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 Researchers from Vrije Universiteit in Amsterdam, The Netherlands, examined whether a self-help intervention might offer an inexpensive and more accessible alternative to face-to-face therapy for the non-pharmacologic treatment of insomnia.
They conducted a meta-analysis of randomized controlled studies examining the effects of self-help interventions for insomnia, identified through extensive searches of bibliographical databases. They examined the effects of self-help on different sleep outcomes, in comparison with both wait list controls and face-to-face treatments.
Ten studies with a total of 1000 subjects were included. The
intervention did improve sleep efficiency (d=0.42; p<0.05), sleep
onset delay (d=0.29; p<0.05), waking after falling asleep (d=0.44;
p<0.05) and general sleep quality (d=0.33; p<0.05) but not total
sleep time (d=0.02; p>0.05).
The sleep improvements were
maintained over the long term. Symptoms of anxiety and depression also
decreased after self-help (d=0.28; p<0.05 and d=0.51; p<0.05,
respectively).
Although based on a very limited number of
studies, the face-to-face treatments did not show statistically
significant superiority to the self-help treatments. However, the
authors caution that the effect sizes associated with self-help
treatments might be overestimated due to publication bias.
The
study concludes that the beneficial effects of self-help treatments are
small to moderate, and they may be a useful addition to existing
treatment options.
Citation: van Straten A, Cuijpers P.Self-help therapy for insomnia: a meta-analysis. Sleep Medicine
Review. 2009. Feb; 13 (1): pages 61-71. Epub 2008 Oct 26.
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