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.

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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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    ABSTRACT: Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. Eleven randomized controlled trials examining a total of 1460 participants were included. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges's g) ranging from 0.21 to 1.09. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 wk follow-up. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.
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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.
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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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