Self-help cognitive-behavioral therapy for insomnia (CBT-1): a systematic review of randomized controlled trials

Abstract

This study aimed to review current literature, examine the efficacy, adherence, acceptability, and attrition rate of self-help CBT-I, and to explore possible factors that might contribute to the effectiveness of the treatment. A systematic review was performed up to June 2012 on studies published in 6 major electronic databases. Two researchers performed study identification, data extraction, and methodological quality evaluation. Meta-analyses of self-help CBT-I vs. waiting-list, routine care, or no treatment, therapist-administered CBT-I, and placebo treatment were performed. We identified 20 randomized controlled trials (RCT) that met inclusion criteria. When compared to waiting-list control, self-help CBT-I achieved a moderate to large effect size on improving sleep and reducing sleep-related cognitions and anxiety and depressive symptoms. Therapist-administered CBT-I was slightly better than self-help CBT-I. Subgroup analyses supported the beneficial effect of telephone consultation, but not for “full” multi-component CBT and programs lasting for 6 or more weeks. Treatment adherence, acceptability, perceived usefulness, and credibility were reported as satisfactory. Based on the results of the systematic review, we have designed a Chinese-language self-help CBT-I and now conducting a RCT to evaluate the efficacy of Internet-based self-help CBT-I in Chinese population.