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.
Highlights
Insomnia, which comprises difficulty falling asleep at bedtime or awakening in the middle of the night or too early in the morning, represents a critical public health problem worldwide [1]
By pooling the data obtained from qualified randomized controlled trials (RCTs), we identified evidence that internet-based CBT for insomnia (ICBT-i) was effective in improving comorbid anxiety and depression with a mild strength, which was consistent with doi:10.1371/journal.pone.0142258.g002
In contrast to traditional Cognitive behavioral therapy (CBT), which has been proposed as the best therapy for insomnia and requires face-to-face interactions with therapists [40], patients with insomnia can receive ICBT-i treatment using a computer and other electronic devices
Summary
Insomnia, which comprises difficulty falling asleep at bedtime or awakening in the middle of the night or too early in the morning, represents a critical public health problem worldwide [1]. Insomnia is associated with several detrimental consequences, including mental disorders, low work productivity and a decrease cognitive impairment [2,3]. Anxiety and depression are the most common comorbid mental symptoms of insomnia and exacerbate the sleep disorder [4]. ICBT-i Improves Anxiety and Depression hypnotics) have been used because of their quick effects in a short time period [5]. Medication for insomnia can present several adverse effects, such as headache and dizziness during short-term use [6] and addiction during long-term use [7]. Medication has a limited effect on the long-term relief of insomnia [8]
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