Internet-based cognitive–behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials
Open accessAbstract
Objective: To evaluate the effectiveness of internet-based cognitive–behavioural therapy for insomnia (ICBT-i) in adults. Design: A meta-analysis of ICBT-i. Data sources: Systematic searches of randomised controlled trials of ICBT-i were performed in the PubMed, EMBASE, PsycINFO and Cochrane Library databases up to 19 June 2016. Review method: 2 reviewers independently performed study selection, quality assessment and data extraction. Outcomes of interest included sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of nocturnal awakenings (NWAK), and Insomnia Severity Index (ISI). RevMan 5.2 and Stata 13.0 meta-analysis software were used to perform statistical analysis. Results: 14 records for 15 studies (1013 experimental group participants, 591 waiting list group participants) were included. The meta-analysis indicated that, at the post-test time point, SOL decreased by 18.41 min (95% CI 13.60 to 23.21), TST increased by 22.30 min (95% CI 16.38 to 28.23), SE increased by 9.58% (95% CI 7.30% to 11.85%), WASO decreased by 22.31 min (95% CI 13.50 to 31.11), NWAK decreased by 0.52 (95% CI 0.28 to 0.76), and ISI decreased by 5.88 points (95% CI 4.29 to 7.46). Additionally SOL, TST, SE, and WASO exhibited statistically significant improvements at follow-up versus before treatment. Conclusions: ICBT-i is an effective treatment for adults with insomnia. This conclusion should be verified in further studies.
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CBT-I may provide an attractive non-pharmacological option for improving sleep and other aspects of mental health.
“Overall, poor sleep appears to play an important part in the onset and aggravation of mental illness, and CBT-I may provide an attractive non-pharmacological option (which can also be delivered digitally) for improving sleep and other aspects of mental health 94-96 .”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [94]
The Introduction describes CBT-I as a non-pharmacological treatment that can be delivered online, and the Results report improvements in sleep measures. The paper notes an association between persistent insomnia and depression or anxiety, but its reported treatment outcomes do not establish that CBT-I improves other aspects of mental health. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSleep therapies have even larger effects on depression in those with mental illness compared to subclinical depressive symptoms.
“Of note, whereas many trials have shown the alleviation of subclinical depressive symptoms following sleep interventions, the available evidence suggests that even larger effects of sleep therapies on depression are observed in those with mental illness 79-81,94 .”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [94]
The Results section reports improvements in sleep measures, not effects on depression. Although the study-characteristics table includes a trial with depression as a comorbidity, our copy does not compare depression outcomes in people with mental illness and people with subclinical depressive symptoms (searched: depression, depressive symptoms, mental illness). (LLM, conf=0.77)
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- Authors
- Ye, Y.-Y., Chen, N.-K., Chen, J., Liu, J., Lin, L., Liu, Y.-Z., Lang, Y., Li, X.-J., Yang, X.-J., & Jiang, X.-J.
- Affiliations
- Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
- Department of Neurology, PLA 187 Hospital, Haikou, China
- Department of Neurology, PLA 123 Hospital, Bengbu, China
- Army Medical University (CN)
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2016-11
- Volume
- 6
- Issue
- 11
- Pages
- e010707
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5168528
- OpenAlex
- W2558952307
- Cited by
- 115
- References
- 51
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 12 · 2023: 16 · 2022: 13 · 2021: 14 · 2020: 17 · 2019: 13 · 2018: 8 · 2017: 2
- FWCI
- 1.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- internet-based cognitive behavioral therapy, insomnia, sleep latency, total sleep time, sleep efficiency, wake after sleep onset, nocturnal awakenings, Insomnia Severity Index, adults, digital mental health interventions
- MeSH terms
- Adult, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Telemedicine
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