title: Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials.
abstract: Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. Eleven randomized controlled trials examining a total of 1460 participants were included. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges's g) ranging from 0.21 to 1.09. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 wk follow-up. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.
authors.affiliation: Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark. Electronic address: bzach@aarhus.rm.dk.
authors.forename: Robert
authors.initials: R
authors.lastname: Zachariae
authors.affiliation: Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark.
authors.forename: Marlene S
authors.initials: MS
authors.lastname: Lyby
authors.affiliation: Behavioral Health and Technology Lab, Dept. of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ritterband
authors.affiliation: Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark.
authors.forename: Mia S
authors.initials: MS
authors.lastname: O'Toole
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods; D006801:Humans; D020407:Internet; D016032:Randomized Controlled Trials as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Cognitive-behavioral therapy; Insomnia; eHealth; internet-delivered