Comparison of therapeutic effects of individual versus group cognitive-behavioural therapy for insomnia: A systematic review and meta-analysis

Abstract

Abstract Background: Insomnia is one of the most prevalent and significant public health disorders worldwide. It can negatively affect individual’s daily life in different aspects such as reducing physical activities, changing mood and causing early morning fatigue. This disorder also contributes to increase the risk of developing cardiac diseases, diabetes, mental disorders and raised the mortality rate. Cognitive behavioural therapy was identified as the most effective and preferred treatment for insomnia, because there are no side effects for such practices compared to pharmacological treatment. There are several formats for delivering this therapy, such as individual face to face format, group face to face format, and self-help format. The group CBT-I and self-help CBT-I were developed as an alternative therapy for individual CBT-I to make the intervention more widely available. It is believed that the group CBT-I is most preferable replacement for the individual CBT-I and provide similar effective to the individual format. However, there is no current systematic meta-analyses proving and examine the group CBT-I effect compared to individual CBT-I. Objective: The current systematic review and meta-analysis was aimed to evaluate the effectiveness of group CBT-I compared to individual CBT-I as active treatments for adults with primary or chronic insomnia and who have no major medical conditions or psychiatric comorbidities. Methods: MEDLINE, CINAHL Complete, and PsycINFO were systematically and independently searched. Three studies (one randomized controlled trial and two non- randomized controlled trials, comparing group CBT-I (n = 119) to in individual CBT-I (n = 71) were investigated. Results: The analysis demonstrated non-significant mild effect size differences between the two intervention groups in the following sleep parameters: sleep efficiency (95% CI: 0.28 to 1.07), total sleep time (95% CI: 0.23 to 0.96), wake after sleep onset (95% CI: 0.14 to 0.87) and dysfunctional beliefs and attitudes about sleep (95% CI: -0.63 to 0.25), except for sleep onset latency a mild clinical significant difference was seen (95% CI: -1.53, -068). Overall, both cognitive behaviour intervention formats provided similar improvement in insomnia symptoms without showing any advantage of one method over the other. Conclusion: This review indicated that there was inadequate robust evidence to establish that the group CBT-I was as effective as the individual CBT-I in improving sleep parameters. However, it is suggested that the group CBT-I represent a cost-effective alternative for individual CBT-I for managing insomnia symptoms in adults.