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Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis

Hasan, Faizul, Tu, Yu-Kang, Yang, Chien-Ming, James Gordon, Christopher, Wu, Dean, Lee, Hsin-Chien, Yuliana, Lia Taurussia, Herawati, Lucky, Chen, Ting-Jhen, Chiu, Hsiao-Yean·2022·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2021.101567

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Abstract

The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms; these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98-27.39 min), shorter SOL (MD: -18.76 min, 95% CI -24.20 to -13.31 min), lower WASO (MD: -31.40 min, 95% CI: -36.26 to -26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08%-12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO REGISTRATION NUMBER: CRD42020171134.

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Smartphone application‐delivered cognitive behavioural therapy for insomnia with telephone support for insomnia disorder compared to a waitlist control: a randomised clinical trial
Jansson‐Fröjmark, M., & Sunnhed, R. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14363 · Cited by 6
“As meta-analytic findings have shown superior outcomes for therapeutic guidance compared to non-human guidance, on both symptom severity and adherence (Baumeister et al., 2014; Hasan et al., 2021), the role of therapist support in app-based CBT-I is an interesting, yet unaddressed gap in research.”
The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients – Trial protocol of a randomised controlled trial
Treacy, T., O'Meara, Y., Galligan, M. C., Henry, A. L., Lensen, S. F., Higgins, M. J., Hickey, M., & Brennan, D. J. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107337 · Cited by 6
Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial
Clara, M. I., Van Straten, A., Canavarro, M. C., & Allen Gomes, A. (2024) · Acta Medica Portuguesa · doi:10.20344/amp.21094 · Cited by 5
The Effectiveness of Digital Cognitive Behavioral Therapy to Treat Insomnia Disorder in US Adults: Nationwide Decentralized Randomized Controlled Trial
Prather, A. A., Krystal, A. D., Emsley, R., Carl, J. R., Ball, T. M., Tarnai, K., Aguilera, A., Espie, C. A., & Henry, A. L. (2025) · JMIR Mental Health · doi:10.2196/84323 · Cited by 8
“Substantial evidence supports the effectiveness of digital CBT for insomnia (digital CBT-I), demonstrating robust effects on insomnia and sleep outcomes compared with a range of controls [26-29].”
Thematic trends and knowledge structure on cognitive behavior therapy for insomnia: A bibliometric and visualization analysis
Xin, Q., Paudel, D., An, K., Ye, Y., Zheng, S., Chen, L., Zhang, B., & Yin, H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.940741 · Cited by 5
Industry sponsorship bias in randomized controlled trials of digital cognitive behavioral therapy for insomnia: a meta-research study based on the 2023 Brazilian guidelines on the diagnosis and treatment of insomnia in adults
Kakazu, V. A., Assis, M., Bacelar, A., Bezerra, A. G., Ciutti, G. L. R., Conway, S. G., Galduróz, J. C. F., Drager, L. F., Khoury, M. P., Leite, I. P. A., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1600767 · Cited by 5
Understanding the research on tracking, diagnosing, and intervening in sleep disorders using mHealth apps: Bibliometric analysis and systematic reviews
Nuo, M., Fang, H., Wang, T., Liang, J., He, Y., Han, H., & Lei, J. (2023) · Digital Health · doi:10.1177/20552076231165967 · Cited by 6
“All apps correlated significantly with the PSG and were highly similar to PSG.22 Moreover, Hasana et al.23 conducted a systematic review and meta-analysis of 54 randomized controlled trials including 11,815 participants.”
Background
Embedding digital sleep health into primary care practice: A triangulation of perspectives from general practitioners, nurses, and pharmacists
Cheung, J. M. Y., Schrire, Z. M., Aji, M., Rahimi, M. M., Salomon, H., Doggett, I., Glozier, N., Bartlett, D. J., WONG, K. K. H., Grunstein, R. R., et al. (2023) · Digital Health · doi:10.1177/20552076231180970 · Cited by 5
Efficacy of Remote Cognitive Behavioural Therapy for Insomnia in Improving Health Status of Patients with Insomnia Symptoms: A Meta-analysis
Xu, D., Li, Z., Leitner, U., & Sun, J. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10458-6 · Cited by 5
“Recent meta-analysis studies (Gao et al., 2022; Hasan et al., 2022; Simon et al., 2023) have mentioned that remote CBT-I has significant effects on improving sleep in insomnia patients.”
Who is the “Therapist” in Digital Cognitive Behavioural Therapy for Insomnia (dCBTi)?
Stanley, N., Heslop-Marshall, K., & Gardiner, A. (2025) · Nature and Science of Sleep · doi:10.2147/nss.s516276 · Cited by 4
“One dCBTi product 8 has used what Hasan et al 7 term a “virtual therapist” to present CBTi instruction.”
Digital App Based Cognitive Behaviour Therapy CBT ‐I Course Improving Insomnia and Sleep Hygiene: A Randomised Controlled Trial
Kater, M., Wegener, N., Morath, N., & Vorster, A. P. A. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70195 · Cited by 4
Leveraging Artificial Intelligence for personalised insomnia-sleep calibration via the Big Five Personality Traits
Papatheodosiou, P., Panagoulias, D. P., Virvou, M. K., Tsihrintzis, G. A., Bonakis, A., & Dikeos, D. (2024) · Procedia Computer Science · doi:10.1016/j.procs.2024.09.723 · Cited by 4
Efficacy of digital cognitive behavioral therapy for treating insomnia in adults aged 65 and older: a secondary analysis using individual participant data from three randomized controlled trials
Tarnai, K., Miller, C. B., Magill, N., Emsley, R., Robinson, W., Kyle, S. D., McGrath, E. R., Espie, C. A., & Henry, A. L. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2480124 · Cited by 5
Feasibility and Acceptability of Brief Behavioral Treatment for Insomnia After Eating Disorder Treatment: The TIRED Study
Christensen, K. A., Bottera, A. R., Forbush, K. T., Isquith, J., & Young, K. P. D. (2025) · International Journal of Eating Disorders · doi:10.1002/eat.24540 · Cited by 4
Efficacy of digital cognitive behavioral therapy for insomnia in hypnotic reduction among patients with insomnia: A randomized controlled trial
Liu, M., Yi, R., Han, Z., Wang, R., Chen, M., Yao, P., Zhang, B., Lin, W., & Lv, D. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.108727 · Cited by 3
Digital Cognitive Behavioural Therapy for Insomnia Delivered Within a Crenotherapy Setting: Results from a Multicentre Proof-of-Concept Randomised Controlled Trial
Julie, L., Mengarduque, M., Coelho, J., Geoffroy, P. A., Denechere, E., Aouizerate, B., Jaafari, N., Philip, P., Taillard, J., Dubois, O., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062176 · Cited by 3
“A network meta-analysis by [22] showed that web-based dCBT-I incorporating automated therapeutic feedback achieved outcomes comparable to therapist-guided web-based dCBT-I, whereas fully automated interventions without guidance were associated with lower effectiveness.”
The beneficial effects of integrating a personalized telephone-delivered component into digital cognitive behavioral therapy for insomnia in a large, hospital-based population
Ren, R., Zhang, Y., Shi, Y., Zhang, H., Vitiello, M. V., & Tang, X. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.03.012 · Cited by 3
Does vestibular stimulation modify circadian rhythms and sleep? A systematic review
Galin, M., Milot, E., Martin, T., Bessot, N., Giffard, B., Denise, P., Perrier, J., & Quarck, G. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106520 · Cited by 3
Effects of a hybrid digital cognitive–behavioural therapy for insomnia and emotion regulation in the workplace (SLEEP): study protocol for a randomised waitlist control trial
Moukhtarian, T. R., Patel, K., Toro, C. T., Russel, S., Daly, G. B. J., Walasek, L., Tang, N. K. Y., & Meyer, C. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058062 · Cited by 3
Chronische Insomnie - alte, neue und zukünftige Therapieoptionen
Heidbreder, A. (2023) · InFo Neurologie + Psychiatrie · doi:10.1007/s15005-023-3275-y · Cited by 3
“Die Fläche unter der kumulativen Rangkurve deutet außerdem darauf hin, dass webbasierte KVT-I wahrscheinlich den höchsten Rang unter allen Behandlungen einnahm [31, 32, 33].”
Background
Factors facilitating and hindering the implementation of digital sleep coaching for bus drivers
Järnefelt, H., Anttilainen, J., Karhula, K., Hublin, C., Pehkonen, I., & Sallinen, M. (2024) · Applied Ergonomics · doi:10.1016/j.apergo.2024.104356 · Cited by 4
A Systematic Review on the Clinical Efficacy of Digital Therapeutics for Sleep Disorders: Subgroup Analysis by Control Groups
Jeon, H., Kang, E., & Yoo, S. (2023) · Korean Journal of Clinical Pharmacy · doi:10.24304/kjcp.2023.33.4.221 · Cited by 2
Validating the Efficacy of a Mobile Digital Therapeutic for Insomnia (WELT-I): Randomized Controlled Decentralized Clinical Trial
Park, K., Lee, S., Lee, Y., Moon, D. U., & Lee, E. M. (2025) · Journal of Medical Internet Research · doi:10.2196/70722 · Cited by 3
“Second, the sample size of the study was relatively small compared with previous clinical trials for digital CBT-I [67].”
Effects of Digital Cognitive Behavioral Therapy for Insomnia on Self-Reported Sleep Parameters: Systematic Review and Meta-Analysis
Leite, I. P. A., Kakazu, V. A., de Carvalho, L. A. T., Tufik, S., & Pires, G. N. (2025) · Clocks & Sleep · doi:10.3390/clockssleep7040069 · Cited by 4
“DCBT-I has already been recognized as a valid and recommended treatment for insomnia by recent guidelines [2,3,5], and its efficacy has been consistently demonstrated in a substantial number of studies [9,10].”
The acceptability of digital cognitive behavioural therapy for insomnia interventions: A mixed methods systematic review
Thomson, N., Gilarova, M., Lawrence, J., Cullen, B., & Gardani, M. (2026) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2026.102279 · Cited by 2
How to Better Manage Insomnia in French Cancer Patients With a Guided Internet‐Based Cognitive Behavioral Therapy? The Sleep‐4‐All 2.0 Real World Multicenter Single‐Arm Interventional Study
Boinon, D., Pagès, A., Zanni, L., Journiac, J., Charles, C., Borinelli-Franzoi, M. A., Vaz-Luís, I., Fasse, L., Hernot, D., Monod, A., et al. (2026) · Cancer Medicine · doi:10.1002/cam4.71871 · Cited by 2
“These benefits included increased total sleep time, reduced sleep onset latency, decreased wake time after sleep onset, and improved sleep efficiency [35].”
The design process and development of MySleepSolutions - A sleep module for a lifestyle self-management app for low back pain
Roberts, K. E., Beckenkamp, P. R., Comachio, J., Castrillón, C. I. M., Cabral, A. M., Ho, E. K., Comis, J., Jensen, C., Gordon, C., & Ferreira, P. H. (2025) · Health Informatics Journal · doi:10.1177/14604582251340548 · Cited by 3
Digital Cognitive Behavioural Therapy for Insomnia in People with Co-Morbid Insomnia and Sleep Apnoea (COMISA): Recent Evidence and Clinical Considerations
Sweetman, A., Reynolds, C. M., Spiegelhalder, K., Rajagopalan, P., & Richardson, C. E. (2025) · Current Pulmonology Reports · doi:10.1007/s13665-025-00387-y · Cited by 2
“In a 2022 network meta-analysis, Hasan and colleagues [ 40 ] found that digital CBTi with a virtual/real therapist resulted in optimal treatment efficacy across sleep/ insomnia outcomes, when compared to treatment as usual.”
The influence of digital cognitive behavioral therapy treatment for perioperative sleep disorders in patients undergoing total knee arthroplasty
Wang, Y., Shao, J., Yu, P., Li, Y., Huo, X., Li, Q., Li, S., Wang, Q., & Qie, X. (2025) · Sleep And Breathing · doi:10.1007/s11325-025-03387-z · Cited by 1
Effects of nurse-led, web-based brief behavioral therapy on insomnia severity in patients in the chronic stage of stroke recovery: a preliminary randomized controlled trial
Hasan, F., Prasetya, E. C., Gordon, C. J., Romadlon, D. S., Chang, K.-M., Bartlett, D. J., Lin, C., Gautama, M. S. N., Izzati, N., & Chiu, H. (2025) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11856 · Cited by 1
“14 The other challenge (ie, prolonged treatment durations) cannot be overcome by employing digital CBT-I modalities.”
Self-citation
A Systematic Review of Economic Evaluations on Interventions Targeting Insomnia or Hypersomnia
Le, P. H., Le, L. K., Le, D. Q., Rajaratnam, S. M. W., & Mihalopoulos, C. (2025) · Applied Health Economics and Health Policy · doi:10.1007/s40258-025-00997-2 · Cited by 1
“Moreover, digital CBT-I can improve consumer accessibility, given the limited availability of healthcare professionals who can deliver CBT-I [33, 62, 63].”
Bibliometric and visual analysis of cancer-related insomnia research from 2015 to 2025
Chen, L., Wang, R., Xu, F. G., Zhao, J., Wang, F., & Zhou, D. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09909-5 · Cited by 1
Sleep health in the primary care setting
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ADHD and Sleep Problems
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Substance Abuse Prevention and Treatment: A Specialization in Lifestyle Medicine Centers
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Does digital cognitive behavioral therapy improve the insomnia and depression of workers to healthy levels? An open trial
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Disentangling what works best for whom in comorbidity
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Background
Cognitive behaviour therapy for insomnia works. It's time to make it accessible
Cunnington, D. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101586
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Authors: Hasan, F., Tu, Y.-K., Yang, C.-M., James Gordon, C., Wu, D., Lee, H.-C., Yuliana, L. T., Herawati, L., Chen, T.-J., & Chiu, H.-Y.
Affiliations: Taipei Medical University (TW)
National Taiwan University (TW)
National Chengchi University (TW)
Taipei Medical University-Shuang Ho Hospital (TW)
Taipei Medical University Hospital (TW)
Kementerian Kesehatan Republik Indonesia (ID)
Corresponding author: Chiu, Hsiao-Yean
ORCID: Hasan, Faizul
Tu, Yu-Kang
Yang, Chien-Ming
Wu, Dean
Lee, Hsin-Chien
Yuliana, Lia Taurussia
Herawati, Lucky
Chen, Ting-Jhen
Chiu, Hsiao-Yean
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2022-02
Volume: 61
Pages: 101567
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2021.101567
OpenAlex: W3214315566
Cited by: 137
References: 91
Citations by year: 2026: 26 · 2025: 38 · 2024: 30 · 2023: 29 · 2022: 13
FWCI: 2.99
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Funders: Ministry of Science and Technology, Taiwan (110-2628-B-038-017)
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: digital cognitive behavioral therapy for insomnia, insomnia, online therapy, total sleep time, sleep latency, wake after sleep onset, sleep efficiency, sleep duration, insomnia symptoms, treatment efficacy comparison
MeSH terms: Adult, Humans, Sleep Initiation and Maintenance Disorders, Sleep, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Polysomnography, Self Report

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Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis

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