Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis
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...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2023-02-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-28853-0 |
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| Summary: | 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 yielded significant effects when compared to WL. Large standardized mean differences were found for telehealth (− 1.35;95%CI − 1.73, − 0.97), individual onsite CBT-I (− 1.30;95%CI − 1.51, − 1.09), guided bibliotherapy (− 1.05;95%CI − 1.38, − 0.71), smartphone (− 1.04;95%CI − 1.62, − 0.46), group-delivered CBT-I (− 1.01;95%CI − 1.21, − 0.82), and unguided iCBT-I (− 1.01;95%CI − 1.20, − 0.82). Guided iCBT-I (− 0.73;95%CI − 0.95, − 0.51) and unguided bibliotherapy (− 0.67;95%CI − 1.00, − 0.35) 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. |
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| ISSN: | 2045-2322 |