Internet-Based Cognitive Behavioral Therapy for Insomnia (ICBT-i) Improves Comorbid Anxiety and Depression—A Meta-Analysis of Randomized Controlled Trials

Abstract

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.

Improvements of adolescent psychopathology after insomnia treatment: results from a randomized controlled trial over 1 year

“…These findings are in line with previous research that has shown that insomnia can cause and aggravate psychopathology, including depression, anxiety and ADHD (Baglioni et al., ; Johnson, Roth, & Breslau, ; Millman, ; Owens et al., ; Roberts & Duong, ; Shanahan et al., ). In adults, insomnia treatment produces large effects on insomnia symptoms and small‐to‐moderate effects on psychopathology symptoms (Jansson‐Fröjmark & Norell‐Clarke, ; Ye et al., ). Studies comparing online to face‐to‐face or group treatments show similar results for group and online treatment for diminishing depressive symptoms (Blom et al., ) and better results for face‐to‐face treatment in diminishing depressive and anxiety symptoms (Lancee, Van Straten, Morina, Kaldo, & Kamphuis, ).…”

“…In a meta‐analysis, Ye et al. () showed that internet‐delivered CBTI, in comparison to control conditions, had significant but small effects on comorbid anxiety and depression.…”

“…These mixed results may be attributable to differences between patient groups, CBTI packages and methodological quality of the studies (Jansson-Fr€ ojmark & Norell- Clarke, 2016). In a meta-analysis, Ye et al (2015) showed that internet-delivered CBTI, in comparison to control conditions, had significant but small effects on comorbid anxiety and depression.…”

Advances in the management of chronic insomnia

“…57 Overall cCBT-I also improved comorbid depression and anxiety (effect sizes −0.35, 95% confidence interval −0.46 to −0.25 for anxiety and −0.36, −0.47 to −0.26 for depression). 58 A meta-analysis of six RCTs found that cCBT-I does not consistently improve total sleep time (TST) (0.22, −0.03 to 0.46; Ι²=0%) or wake after sleep onset (WASO) (−0.18, −0.43 to 0.06; Ι²=55%). 59 However, it does have a high adherence rate (78%) 53 59 and a low number needed to treat (3.59).…”

Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders

“…post-traumatic stress disorder (PTSD), excessive pre-sleep arousal and high trait anxiety] and those who did not display significant anxiety symptoms (Hedges’ g  = 0.40). Second, another meta-analysis suggest that internet-delivered CBT-I is moderately (Cohen’s d  = 0.35) effective in reducing anxiety symptoms, as assessed by validated anxiety scales [22•]. A notable caveat with the second meta-analysis is, however, that the patients in the nine included trials were not exclusively individuals with anxiety disorders or significant anxiety problems.…”