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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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“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]
In the citing paper
“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
In the citing paper
“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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“…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).”
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“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.”
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“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).”
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Video cognitive‐behavioral therapy for insomnia in cancer patients: A cost‐effective alternative
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Cognitive behavioural therapy self-help for depression: an overview
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“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
Zhu, X., Ren, Y., Tan, S., & Ma, X. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.12.037 · Cited by 27
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
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
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
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
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 25
Goodday, A., Corkum, P. V., & Smith, I. M. (2013) · Children s Health Care · doi:10.1080/02739615.2014.850879 · Cited by 23
“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
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 23
“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 20
“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. (2016) · Clinical Case Studies · doi:10.1177/1534650116674594 · Cited by 22
“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
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
“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
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 18
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
Prevention of common mental disorders
D’Arcy, C., & Meng, X. (2014) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000076 · Cited by 16
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 17
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
“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
“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
“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
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
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
Krishna, J., Kalra, M., & McQuillan, M. E. (2023) · Pediatrics in Review · doi:10.1542/pir.2022-005521 · Cited by 12
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
“, sleep diary, stimulus control, relaxation, sleep restriction) is small to moderate, which is equivalent to individual treatments [7].”
BackgroundResultInfluential
Metadata
- 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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