Efficacy of online and face-to-face cognitive behavioral therapy in the treatment of neurological insomnia: a systematic review and meta-analysis

Background: The treatment of insomnia mainly includes drug therapy and non-drug therapy (cognitive behavioral therapy [CBT]). Traditional face-to-face CBT is affected by factors such as location, time, and treatment cost, making the treatment impossible to implement effectively. With the continuous development of network technology, internet-based CBT (ICBT) has been widely used due to the advantages of time and location. Methods: It searched the China National Knowledge Internet (CNKI) database (1979- Apr 2021), China Biomedical Literature Database (1994 - Apr 2021), Cochrane Library (2005 - Apr 2021), Medline (1948Apr 2021), and Embase (Jan 1966 - Apr 2021). Chinese and English databases were searched using the following terms: internet-based cognitive behavioral therapy, cognitive behavioral therapy, sleep problems, and sleep disorders. Meta-analysis was performed using RevMan 5.3 and Stata SE 12.0 software provided by the Cochrane collaboration. Results: A total of 14 randomized controlled trials were included in this study. Of these, 10 described the correct random allocation method, 6 described the allocation scheme in detail, and 1 article used the blind method. Sleep onset latency after ICBT was much shorter than that of the control group [mean difference (MD): -12.27, 95% confidence interval (CI): -16.43 to -9.90, P<0.01]. Total sleep time after ICBT was much longer than that of the control group (MD: 38.67, 95% CI: 34.70-42.65, P<0.01). Sleep efficacy after ICBT was significantly higher in contrast with the control group (MD: 13.28, 95% CI: 10.49-16.06, P<0.01). Anxiety and depression levels after the ICBT were significantly lower than those in the control group (P<0.01). Discussion: Meta-analysis was adopted to confirm that ICBT can greatly improve the sleep parameters of patients with insomnia, and it was found to have a relieving effect on patients with anxiety and depression.