Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. (April 2018)

• Record Type: Journal Article
• Authors: van Straten, Annemieke; van der Zweerde, Tanja; Kleiboer, Annet; Cuijpers, Pim; Morin, Charles M.; Lancee, Jaap
• Is Part Of: Sleep medicine reviews. Volume 38(2018)
• Page Start: 3
• Page End: 16
• Publication Date: 2018-04
• Subjects: Behavior therapy -- Cognitive therapy -- Cognitive behavior therapy -- Insomnia -- Sleep initiation or maintenance disorder; Sleep disorders -- Periodicals; Sleep Disorders -- Periodicals; Sommeil, Troubles du -- Périodiques; Electronic journals; 616.8498
• DOI: 10.1016/j.smrv.2017.02.001
• Languages: English
• ISSNs: 1087-0792

Abstract

Summary: Insomnia is a major public health problem considering its high prevalence, impact on daily life, co-morbidity with other disorders and societal costs. Cognitive behavioral treatment for insomnia (CBTI) is currently considered to be the preferred treatment. However, no meta-analysis exists of all studies using at least one component of CBTI for insomnia, which also uses modern techniques to pool data and to analyze subgroups of patients. We included 87 randomized controlled trials, comparing 118 treatments (3724 patients) to non-treated controls (2579 patients). Overall, the interventions had significant effects on: insomnia severity index ( g = 0.98), sleep efficiency ( g = 0.71), Pittsburgh sleep quality index ( g = 0.65), wake after sleep onset ( g = 0.63) and sleep onset latency (SOL; g = 0.57), number of awakenings ( g = 0.29) and sleep quality ( g = 0.40). The smallest effect was on total sleep time ( g = 0.16). Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions. Otherwise the results seem to be quite robust (similar for patients with or without comorbid disease, younger or older patients, using or not using sleep medication). We conclude that CBTI, either its components or the full package, is effective in the treatment of insomnia.