title: Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials.
abstract: Self-help cognitive-behavioral therapy (CBT) is an increasingly popular treatment option for insomnia. The objective of this meta-analysis was to compile an up-to-date evaluation on the efficacy, adherence, acceptability and dropout rate of self-help CBT for insomnia. We systematically searched six key electronic databases up until May 2013. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Twenty randomized controlled trials were included; 10 of which were published after the last review up until January 2007. Meta-analysis of self-help CBT vs. waiting-list, routine care or no treatment was performed. Results showed that self-help CBT improved sleep, sleep-related cognitions and anxiety and depressive symptoms. Effect sizes for sleep-diary-derived sleep efficiency, sleep onset latency, and wake after sleep onset at immediate posttreatment were 0.80, 0.66, and 0.55, respectively. The average dropout rate of self-help CBT at immediate posttreatment was 14.5%, which was not significantly different from the 16.7% in therapist-administered CBT. Subgroup analyses supported the added benefit of telephone consultation. In conclusion, self-help CBT is efficacious and acceptable as an entry level of a stepped care model for insomnia. In places where face-to-face treatments are unavailable or too costly, self-help CBT can be considered as a compromise.
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Fiona Yan-Yee
authors.initials: FY
authors.lastname: Ho
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong. Electronic address: kfchung@hkucc.hku.hk.
authors.forename: Ka-Fai
authors.initials: KF
authors.lastname: Chung
authors.affiliation: School of Chinese Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Wing-Fai
authors.initials: WF
authors.lastname: Yeung
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Tommy H
authors.initials: TH
authors.lastname: Ng
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Ka-Shing
authors.initials: KS
authors.lastname: Kwan
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Kam-Ping
authors.initials: KP
authors.lastname: Yung
authors.affiliation: Dr. Sammy Cheng Psychological Services, Hong Kong.
authors.forename: Sammy K
authors.initials: SK
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods* / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*
keywords: Cognitive-behavioral therapy; Insomnia; Meta-analysis; Psychological treatment; Randomized controlled trial; Self-help; Sleep; Systematic review