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The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: A systematic review and network meta-analysis
Open accessAbstract
This review aimed to assess the impact of behavioural therapy for insomnia administered alone (BT-I) or in combination with cognitive techniques (cognitive-behavioural therapy for insomnia, CBT-I) on depressive and fatigue symptoms using network meta-analysis. PubMed, Scopus and Web of Science were searched from 1986 to May 2015. Studies were included if they incorporated sleep restriction, a core technique of BT-I treatment, and an adult insomnia sample, a control group and a standardised measure of depressive and/or fatigue symptoms. Face-to-face, group, self-help and internet therapies were all considered. Forty-seven studies were included in the meta-analysis. Eleven classes of treatment or control conditions were identified in the network. Cohen's d at 95% confidence interval (CI) was calculated to assess the effect sizes of each treatment class as compared with placebo. Results showed significant effects for individual face-to-face CBT-I on depressive (d = 0.34, 95% CI: 0.06-0.63) but not on fatigue symptoms, with high heterogeneity between studies. The source of heterogeneity was not identified even after including sex, age, comorbidity and risk of bias in sensitivity analyses. Findings highlight the need to reduce variability between study methodologies and suggest potential effects of individual face-to-face CBT-I on daytime symptoms.
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“To illustrate, treating symptoms of insomnia also improved symptoms of depression (93), anxiety, and stress (94–99).”
In the citing paper
“As would be expected given that most eligible trials were of CBT-I, or CBT-informed interventions for insomnia, the effect on depression symptoms we identified is comparable to the effects on depression symptoms reported in previous meta-analyses of CBT-I for insomnia [36][37][38].”
From The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials (2019) · cites this paper as [38]
In the citing paper
“However, a recent network meta-analysis of behavioural and cognitive behavioural interventions for adults with insomnia [38] found that only individual, face-to-face CBT-I had a significant effect on depression symptoms when compared to a placebo condition.”
From The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials (2019) · cites this paper as [38]
In the citing paper
“However, tThe conclusions that could be drawn from this analysis were limited by significant heterogeneity that was not explained by the clinical, demographic or methodological characteristics examined, which included age, sex, whether participants with comorbidities were excluded, and risk of bias.”
From The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials (2019) · cites this paper as [38]
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Citations
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The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023
Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., Bassetti, C. L. A., Bastien, C., Berzina, N., Bjorvatn, B., Dikeos, D., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14035 · Cited by 834
Blake, M. J., Trinder, J. A., & Allen, N. B. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.05.006 · Cited by 477
Jahrami, H., Alhaj, O. A., Humood, A. M., Alenezi, A. F., Fekih‐Romdhane, F., Al-Rasheed, M. M., Saif, Z., Bragazzi, N. L., Pandi-Perumal, S. R., BaHammam, A. S., et al. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101591 · Cited by 359
“…students, and special populations, such as pregnant women, etc. Evidence-based strategies, e.g., cognitive behavioral therapy for insomnia [307], meditation [308], sports interventions [309], and wellness interventions [310], can be included in self-help applications, and healthcare staff…”
Psychopathological networks: Theory, methods and practice
Bringmann, L. F., Albers, C. J., Bockting, C., Borsboom, D., Ceulemans, E., Cramer, A. O. J., Epskamp, S., Eronen, M. I., Hamaker, E. L., Kuppens, P., et al. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104011 · Cited by 325
Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions
Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-017-0234-5 · Cited by 242
“There is also emerging evidence that CBT-I leads to improvements in physical and mental health symptoms, including reductions in anxiety and depression, with small– medium effect sizes (Ballesio et al. 2017; Belleville et al. 2011; Taylor and Pruiksma 2014).”
Background
Metadata
- Authors
- Ballesio, A., Aquino, M. R. J. V., Feige, B., Johann, A. F., Kyle, S. D., Spiegelhalder, K., Lombardo, C., Rücker, G., Riemann, D., & Baglioni, C.
- Affiliations
- Sapienza University of Rome (IT)
- City, University of London (GB)
- University of Freiburg (DE)
- University of Oxford (GB)
- Corresponding author
- Baglioni, Chiara
- ORCID
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 37
- Pages
- 114-129
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2587622674
- Cited by
- 172
- References
- 100
- Citations by year
- 2026: 16 · 2025: 17 · 2024: 16 · 2023: 16 · 2022: 15 · 2021: 24 · 2020: 21 · 2019: 25 · 2018: 13
- FWCI
- 2.96
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Funders
- University Medical Center of Freiburg, Germany
- Sapienza University of Rome, Italy
- 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
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Keywords
- insomnia, cognitive behavioral therapy for insomnia, depression, fatigue, sleep restriction, online therapy, group therapy, self-help intervention, face-to-face therapy, daytime symptoms
- MeSH terms
- Depression, Fatigue, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy
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