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

Yuan-Yuan Ye, Yuan-Feng Zhang, Jia Chen, Juan Liu, Xun-Jun Li, Ya-Zhen Liu, Ying Lang, Ling Lin, Xin-Ju Yang, Xiao-Jiang Jiang, Yuan-Yuan Ye, Yuan-Feng Zhang, Jia Chen, Juan Liu, Xun-Jun Li, Ya-Zhen Liu, Ying Lang, Ling Lin, Xin-Ju Yang, Xiao-Jiang Jiang

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the qualified…
Fig 1. Flow diagram of the qualified studies.
Fig 2. Meta-analysis of the effect of…
Fig 2. Meta-analysis of the effect of ICBT-i on anxiety.
Fig 3. Meta-analysis of the effect of…
Fig 3. Meta-analysis of the effect of ICBT-i on depression.

References

    1. Kaldo V, Jernelov S, Blom K, Ljotsson B, Brodin M, Jörgensen M, et al. Guided internet cognitive behavioral therapy for insomnia compared to a control treatment—A randomized trial. Behav Res Ther. 2015; 71: 90–100. 10.1016/j.brat.2015.06.001
    1. Lian Y, Xiao J, Liu Y, Ning L, Guan S, Ge H, et al. Associations between insomnia, sleep duration and poor work ability. J Psychosom Res. 2015; 78: 45–51. 10.1016/j.jpsychores.2014.09.009
    1. Altena E, Van Der Werf YD, Strijers RL, Van Someren EJ. Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy. J Sleep Res. 2015; 17:335–343.
    1. Ashworth DK, Sletten TL, Junge M, Simpson K, Clarke D, Cunnington D, et al. A randomized controlled trial of cognitive behavioral therapy for insomnia: an effective treatment for comorbid insomnia and depression. J Couns Psychol. 2015; 62: 115–123. 10.1037/cou0000059
    1. Becker PM. Hypnosis in the Management of Sleep Disorders. Sleep Med Clin. 2015; 10: 85–92. 10.1016/j.jsmc.2014.11.003
    1. Vermeeren A. Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs. 2004; 18: 297–328.
    1. Takaesu Y, Komada Y, Asaoka S, Kagimura T, Inoue Y. Factors associated with long-term use of hypnotics among patients with chronic insomnia. PLoS One. 2014; 9: e113753 10.1371/journal.pone.0113753 eCollection 2014.
    1. Chen PL, Lee WJ, Sun WZ, Oyang YJ, Fuh JL. Risk of dementia in patients with insomnia and long-term use of hypnotics: a population-based retrospective cohort study. PLoS One. 2012; 7: e49113 10.1371/journal.pone.0049113 Epub 2012 Nov 7.
    1. Wise J. Cognitive behavioural therapy can help chronic insomnia, review finds. BMJ. 2015; 350: h3076 10.1136/bmj.h3076
    1. Bastien CH, Morin CM, Ouellet MC, Blais FC, Bouchard S. Cognitive–Behavioral Therapy for Insomnia: Comparison of Individual Therapy, Group Therapy, and Telephone Consultations. J Consult Clin Psychol. 2004; 72:653–659.
    1. Morin CM, Benca R. Chronic insomnia. Lancet. 2012; 379: 1129–1141. 10.1016/S0140-6736(11)60750-2
    1. Bonin EM, Beecham J, Swift N, Raikundalia S, Brown JS. Psycho-educational CBT-Insomnia workshops in the community. A cost-effectiveness analysis alongside a randomised controlled trial. Behav Res Ther. 2014; 55: 40–47. 10.1016/j.brat.2014.01.005
    1. Ström L, Pettersson R, Andersson G. Internet-Based Treatment for Insomnia: A Controlled Evaluation. J Consult Clin Psychol. 2004; 72:113–120.
    1. Cheng SK, Dizon J. Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychother Psychosom. 2012; 81: 206–216. 10.1159/000335379
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151: 264–269, W264.
    1. Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005; 85: 257–268.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996; 17:1–12.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7: 177–188.
    1. de Bruin EJ, Oort FJ, Bogels SM, Meijer AM. Efficacy of internet and group-administered cognitive behavioral therapy for insomnia in adolescents: a pilot study. Behav Sleep Med. 2014; 12: 235–254. 10.1080/15402002.2013.784703
    1. Lancee J, van den Bout J, van Straten A, Spoormaker VI. Baseline depression levels do not affect efficacy of cognitive-behavioral self-help treatment for insomnia. Depress Anxiety. 2013; 30: 149–156. 10.1002/da.22004
    1. Suzuki E, Tsuchiya M, Hirokawa K, Taniguchi T, Mitsuhashi T, Kawakami N. Evaluation of an internet-based self-help program for better quality of sleep among Japanese workers: a randomized controlled trial. J Occup Health. 2008; 50: 387–399.
    1. Thiart H, Lehr D, Ebert DD, Sieland B, Berking M, Riper H. Log in and breathe out: efficacy and cost-effectiveness of an online sleep training for teachers affected by work-related strain—study protocol for a randomized controlled trial. Trials. 2013; 14: 169 10.1186/1745-6215-14-169
    1. Thiart H, Lehr D, Ebert DD, Berking M, Riper H. Log in and breathe out: internet-based recovery training for sleepless employees with work-related strain—results of a randomized controlled trial. Scand J Work Environ Health. 2015; 41: 164–174. 10.5271/sjweh.3478
    1. Lancee J, van den Bout J, van Straten A, Spoormaker VI. Internet-delivered or mailed self-help treatment for insomnia? a randomized waiting-list controlled trial. Behav Res Ther. 2012; 50: 22–29. 10.1016/j.brat.2011.09.012
    1. Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD. Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012; 21: 695–705. 10.1002/pon.1969
    1. Lancee J, van den Bout J, Sorbi MJ, van Straten A. Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: a randomized trial. Behav Res Ther. 2013; 51: 797–805. 10.1016/j.brat.2013.09.004
    1. Thorndike FP, Ritterband LM, Gonder-Frederick LA, Lord HR, Ingersoll KS, Morin CM. A randomized controlled trial of an internet intervention for adults with insomnia: effects on comorbid psychological and fatigue symptoms. J Clin Psychol. 2013; 69: 1078–1093. 10.1002/jclp.22032
    1. Espie CA, Kyle SD, Miller CB, Ong J, Hames P, Fleming L. Attribution, cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy. Sleep Med. 2014; 15: 913–917. 10.1016/j.sleep.2014.03.001
    1. Ho FY, Chung KF, Yeung WF, Ng TH, Cheng SK. Weekly brief phone support in self-help cognitive behavioral therapy for insomnia disorder: Relevance to adherence and efficacy. Behav Res Ther. 2014; 63C: 147–156. 10.1016/j.brat.2014.10.002
    1. van Straten A, Emmelkamp J, de Wit J, Lancee J, Andersson G, van Someren EJ, et al. Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial. Psychol Med. 2014; 44: 1521–1532. 10.1017/S0033291713002249
    1. Blom K, Jernelov S, Kraepelien M, Bergdahl MO, Jungmarker K, Ankartjärn L, et al. Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep. 2015; 38: 267–277. 10.5665/sleep.4412
    1. Blom K, Tarkian Tillgren H, Wiklund T, Danlycke E, Forssen M, Söderström A, et al. Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial. Behav Res Ther. 2015; 70: 47–55. 10.1016/j.brat.2015.05.002
    1. Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997; 27: 363–370.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 361–370.
    1. Beekman AT, van Limbeek J, Deeg DJ, Wouters L, van Tilburg W. A screening tool for depression in the elderly in the general population: the usefulness of Center for Epidemiological Studies Depression Scale (CES-D). Tijdschr Gerontol Geriatr. 1994; 25: 95–103.
    1. Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med. 1997; 27: 231–235.
    1. Gros DF, Antony MM, Simms LJ, McCabe RE. Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): comparison to the State-Trait Anxiety Inventory (STAI). Psychol Assess. 2007; 19: 369–381.
    1. Henry JD, Crawford JR.The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005; 44: 227–239.
    1. Svanborg P, Asberg M. A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale. Acta Psychiatr Scand. 1994; 89: 21–28.
    1. Bastien CH, Morin CM, Ouellet MC, Blais FC, Bouchard S.Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. J Consult Clin Psychol. 2004; 72: 653–659.
    1. Espie CA, Kyle SD, Williams C, Ong JC, Douglas NJ, Hames P, et al. A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep. 2012; 35: 769–781. 10.5665/sleep.1872
    1. Fernandez-Mendoza J, Vela-Bueno A, Vgontzas AN, Olavarrieta-Bernardino S, Ramos-Platon MJ, Bixler EO, et al. Nighttime sleep and daytime functioning correlates of the insomnia complaint in young adults. J Adolesc. 2009; 32: 1059–1074. 10.1016/j.adolescence.2009.03.005
    1. Uhde TW, Cortese BM, Vedeniapin A. Anxiety and sleep problems: emerging concepts and theoretical treatment implications. Curr Psychiatry Rep. 2009; 11: 269–276.
    1. Germain A, Moul DE, Franzen PL, Miewald JM, Reynolds CF 3rd, Monk TH, Monk TH, et al. Effects of a brief behavioral treatment for late-life insomnia: preliminary findings. J Clin Sleep Med. 2006; 2:403–406.
    1. OKAJIMA Isa, KOMADA Yoko and INOUE Yuichi. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia.SLEEP BIOL RHYTHMS. 2011; 9: 24–34.
    1. Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme MÈ. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev. 2011; 31:638–652. 10.1016/j.cpr.2011.02.004
    1. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA. 2001; 285:1856–1864.
    1. Cheung G, Patrick C, Sullivan G, Cooray M, Chang CL. Sensitivity and specificity of the Geriatric Anxiety Inventory and the Hospital Anxiety and Depression Scale in the detection of anxiety disorders in older people with chronic obstructive pulmonary disease. Int Psychogeriatr. 2012; 24: 128–136. 10.1017/S1041610211001426
    1. Ritterband LM, Thorndike FP, Gonder-Frederick LA, Magee JC, Bailey ET, Saylor DK, et al. Efficacy of an Internet-based behavioral intervention for adults with insomnia. Arch Gen Psychiatry. 2009; 66: 692–698. 10.1001/archgenpsychiatry.2009.66

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner