Comparative efficacy and acceptability of cognitive behavioral therapy delivery formats for insomnia in adults: A systematic review and network meta-analysis
Abstract
This review compared the efficacy and acceptability of different delivery formats for cognitive behavioral therapy for insomnia (CBT-I) in insomnia. We searched five databases for randomized clinical trials that compared one CBT-I delivery format against another format or control conditions for insomnia in adults. We used pairwise meta-analyses and frequentist network meta-analyses with the random-effects model to synthesize data. A total of 61 unique trials including 11,571 participants compared six CBT-I delivery formats with four control conditions. At post-intervention, with low to high certainty evidence, individual, group, guided self-help, digital assisted, and unguided self-help CBT-I could significantly increase sleep efficiency and total sleep time (TST) and reduce sleep onset latency (SOL), wake after sleep onset (WASO), and insomnia severity compared with treatment as usual (MD range for sleep efficiency: 7.81%-12.45%; MD range for TST: 16.14-33.96 min; MD range for SOL: -22.42 to -13.81 min; MD range for WASO: -40.84 to -19.48 min; MD range for insomnia severity: -6.40 to -3.93) and waitlist (MD range for sleep efficiency: 7.68%-12.32%; MD range for TST: 12.67-30.49 min; MD range for SOL: -19.07 to -10.46 min; MD range for WASO: -47.10 to -19.15 min; MD range for insomnia severity: -7.59 to -5.07). The effects of different CBT-I formats persisted at short-term follow-up (4 wk-6 mo). Individual, group, and digital assisted CBT-I delivery formats would be the more appropriate choices for insomnia in adults, based on post-intervention and short-term effects. Further trials are needed to investigate the long-term effects of different CBT-I formats.
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In-person therapies and digital therapy with clinician support are the most effective approaches for CBT-I delivery.
“This is in line with another meta-analysis that evaluated various delivery CBT-I formats and found in-person therapies and digital therapy with clinician support to be the most effective approaches. 43”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [43]
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- Authors
- Gao, Y., Ge, L., Liu, M., Niu, M., Chen, Y., Sun, Y., Chen, J., Yao, L., Wang, Q., Li, Z., Xu, J., Li, M., Hou, L., Shi, J., Yang, K., Cai, Y., Li, L., Zhang, J., & Tian, J.
- Affiliations
- Lanzhou University (CN)
- Peking University (CN)
- McMaster University (CA)
- Lanzhou University Second Hospital (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- KU Leuven (BE)
- Central South University (CN)
- Tianjin University of Traditional Chinese Medicine (CN)
- Corresponding author
- Tian, Jinhui
- ORCID
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 64
- Pages
- 101648
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W4281728610
- Cited by
- 89
- References
- 50
- Citations by year
- 2026: 19 · 2025: 25 · 2024: 23 · 2023: 19 · 2022: 3
- FWCI
- 2.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Lanzhou University Institutional Repository (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Funders
- National Key Research and Development Program of China
- National Key Research and Development Program of China Stem Cell and Translational Research (2019YFC1709805)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive behavioral therapy for insomnia, insomnia, group therapy, individual psychotherapy, guided self-help, sleep efficiency, total sleep time, sleep latency, wake after sleep onset, insomnia severity, treatment acceptability, adults
- MeSH terms
- Network Meta-Analysis, Sleep Latency, Adult, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Treatment Outcome
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