Remission, treatment response, and treatment adherence across the delivery methods of cognitive behavioral therapy for insomnia: A systematic review and meta-analysis of randomized controlled trials.

This study aimed to clarify the clinically meaningful outcomes and treatment adherence across different delivery methods of cognitive behavioral therapy for insomnia (CBT-I). CBT-I was defined as incorporating both sleep restriction and stimulus control techniques. This study included individual, group, fully automated Internet-based, and supported Internet-based formats.

Remission from insomnia increased significantly across all delivery methods compared with the control group (individual: k = 36, n = 1696, odds ratio [OR] = 8.36; group: k = 22, n = 2356, OR = 4.65; fully automated Internet-based: k = 50, n = 15590, OR = 3.87; supported Internet-based: k = 19, n = 1759, OR = 8.35). After adjusting for comorbidities and types of control group, meta-regression analysis showed that the individual and supported Internet-based formats were significantly associated with higher odds of remission from insomnia compared with the fully automated Internet-based format. The completion rate for all sessions was significantly higher in the individual format (k = 8, 83.8%) than in the Internet-based formats (supported Internet-based: k = 15, 70.7%; fully automated Internet-based: k = 26, 58.4%).

CBT-I is robustly effective in managing insomnia, although relatively lower treatment adherence continues to be a major challenge for Internet-based CBT-I.