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Efficacy of internet-delivered cognitive-behavioral therapy for insomnia— a systematic review and meta-analysis of randomized controlled trials

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Zachariae, Robert, Lyby, Marlene S., Ritterband, Lee M., O'Toole, Mia S.·2016·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2015.10.004

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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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Additional file 1 of Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: study protocol for a parallel group randomized controlled trial
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Additional file 3 of Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial
Ho, K. K., Simić, M., Pinheiro, M. B., Miller, C. B., Ferreira, M. L., Grunstein, R. R., Hopper, J. L., Ordoñana, J. R., & Ferreira, P. H. (2022) · Figshare · doi:10.6084/m9.figshare.20070967
Additional file 1 of Investigating non-inferiority of internet-delivered versus face-to-face cognitive behavioural therapy for insomnia (CBT-I): a randomised controlled trial (iSleep well)
Benz, F., Grolig, L., Hannibal, S., Buntrock, C., Cuijpers, P., Domschke, K., Ebert, D. D., Ell, J., Janneck, M., Jenkner, C., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26731849
Additional file 2 of Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial
Ho, K. K., Simić, M., Pinheiro, M. B., Miller, C. B., Ferreira, M. L., Grunstein, R. R., Hopper, J. L., Ordoñana, J. R., & Ferreira, P. H. (2022) · Figshare · doi:10.6084/m9.figshare.20070964
Additional file 1 of Temporal network of experience sampling methodology identifies sleep disturbance as a central symptom in generalized anxiety disorder
Peng, J., Yuan, S., Wei, Z., Liu, C., Li, K., Wei, X., Yuan, S., Guo, Z., Wu, L., Feng, T., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26699663
Additional file 1 of Effects of exercise interventions on cancer-related fatigue and quality of life among cancer patients: a meta-analysis
Chen, X., Li, J., Chen, C., Zhang, Y., Zhang, S., Zhang, Y., Zhou, L., & Hu, X. (2024) · Figshare · doi:10.6084/m9.figshare.26596877
Continuous sleep tracking in digital CBT-I: Efficacy and insights from a naturalistic-environment study
Hinterberger, A., Eigl, E.-S., Szeko, A., Topalidis, P. I., & Schabus, M. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100646 · Cited by 1
“Several meta-analyses investigated the efficacy of dCBT-I on insomnia severity, and sleep parameters such as SE, SOL, and WASO (e.g., Soh et al., 2020; Zachariae et al., 2016) and usually find similar effects sizes as compared to F2F CBT-I (Luik et al., 2017; Simon et al., 2023).”
Insomnische Störungen
Pöschel, L., & Frase, L. (2026) · PSYCH up2date · doi:10.1055/a-2550-7222
Sponsorship bias and control group composition in trials evaluating digital cognitive behavioral therapy for insomnia – A comment on Grolig et al.
Pires, G. N., Kakazu, V. A., Leite, I. P. A., & Tufik, S. B. (2026) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2026.102243
Summary of the best evidence that cognitive behavioral therapy for insomnia improves sleep quality in patients with chronic insomnia
Yan, P., Feng, S., Ma, M., Li, B., & Liu, J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1688561 · Cited by 2
Cognitive-Behavioral Sleep and Nutritional Intervention Enhances Recovery and Survival in Rectal Cancer Patients Undergoing Abdominoperineal Resection: A Randomized Controlled Trial
Wang, G., & Pan, S. (2026) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001468
Topic Modeling of Social Media Sleep Health Discourse Using BERTopic: A Study of Naver Blog Big Data
Song, J. (2026) · Journal of Health Informatics and Statistics · doi:10.21032/jhis.2026.51.1.12
Finding a balance between principles and practice in internet-delivered CBT-I trials
Arem, H. E., & Zhou, E. S. (2026) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2026.102278
“Notably, internet-delivered CBT-I, (iCBT-I) has decades of literature demonstrating its effectiveness across healthy, as well as medical and psychiatric populations [5,6].”
Culturally adapted digital cognitive behavioral therapy for insomnia in South Korea – a double-blind randomized controlled trial
Kabbani, A., Passler, M., Park, K., Lee, E. Y., Lee, Y., Jansen, M., & Moon, D. U. (2026) · Internet Interventions · doi:10.1016/j.invent.2026.100933
“…shown that dCBT-I effectively alleviates insomnia symptoms, enhances sleep efficiency, and improves daytime functioning with sustained benefits observed over the long term (Soh et al., 2020; Zachariae et al., 2016; Ebert et al., 2018; Espie et al., 2019; Lorenz et al., 2019; Luik et al., 2017).”
Efficacy of digital cognitive behavioural therapy for insomnia in Armed Forces and Veteran populations – A systematic review and meta-analysis of randomised controlled trials
Rawcliffe, A. J., & Pereira, S. I. R. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108974
Randomised Evaluation of Sleep in Cognitive Impairment Trial (REST)—Protocol for a Feasibility Study of a Digital Cognitive Behavioural Therapy for Insomnia Intervention
Crowley, P., Henry, A. L., O’Donovan, M., Sheehan, R., Flanagan, E., & Ó’Caoimh, R. (2026) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23060695 · Cited by 1
“Evidence from meta-analyses supports the effectiveness of dCBT-I among adults (without cognitive impairment) [27,28], and more recent studies indicate that it is both feasible and beneficial for older adults [29].”
Efficacy of fully automated digital cognitive behavioral therapy for insomnia in adults: a systematic review and meta-analysis
Gao, K., Zhao, Y., Zhang, X., Su, K., Jia, J., & Xu, Y. (2026) · Sleep And Breathing · doi:10.1007/s11325-026-03723-x
“Our findings are broadly consistent with prior meta-analyses showing beneficial effects of digital CBT-I on insomnia outcomes across a range of delivery formats [18, 45, 58 ].”
Design and Recruitment for the Comparative Effectiveness of Zolpidem/Trazodone and Cognitive Behavioral Therapy for Insomnia (COZI) Study in Rural Adults
Johnson, E. M., Buysse, D. J., Krishnan, J. A., Parthasarathy, S., Ritterband, L. M., Thomas, S. M., Davis, E. M., Fernández‐Mendoza, J., Singh, A., Koopman, R. J., et al. (2026) · Behavioral Sleep Medicine · doi:10.1080/15402002.2026.2678881
Management of adult insomnia in Australia: a joint position statement of the Australasian Sleep Association, Sleep Health Foundation, Royal Australian College of General Practitioners, Australian Psychological Society, Pharmaceutical Society of Australia, and Australian Primary Health Care Nurses Association
Sweetman, A., Putland, S., Meaklim, H., Winter, S., Kennedy, G., Lack, L. C., Bartlett, D. J., Szeto, J., Blunden, S. L., Salles, H., et al. (2026) · SLEEP Advances · doi:10.1093/sleepadvances/zpag086
The historical and contemporary aspects of cognitive behavioral therapy for insomnia in recent 30 years: a bibliometric study
He, H., Hu, M., Li, S., & Yue, F. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1878379
Schlafstörungen – Insomnien
Riemann, D. W., & Bergmann, A. (2023) · Elsevier eBooks · doi:10.1016/b978-3-437-15270-2.00009-0
Insomnia Treatment Preferences and Barriers of Individuals With Arthritis
McGuire, E., Andersen, N. J., Lacaille, D. V., Savard, J., Fortin, P. R., Rahme, E., & Costa, D. D. (2026) · ACR Open Rheumatology · doi:10.1002/acr2.90104
Clinical trials for digital health interventions: a rapid review of study independence and the developer effect
Zhou, H., Kohli, S., & Tiemeier, H. W. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-03234-9

Authors: Zachariae, R., Lyby, M. S., Ritterband, L. M., & O'Toole, M. S.
Affiliations: Aarhus University (DK)
University of Virginia (US)
Corresponding author: Zachariae, Robert
ORCID: Zachariae, Robert
Ritterband, Lee M.
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2016-12
Volume: 30
Pages: 1-10
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2015.10.004
OpenAlex: W1863769327
Cited by: 704
References: 82
Citations by year: 2026: 27 · 2025: 81 · 2024: 69 · 2023: 76 · 2022: 78 · 2021: 70 · 2020: 136 · 2019: 47 · 2018: 45 · 2017: 50 · 2016: 22
FWCI: 5.07
Type: journal article
Language: en
Open access: green
pure.au.dk
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Keywords: internet-based cognitive behavioral therapy, insomnia, treatment efficacy, sleep efficiency, sleep quality, wake after sleep onset, sleep latency, nocturnal awakenings, treatment duration, follow-up maintenance, dropout
MeSH terms: Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Internet

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Efficacy of internet-delivered cognitive-behavioral therapy for insomnia— a systematic review and meta-analysis of randomized controlled trials

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