Article

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

ABSTRACT

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.

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Available from: Sammy Cheng, Jul 01, 2014
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    • "An a priori statistical power analysis [49] indicated that to detect a small statistically significant ES (0.30), smaller than the average ES (0.42) found across all outcomes in a previous meta-analysis [29], with an alpha of 5%, a statistical power of 80%, and an average sample size of 75, as found in the previous meta-analysis, would require 8 studies using a random effects model. "
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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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    • "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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