Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials

• Published in: Sleep medicine Vol. 75; pp. 315 - 325
• Main Authors: Soh, Hui Ling, Ho, Roger C., Ho, Cyrus S., Tam, Wilson W.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-11-2020
• Subjects: CBT-I; Cognitive behavioural therapy; Digital; Insomnia; Internet; Digital; Internet; Cognitive behavioural therapy; Insomnia; CBT-I
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2020.08.020

Although cognitive behavioural therapy for insomnia (CBT-I) has been recommended the initial therapy for insomnia, its clinical usage remains limited due to the lack of therapists. Digital CBT-I (dCBT-I) can potentially circumvent this problem. This meta-analysis aims to evaluate the short-term and long-term efficacy of dCBT-I for adults with insomnia.
Systematic search of PubMed, EMBASE, PsycINFO, and CENTRAL from inception till 5 March 2020 was conducted. Randomised controlled trials (RCTs) comparing dCBT-I with controls (wait-list/treatment-as-usual/online education) in adults with insomnia were eligible. The primary outcome was insomnia severity index (ISI) at post-intervention, short-term follow-up (ranging 4 weeks to 6 months) and 1-year follow-up. Mean differences were pooled using the random-effects model.
94 articles were assessed full-text independently by two team members and 33 studies were included in this meta-analysis. 4719 and 4645 participants were randomised to dCBT-I and control respectively. dCBT-I significantly reduces ISI at post-intervention with mean difference −5.00 (95% CI −5.68 to −4.33, p < 0.0001) (I2 = 79%) compared to control. The improvements were sustained at short-term follow-up, −3.99 (95% CI −4.82 to −3.16, p < 0.0001) and 1-year follow-up, −3.48 (95% CI −4.21 to −2.76, p < 0.0001). Compared to dCBT-I, face-to-face CBT-I produced greater improvement in ISI, 3.07 (95% CI 1.18 to 4.95, p = 0.001). However, this was within the non-inferiority interval of 4 points on ISI.
This meta-analysis provides strong support for the effectiveness of dCBT-I in treating insomnia. dCBT-I has potential to revolutionise the delivery of CBT-I, improving the accessibility and availability of CBT-I content for insomnia patients worldwide.
•dCBT-I reduced ISI by mean difference of −5.00 (95% CI −5.68 to −4.33, p < 0.0001).•dCBT-I also improved SOL, WASO, TST, SE, and NWAK at post-intervention.•Improvements in ISI were sustained at short-term and 1-year follow-up.•dCBT-I was found to be non-inferior to face-to-face CBT-I.•dCBT-I is an effective therapeutic option for patients with insomnia.