Insomnia is recognized as one of the most common sleep complaints accompanied by daytime consequences in the general population worldwide. In recent years, the use of self-help cognitive behavioral therapy (CBT) has become a popular treatment option for insomnia.
Firstly, a systematic review was conducted as an update and extension of a previous review (van Straten & Cuijpers, 2009). Two researchers systematically searched 6 major electronic databases in June 2012. We independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Meta-analyses of self-help CBT vs. waiting-list (WL), routine care or no treatment, therapist-administered CBT, and placebo were performed. Twenty randomized controlled trials were included; 10 of which were recent publications. Results showed that self-help CBT improved sleep, sleep-related cognitions, and anxiety and depressive symptoms. Effect sizes for sleep diary-derived sleep efficiency (SE), sleep onset latency (SOL), and wake after sleep onset (WASO) at immediate posttreatment were 0.80, 0.66, and 0.55, respectively. The average attrition rate of self-help CBT at immediate posttreatment was 15.6%. Therapist-administered CBT was significantly more effective than self-help CBT. Subgroup analyses supported the inclusion of telephone consultation, but not “full” multi-component CBT and programs 6 weeks. In conclusion, self-help CBT is efficacious and acceptable as an entry level of a stepped-care model for insomnia. In places where face-to-face treatments are unavailable or too costly, self-help CBT can be considered as an adequate compromise.
Secondly, a randomized controlled trial was conducted to evaluate the efficacy of an Internet-based cognitive behavioral therapy for insomnia (CBT-I) in Chinese insomnia population with or without medical and psychiatric comorbidities. Three hundred and twelve eligible participants were randomized to self-help CBT with telephone support (SHS), self-help CBT without telephone support (SH), and WL groups in a ratio of 1:1:1. Participants in the SHS and SH groups received self-help treatment once per week for 6 consecutive weeks, whereas participants in the WL group began treatment after 12 weeks of assessment. In addition to the standard self-help treatment, the participants in the SHS group received weekly brief therapist-administered telephone support. The Internet-based CBT-I showed significant improvements in insomnia symptoms and sleep-related dysfunctional cognitions. Improvement was further enhanced by weekly brief telephone support. The results suggested that Internet-based CBT-I is effective and acceptable to treat insomnia. / published_or_final_version / Psychiatry / Master / Master of Philosophy
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/197535 |
| Date | January 2014 |
| Creators | Ho, Yan-yee, Fiona, 何欣儀 |
| Contributors | Chung, KF, Lee, AM |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Rights | Creative Commons: Attribution 3.0 Hong Kong License, The author retains all proprietary rights, (such as patent rights) and the right to use in future works. |
| Relation | HKU Theses Online (HKUTO) |
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