Cognitive behavioural therapy monotherapy for insomnia: a comprehensive meta-analysis of randomized controlled trials

Abstract This is a systematic review and meta-analysis on randomized controlled trials (RCTs) comparing the effects of cognitive behavioural therapy for insomnia (CBTI) as a monotherapy and active control treatments in persons with insomnia who have no major medical conditions or psychiatric comorbidities. PubMed, Embase,PsycINFO, and Cochrane Library databases, CNKI and WanFang were systematically and independently searched. Nine RCTs with 12 treatment arms comparing CBTI (n = 479) and active control (n = 510) groups were investigated. Compared to the active control group, the CBTI group demonstrated significantly less enhancement in insomnia at post-CBTI assessment in terms of sleep efficiency (SMD: 0.32, 95% CI: 0.00 to 0.63), sleep latency (SMD: -0.33, 95% CI: -0.56 to -0.09), wake after sleep onset (SMD: -0.27, 95% CI: -0.52 to -0.01) and the total scores of Pittsburgh Sleep Quality Index (SMD: -0.52, 95% CI: -0.86 to -0.19), the Insomnia Symptom Index (SMD: -0.68, 95% CI: -1.01 to -0.36), the Dysfunctional Attitudes and Beliefs About Sleep Scale (SMD: -0.76, 95% CI: -1.25 to -0.27), and the Athens Insomnia Scale (SMD: -0.66, 95% CI: -1.07 to -0.24). In this meta-analysis, CBTI monotherapy showed no advantage in improving insomnia compared with other standard treatments. Probably CBTI works well when it is combined with other treatments, such as pharmacotherapy. The findings need to be replicated in future RCTs with larger samples.