Self-help therapy for insomnia: a meta-analysis
Abstract
Background Insomnia is a prevalent problem which often leads to a reduced quality of life and diminished work productivity. Only a minority of patients are treated with effective non-pharmacological therapies. A self-help intervention might offer an inexpensive and more accessible alternative to face-to-face treatment.Methods We conducted a meta-analysis of randomized controlled studies examining the effects of self-help interventions for insomnia, identified through extensive searches of bibliographical databases. We examined the effects of self-help on different sleep outcomes, in comparison with both waiting lists controls and face-to-face treatments.Results Ten studies with a total of 1000 subjects were included. The intervention did improve sleep efficiency (d=0.42; p<0.05), sleep onset latency (d=0.29; p<0.05), wake after sleep onset (d=0.44; p<0.05) and sleep quality (d=0.33; p<0.05) but not total sleep time (d=0.02; p>0.05). The sleep improvements were maintained over the longer term. Symptoms of anxiety and depression also decreased after self-help (d=0.28; p<0.05 and d=0.51; p<0.05, respectively). Although based on a very limited number of studies, the face-to-face treatments did not show statistically significant superiority to the self-help treatments. The effect sizes associated with self-help treatments might be overestimated due to publication bias.Conclusions The effects of self-help treatments are small to moderate. Nevertheless, they might constitute a useful addition to existing treatment options especially when integrated in a stepped care approach.
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Self-guided interventions may result in smaller treatment effects compared to face-to-face CBT-I.
“Second, albeit comparable in efficacy to face-to-face CBT-I, self-guided interventions may result in smaller treatment effects. 14,37,38”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [38]
Previous meta-analyses provide evidence that CBT-I moderately improves anxiety symptoms.
“Previous meta-analyses provide some evidence to suggest Cognitive Behavioural Therapy for Insomnia moderately improves anxiety”
From Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis (2022) · cites this paper as van Straten & Cuijpers, 2009
Previous studies with community samples have shown self-help sleep treatment to reduce anxiety and depression.
“while previous studies36, 37 with community samples have shown self-help sleep treatment to reduce anxiety and depression.”
From The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis (2017) · cites this paper as [37]
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Sleep as a public health concern: insomnia and mental health
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Majd, N. R., Broström, A., Ulander, M., Lin, C., Griffiths, M. D., Imani, V., Ahorsu, D. K., Ohayon, M. M., & Pakpour, A. H. (2020) · Journal of Medical Internet Research · doi:10.2196/15841 · Cited by 75 · see citing works
Savard, J., Ivers, H., Savard, M., Morin, C. M., Caplette‐Gingras, A., Bouchard, S., & Lacroix, G. (2021) · SLEEP · doi:10.1093/sleep/zsab166 · Cited by 74 · see citing works
“However, a meta-analysis indicated that sleep improvements from selfadministered CBT-I were consistently of a lower magnitude than those from face-to-face CBT-I [16].”
BackgroundScott, A. J., Webb, T. L., & Rowse, G. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016873 · Cited by 72 · see citing works
Hagatun, S., Vedaa, Ø., Nordgreen, T., Smith, O. R. F., Pallesen, S., Havik, O. E., Bjorvatn, B., Thorndike, F. P., Ritterband, L. M., & Sivertsen, B. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2017.1301941 · Cited by 61 · see citing works
“…achieve effect sizes that are comparable to those achieved in face-toface psychotherapy (Andersson, Topooco, Havik, & Nordgreen, 2015; Barak, Hen, Boniel-Nissim, & Shapira, 2008; Cheng & Dizon, 2012; Seyffert et al., 2016; van Straten & Cuijpers, 2009; Zachariae, Lyby, Ritterband, & O’Toole, 2016).”
BackgroundInfluentialSkin disorders and sleep in adults: Where is the evidence?
Thorburn, P., & Riha, R. L. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.12.001 · Cited by 62 · see citing works
Savard, J., & Savard, M. (2013) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2013.04.006 · Cited by 61 · see citing works
Sedov, I. D., & Tomfohr‐Madsen, L. M. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2020.1771339 · Cited by 61 · see citing works
“…at a higher risk of postpartum depression, as such they may benefit from CBT-I or lower intensity resources such as internet or bibliotherapy (Van Straten & Cuijpers, 2009; Zachariae et al., 2016), which have been shown to be effective in the broader population but have not been tested in…”
BackgroundBJORVATN, B., FISKE, E., & PALLESEN, S. (2011) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.2011.00902.x · Cited by 60 · see citing works
“The majority of the studies compared self-help therapy with waiting list controls (van Straten & Cuijpers, 2009).”
BackgroundResultInfluentialRybarczyk, B. D., Lund, H. G., Shamaskin‐Garroway, A., & Mack, L. (2012) · Clinical Gerontologist · doi:10.1080/07317115.2012.731478 · Cited by 58 · see citing works
“The results of a meta-analysis on the efficacy of self-help CBT-I for primary insomnia demonstrated small to moderate treatment effect sizes (van Straten & Cuijpers, 2009).”
BackgroundFeasibility of a self‐help treatment for insomnia comorbid with cancer
Savard, J., Villa, J., Simard, S., Ivers, H., & Morin, C. M. (2010) · Psycho-Oncology · doi:10.1002/pon.1818 · Cited by 58 · see citing works
“Overall, effects found in this study were generally larger than those that have been reported in a recent meta-analysis of studies on the efficacy of self-administered CBT for primary insomnia [11].”
BackgroundResultLappalainen, P., Langrial, S., Oinas-Kukkonen, H., Muotka, J., & Lappalainen, R. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.04.001 · Cited by 57 · see citing works
Lancee, J., van den Bout, J., van Straten, A., & Spoormaker, V. I. (2012) · Depression and Anxiety · doi:10.1002/da.22004 · Cited by 53 · see citing works
Savard, J., Ivers, H., Savard, M., & Morin, C. M. (2016) · SLEEP · doi:10.5665/sleep.5634 · Cited by 53 · see citing works
Behrendt, D., Ebert, D. D., Spiegelhalder, K., & Lehr, D. (2020) · Journal of Medical Internet Research · doi:10.2196/13346 · Cited by 52 · see citing works
A Systematic Review and Meta-Analysis on the Efficacy of Self-Help Interventions in Tinnitus
Nyenhuis, N., Golm, D., & Kröner‐Herwig, B. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.803496 · Cited by 52 · see citing works
“Current reviews have come to the conclusion that self-help interventions reduce distress in different psychological disorders such as depression, anxieties, or insomnia with medium to large effect sizes (Lewis, Pearce, & Bisson, 2012; Van Straten & Cuijpers, 2009; Van’t Hof et al., 2009) and might even be as effective…”
BackgroundResultInfluentialMorgan, K., Gregory, P., Tomeny, M., David, B. M., & Gascoigne, C. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04175.x · Cited by 52 · see citing works
Bachem, R., & Maercker, A. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1191083 · Cited by 50 · see citing works
“…evidence suggests that self-help interventions with minimal or no therapist contact can be an effective treatment for depression (Cuijpers et al., 2011), anxiety disorders (Lewis, Pearce, & Bisson, 2012), insomnia (van Straten & Cuijpers, 2009), or tinnitus (Nyenhuis, Golm, & Kröner-Herwig, 2013).”
BackgroundUse of the Internet and Mobile Media for Delivery of Cognitive Behavioral Insomnia Therapy
Espie, C. A., Hames, P., & McKinstry, B. (2013) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2013.06.001 · Cited by 50 · see citing works
Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis
Sun, Y., Yuan, J., & Yang, Z. (2016) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-016-1179-9 · Cited by 48 · see citing works
Behavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health
Rybarczyk, B. D., & Mack, L. (2011) · Nature and Science of Sleep · doi:10.2147/nss.s12975 · Cited by 45 · see citing works
“Therapist-administered CBT-I is more effective than self-help according to comparisons of effect sized from metaanalyses.(23,98) However, there has not been a study that directly compares these two types of treatment modalities.”
BackgroundMethodEffects of Ramadan Fasting on Health and Athletic Performance
Chtourou, H. (2015) · OMICS International eBooks · doi:10.4172/978-1-63278-030-0-031 · Cited by 30 · see citing works
van der Zweerde, T., Lancee, J., Slottje, P., Bosmans, J. E., Someren, E. J. W. V., Reynolds, C. F., Cuijpers, P. J., & van Straten, A. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0783-z · Cited by 40 · see citing works
Self-citationGuided web-based intervention for insomnia targeting breast cancer patients: Feasibility and effect
Dozeman, E., Leeuw, I. M. V., Savard, J., & van Straten, A. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.03.005 · Cited by 38 · see citing works
Bjorvatn, B., Berge, T., Lehmann, S., Pallesen, S., & Saxvig, I. W. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.02413 · Cited by 37 · see citing works
Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis
Staines, A. C., Broomfield, N., Pass, L., Orchard, F., & Bridges, J. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13451 · Cited by 37 · see citing works
“…I on anxiety, stress and worry (Belleville et al., 2011), (2) the impact of CBT- I delivered in a self- help format on anxiety symptoms (Benz et al., 2020; Ho et al., 2015; van Straten & Cuijpers, 2009) and (3) the impact of non- pharmacological sleep interventions on depression (Gee et al., 2019).”
BackgroundMethodGreenwell, K., Sereda, M., Coulson, N., Refaie, A. E., & Hoare, D. J. (2016) · International Journal of Audiology · doi:10.3109/14992027.2015.1137363 · Cited by 34 · see citing works
“Meta-analyses have demonstrated the positive effects of selfhelp interventions for several long-term conditions, including mental health (Spek et al, 2007), chronic pain (Macea et al, 2010), and insomnia (van Straten & Cuijpers, 2009).”
BackgroundA step towards stepped care: delivery of CBT-I with reduced clinician time
Manber, R., Simpson, N. S., & Bootzin, R. R. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.09.003 · Cited by 32 · see citing works
Krieger, T., Urech, A., Duss, S. B., Blättler, L. T., Schmitt, W. J., Gast, H., Bassetti, C. L., & Berger, T. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.01.045 · Cited by 33 · see citing works
Okajima, I., Nakajima, S., Ochi, M., & Inoue, Y. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102565 · Cited by 32 · see citing works
“Although a number of treatment outcome studies focusing on the CBT-I have been conducted [8], [10], [11], [12], only a few have investigated the underlying mechanisms or actual processes through which improvements after CBT-I occur [13], [14], [15].”
BackgroundLow, T., Conduit, R., Varma, P., Meaklim, H., & Jackson, M. L. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100335 · Cited by 30 · see citing works
Video cognitive‐behavioral therapy for insomnia in cancer patients: A cost‐effective alternative
Savard, J., Ivers, H., Morin, C. M., & Lacroix, G. (2020) · Psycho-Oncology · doi:10.1002/pon.5532 · Cited by 33 · see citing works
Cognitive behavioural therapy self-help for depression: an overview
Ridgway, N., & Williams, C. (2011) · Journal of Mental Health · doi:10.3109/09638237.2011.613956 · Cited by 28 · see citing works
“Self-help overall may be just as effective as face-to-face therapy but is it as acceptable? Waller and Gilbody (2009) conducted a systematic review of quantitative and qualitative evidence investigating the barriers to computerised CBT.”
BackgroundBaron, P., Hermand, É., Bourlois, V., Pezé, T., Aron, C., Lombard, R., & Hurdiel, R. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20085452 · Cited by 28 · see citing works
Zhu, X., Ren, Y., Tan, S., & Ma, X. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.12.037 · Cited by 26 · see citing works
Groeneveld, L., Beulens, J. W. J., Blom, M. T., van Straten, A., van der Zweerde, T., Elders, P. J. M., & Rutters, F. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.05.029 · Cited by 25 · see citing works
Good practice guidance on the use of self-help materials within IAPT services
Baguley, C., Farrand, P. A., Hope, R., Leibowitz, J., Lovell, K., Lucock, M. P., O’Neill, C., Paxton, R., Pilling, S., Richards, D. A., et al. (2010) · University of Huddersfield Repository (University of Huddersfield) · Cited by 25 · see citing works
Lee-Tobin, P. A., Ogeil, R. P., Savic, M., & Lubman, D. I. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6814 · Cited by 25 · see citing works
Tang, N. K. Y., Moore, C., Parsons, H. M., Sandhu, H. K., Patel, S., Ellard, D. R., Nichols, V. P., Madan, J. J., Collard, V. E. J., Sharma, U., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-034764 · Cited by 24 · see citing works
Insomnia: psychological and neurobiological aspects and non-pharmacological treatments
Molen, Y. F., de Carvalho, L. B. C., do Prado, L. B. F., & do Prado, G. F. (2014) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20130184 · Cited by 23 · see citing works
Goodday, A., Corkum, P. V., & Smith, I. M. (2013) · Children s Health Care · doi:10.1080/02739615.2014.850879 · Cited by 23 · see citing works
“A meta-analysis (10 studies, N = 1,000) has shown that adult self-help can improve sleep efficiency and decrease both sleep latency and time awake after sleep onset (van Straten & Cuijpers, 2009).”
MethodManagement of insomnia: update and new approaches
Riemann, D. W. (2010) · Nature and Science of Sleep · doi:10.2147/nss.s6642 · Cited by 23 · see citing works
Chan, W. S., Cheng, W. Y., Lok, S. H. C., Cheah, A. K. M., Lee, A. K. W., Ng, A. S. Y., & Kowatsch, T. (2024) · JMIR Mental Health · doi:10.2196/51716 · Cited by 22 · see citing works
“Consistent with previous meta-analyses [24,69,70] showing that dCBTi was not inferior to face-to-face CBTi for alleviating insomnia, this study did not find any meaningful differences (a change of >4 points in the ISI total score) between guided CBTi conditions and dCBTi-unguided.”
ResultKoffel, E., Branson, M., Amundson, E. C., & Wisdom, J. P. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2020.1828085 · Cited by 19 · see citing works
“Research has shown that self-management CBT-I approaches to treating insomnia are efficacious (Ho et al., 2015; Seyffert et al., 2016) and book and web-based formats appear to have similar efficacy (Ho et al., 2015; Lancee et al., 2012; Rybarczyk et al., 2011; van Straten & Cuijpers, 2009).”
BackgroundCognitive Behavioral Therapy for Insomnia (CBT-I) for an Adult With Multiple Sclerosis
Majendie, C. M. A., Dysch, L., & Carrigan, N. (2017) · Clinical Case Studies · doi:10.1177/1534650116674594 · Cited by 16 · see citing works
“Despite this, it is not widely available due to lack of trained therapists and the associated higher initial costs (van Straten & Cuijpers, 2009).”
BackgroundSavard, M., & Savard, J. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0067-2 · Cited by 17 · see citing works
Kaldo, V., Bothelius, K., Blom, K., Lindhé, M., Larsson, M., Karimi, K., Melder, S., Bondestam, V., Ulfsparre, C., Sternbrink, K., et al. (2019) · Journal of Sleep Research · doi:10.1111/jsr.12881 · Cited by 18 · see citing works
“Self‐help, defined as “standardized psychological treatments which can be worked through independently by the patients them‐ selves” (van Straten & Cuijpers, 2009, p. 6), is another type of cost‐ effective treatment format that has been shown to be effective for insomnia in non‐clinical settings…”
BackgroundYang, Y., Luo, X., Paudel, D., Zhang, J., Li, S. X., & Zhang, B. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-033457 · Cited by 17 · see citing works
Cognitive Behavior Therapies for Insomnia I
Morin, C. M., Davidson, J. R., & Beaulieu‐Bonneau, S. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00085-4 · Cited by 17 · see citing works
Dissemination of CBT for Insomnia
Manber, R., & Simpson, N. S. (2016) · Current Sleep Medicine Reports · doi:10.1007/s40675-016-0048-x · Cited by 16 · see citing works
Prevention of common mental disorders
D’Arcy, C., & Meng, X. (2014) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000076 · Cited by 16 · see citing works
Psychological and Behavioral Treatments for Insomnia II
Edinger, J. D., Leggett, M. K., Carney, C. E., & Manber, R. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00086-6 · Cited by 16 · see citing works
Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial
Vollert, B., Müller, L. K., Jacobi, C., Trockel, M., & Beintner, I. (2022) · JMIR Mental Health · doi:10.2196/39052 · Cited by 13 · see citing works
“Low-threshold and scalable CBT-based self-help interventions may be a means to overcome these barriers and facilitate access to adequate treatment [46], especially if they are provided online [47].”
Savard, J., Savard, M., & Ivers, H. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1210148 · Cited by 14 · see citing works
“Treatment modalities such as bibliotherapy, or video- or Web-based interventions, have been found efficacious to treat primary insomnia and insomnia comorbid with psychological disorders (Ho et al., 2015; Ritterband et al., 2011; van Straten & Cuijpers, 2009).”
BackgroundResultShirotsuki, K., Sugaya, N., & Nakao, M. (2022) · BioPsychoSocial Medicine · doi:10.1186/s13030-021-00233-y · Cited by 14 · see citing works
“have been used to improve depression, anxiety [17–19], and insomnia [20].”
MethodEdinger, J. D., Eldridge-Smith, E. D., Buysse, D. J., Thase, M. E., Krystal, A. D., Wiskniewski, S., & Manber, R. (2023) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10514 · Cited by 13 · see citing works
Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?
Hartley, S., Dagneaux, S., Londe, V., Liane, M.-T., Aussert, F., Francs, C. C. D., & Royant‐Parola, S. (2016) · L Encéphale · doi:10.1016/j.encep.2016.08.013 · Cited by 13 · see citing works
Advances in the management of insomnia
Pigeon, W. R., Bishop, T. M., & Marcus, J. A. (2014) · F1000Prime Reports · doi:10.12703/p6-48 · Cited by 13 · see citing works
Krishna, J., Kalra, M., & McQuillan, M. E. (2023) · Pediatrics in Review · doi:10.1542/pir.2022-005521 · Cited by 12 · see citing works
Self-help therapy for sleep problems in hospital nurses in Japan: a controlled pilot study
Morimoto, H., Tanaka, H., Ohkubo, R., Mimura, M., Ooe, N., 市川, あ., & Yukitoshi, H. (2015) · Sleep and Biological Rhythms · doi:10.1007/s41105-015-0037-3 · Cited by 12 · see citing works
“, sleep diary, stimulus control, relaxation, sleep restriction) is small to moderate, which is equivalent to individual treatments [7].”
BackgroundResultInfluential
- Authors
- van Straten, A., & Cuijpers, P.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- ORCID
- Cuijpers, Pim
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2009-02
- Volume
- 13
- Issue
- 1
- Pages
- 61-71
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2085833142
- Cited by
- 185
- References
- 49
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 6 · 2023: 15 · 2022: 8 · 2021: 6 · 2020: 17 · 2019: 10 · 2018: 4 · 2017: 16 · 2016: 17 · 2015: 14 · 2014: 18 · 2013: 12 · 2012: 10
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- insomnia, self-help intervention, non-pharmacological treatment, sleep efficiency, sleep latency, wake after sleep onset, sleep quality, anxiety, depression, stepped care, long-term treatment outcomes
- MeSH terms
- Anxiety, Combined Modality Therapy, Depression, Humans, Disorders of Excessive Somnolence, Sleep Initiation and Maintenance Disorders, Physician-Patient Relations, Self Care, Comorbidity, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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