Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Sci Rep. 2023 Feb 2;13(1):1929. doi: 10.1038/s41598-023-28853-0.
Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity. A systematic review and frequentist network meta-analysis of available CBT-I settings was performed. PsycINFO, PsycARTICLES, MEDLINE, PubMed, and CINAHL were searched for randomized controlled trials (RCTs) investigating any CBT-I settings in adults with insomnia disorder. The systematic literature search (3851 references) resulted in 52 RCTs. For the primary outcome insomnia severity, all examined CBT-I settings except smartphone-delivered CBT-I yielded significant effects when compared to WL. Large standardized mean differences were found for individual onsite CBT-I (- 1.27;95%CI - 1.70, - 0.84), group-delivered CBT-I (- 1.00;95%CI - 1.42. - 0.59), telehealth (- 1.28;95%CI - 2.06, - 0.50), and guided bibliotherapy (- 0.99;95%CI - 1.67, - 0.32). Both guided iCBT-I (- 0.71;95%CI - 1.18, - 0.24) and unguided iCBT-I (- 0.78;95%CI - 1.18, - 0.38) yielded medium effect sizes. The results underline that health care systems should intensify their efforts to provide synchronously-delivered CBT-I (individual onsite, group-delivered, and telehealth), and particularly individual onsite CBT-I, given its solid evidence base. Medium to large effect sizes for iCBT-I and guided bibliotherapy indicate that self-help settings may be a viable alternative when synchronously-delivered CBT-I is not available.
鉴于现场认知行为疗法治疗失眠症（CBT-I）的可用性和可及性有限，已经提出了其他 CBT-I 环境，例如互联网提供的 CBT-I（iCBT-I）。该研究的主要目的是比较现有的 CBT-I 环境对失眠严重程度的疗效。对现有的 CBT-I 环境进行了系统评价和频繁网络荟萃分析。在 PsycINFO、PsycARTICLES、MEDLINE、PubMed 和 CINAHL 中搜索了关于成年人失眠症障碍的任何 CBT-I 环境的随机对照试验（RCT）。系统文献检索（3851 条参考文献）共产生了 52 项 RCT。对于主要结局失眠严重程度，除智能手机提供的 CBT-I 外，所有接受检查的 CBT-I 环境与 WL 相比均产生显著效果。个别现场 CBT-I（-1.27；95%CI-1.70，-0.84）、小组提供的 CBT-I（-1.00；95%CI-1.42，-0.59）、远程医疗（-1.28；95%CI-2.06，-0.50）和指导的自助阅读疗法（-0.99；95%CI-1.67，-0.32）均发现了较大的标准化均数差。指导的 iCBT-I（-0.71；95%CI-1.18，-0.24）和非指导的 iCBT-I（-0.78；95%CI-1.18，-0.38）的效果中等。结果强调，医疗保健系统应加强努力提供同步提供的 CBT-I（个体现场、小组提供和远程医疗），特别是个体现场 CBT-I，因为它具有可靠的证据基础。iCBT-I 和指导自助阅读疗法的中到大效应大小表明，当同步提供的 CBT-I 不可用时，自我帮助环境可能是一种可行的替代方案。
