Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis

Examining the Utility of a Sleep Resource in Transdiagnostic Internet-Delivered Cognitive Behavior Therapy: An Observational Study

“…In T-ICBT, patients are encouraged to apply the core skills to their specific areas of concern, so patients in the current study may have applied skills such as thought challenging and de-arousal strategies to their symptoms of insomnia and experienced a decrease in symptoms without reviewing the Good Sleep Resource. In a meta-analysis of CBT-I [ 41 ], effect sizes of 0.5 (95% CI = 0.3, 0.8) were reported for reduction of insomnia severity in patients who had comorbid insomnia and depression. Among patients who scored in the clinical range for insomnia symptoms, we found that resource reviewers (Cohen’s d = 0.88; 95% CI = 0.70, 1.05) and non-reviewers (Cohen’s d = 0.80; 95% CI = 0.62, 0.98) had larger effect sizes for insomnia reductions than reported in the meta-analysis, thus suggesting that the T-ICBT course likely had more of an impact on insomnia symptoms than the sleep resource did.…”

Sleep, insomnia and mental health

“…It may have a preventive power and it may protect the brain from the negative effects of insomnia again, eventually. Growing evidence suggests that CBT-I may reduce anxiety symptoms in healthy individuals and in those experiencing anxiety/anxiety-related disorders (Hertenstein et al, 2022). Studies show that CBT-I is effective and safe in reducing anxiety and sleep-related symptoms.…”

Effectivity of (Personalized) Cognitive Behavioral Therapy for Insomnia in Mental Health Populations and the Elderly: An Overview

“…The availability of these adaptations offers the opportunity to personalize the treatment protocol to the individual needs of the patient based on pathology specific recommendations. Hertenstein and colleagues [ 167 ] argued that the heterogeneity between individuals is so large—even within specific diagnostic groups—that disorder specific adaptation may prove redundant. In contrast to this notion, we pose that these adapted protocols may provide elegant and readily available tools to handle commonly observed problems in the applicable comorbid condition.…”

“…It could be that larger studies that do not replicate the effects of earlier published (positive) pilot studies are not offered for publication, resulting in confirmation bias due to selective availability of mostly positive treatment results. In a recent review on CBT-I applied to those with psychiatric comorbidity, Hertenstein and colleagues [ 167 ] found indications for such a publication bias and argued that the small sample sizes in available studies might have inflated effect sizes. In addition, as the pattern of small-sampled studies being more likely to report positive effects extends to meta-analytical estimation [ 169 ], an even stronger overestimation of the effects of CBT-I may be expected in meta-analyses [ 170 ].…”

“…Additionally, potential differences in response to CBT-I treatment based on personal, mental health, and sleep disturbance factors could be investigated using aggregated data with, for example, clustering analyses. Moreover, n = 1 studies included in the database could in themselves be valuable, especially when multiple comorbidities and large interindividual differences exist, as is often the case within mental health populations, because these cases are often excluded in RCTs [ 167 , 173 ]. Naturally, this proposal comes with its own challenges such as heterogeneity in assessed populations and languages, problems in quality control such as potential protocol misalignments between different mental health care institutes, and the burden of structural database maintenance (e.g., financial, time, and staff).…”