Internet-based cognitive behavioral therapy for insomnia (ICBT-i) improves comorbid anxiety and depression—a meta-analysis of randomized controlled trials
Open accessAbstract
As the internet has become popularized in recent years, cognitive behavioral therapy for insomnia (CBT-i) has shifted from a face-to-face approach to delivery via the internet (internet-based CBT-i, ICBT-i). Several studies have investigated the effects of ICBT-i on comorbid anxiety and depression; however, the results remain inconclusive. Thus, a meta-analysis was conducted to determine the effects of ICBT-i on anxiety and depression. Electronic databases, including PubMed, EMBASE, PsycINFO and the Cochrane Library (throughout May 28, 2015), were systematically searched for randomized controlled trials (RCTs) of ICBT-i. Data were extracted from the qualified studies and pooled together. The standardized mean difference (SMD) and 95% confidence interval (95% CI) were calculated to assess the effects of ICBT-i on comorbid anxiety and depression. Nine records that included ten studies were ultimately qualified. The effect sizes (ESs) were -0.35 [-0.46, -0.25] for anxiety and -0.36 [-0.47, -0.26] for depression, which were stable using a between-group or within-group comparison and suggest positive effects of ICBT-i on both comorbid disorders. Although positive results were identified in this meta-analysis, additional high-quality studies with larger sample sizes are needed in the future.
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The effect on depression symptoms identified is comparable to the effects on depression symptoms reported in previous meta-analyses of CBT-I for insomnia.
“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 [36]
Previous meta-analyses suggest that both internet-delivered and group-based CBT-I have small but significant effects on depression symptoms.
“The results of previous meta-analyses suggest that both internet-delivered [36] and group-based [37] CBT-I have small but significant effects on depression symptoms, despite these symptoms not being specifically targeted.”
From The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials (2019) · cites this paper as [36]
The effects on anxiety and depression are consistent with the results of a meta-analysis.
“The effects on anxiety and depression are consistent with the results of a meta-analysis.33”
From The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis (2017) · cites this paper as [33]
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References 53 · Cited by 186
Research works printed but not linked: 2
- [36]Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med. 1997; 27: 231– 235. 9122304
- [40]Bastien CH, Morin CM, Ouellet MC, Blais FC, Bouchard S. Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. J Consult Clin Psychol. 2004; 72: 653– 659. 15301650
- Authors
- Ye, Y.-Y., Zhang, Y.-F., Chen, J., Liu, J., Li, X.-J., Liu, Y.-Z., Lang, Y., Lin, L., Yang, X.-J., & Jiang, X.-J.
- Affiliations
- Army Medical University (CN)
- Ningbo University (CN)
- Corresponding author
- Jiang, Xiao-Jiang
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-11-18
- Volume
- 10
- Issue
- 11
- Pages
- e0142258
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4651423
- OpenAlex
- W2179997912
- Cited by
- 186
- References
- 53
- Citations by year
- 2026: 6 · 2025: 20 · 2024: 17 · 2023: 27 · 2022: 25 · 2021: 21 · 2020: 26 · 2019: 13 · 2018: 11 · 2017: 11 · 2016: 8 · 2014: 1
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- 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
- cognitive behavioral therapy for insomnia, insomnia, anxiety comorbidity, comorbid depression, online therapy, sleep disorders
- MeSH terms
- Anxiety Disorders, Depressive Disorder, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Telemedicine, Internet
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