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.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 41259947 · doi:10.1016/j.smrv.2025.102204
What was done
A systematic review and meta-analysis of randomized controlled trials examined clinical outcomes and adherence across four CBT-I delivery formats (defined as including both sleep restriction and stimulus control): individual, group, fully automated internet-based, and supported internet-based delivery.
What was found
Remission from insomnia significantly increased across all delivery methods versus controls: - Individual: k = 36, n = 1,696, odds ratio (OR) = 8.36 - Supported Internet-based: k = 19, n = 1,759, OR = 8.35 - Group: k = 22, n = 2,356, OR = 4.65 - Fully automated Internet-based: k = 50, n = 15,590, OR = 3.87 Meta-regression adjusted for comorbidities and control types showed individual and supported internet formats had significantly higher odds of remission than the fully automated internet format. Session completion was highest for individual (k = 8, 83.8%), followed by supported internet (k = 15, 70.7%) and fully automated internet formats (k = 26, 58.4%).
Why it matters
While scalable digital CBT-I is effective, adding human support—whether delivered in person or remotely—substantially improves treatment adherence and clinical remission odds.
Limits
The abstract lacks confidence intervals, exact p-values, and data on adverse events or long-term follow-up. Completion rates were not reported for group CBT-I.
Cited by
- context CBT-I removes sleep barriers in approximately 85% of cases.