CBT-I in studies including patients with medical or psychiatric disorders. Studies were identified from 1985 through February 2014 using multiple databases and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I in adult patients with insomnia diagnosed using standardized criteria, who additionally had a comorbid medical or psychiatric condition. Twenty-three studies including 1379 patients met inclusion criteria. Based on weighted mean differences, CBT-I improved subjective sleep quality post-treatment, with large treatment effects for the insomnia severity index and Pittsburgh sleep quality index. Sleep diaries showed a 20 min reduction in sleep onset latency and wake after sleep onset, 17 min improvement in total sleep time, and 9% improvement in sleep efficiency post-treatment, similar to findings of meta-analyses of CBT-I in older adults. Treatment effects were durable up to 18 mo. Results of actigraphy were similar to but of smaller magnitude than subjective measures. CBT-I is an effective, durable treatment for comorbid insomnia.
    Sleep Medicine Reviews 01/2015; 23:54-67. DOI:10.1016/j.smrv.2014.11.007 · 8.51 Impact Factor
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