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Cognitive Behavioural Therapy for Insomnia Monotherapy in Patients with Medical or Psychiatric Comorbidities: a Meta-Analysis of Randomized Controlled Trials

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Abstract

This is a meta-analysis of randomized controlled trials (RCTs) comparing cognitive behaviour therapy for insomnia (CBT-I) monotherapy with active control treatment for insomnia in patients with medical or psychiatric comorbidities. Both international (PubMed, EMBASE, PsycINFO, Cochrane Library) and Chinese (WanFang, and CNKI) databases were systematically searched. The random effects model was used. Thirteen RCTs comparing CBT-I (n = 441) and active controls (n = 412) groups were included. CBT-I group showed significant advantage over active controls at post-treatment assessment in terms of Insomnia Severity Index (ISI; SMD = -0.74), sleep onset latency (SMD = -0.36), wake after sleep onset (SMD = -0.21), sleep quality (SMD = 0.56), Pittsburgh sleep quality index total scores (PSQI; SMD = -0.76) and the total score of dysfunctional beliefs and attitudes about sleep scale (DBAS; SMD = -1.09). Subgroup analyses revealed significant improvement in sleep onset latency in patients with psychiatric disorders (SMD = -0.45), while significant reduction of number of wakeup after sleep onset was found in patients with medical conditions (SMD = -0.31). This meta-analysis found that CBT-I monotherapy had greater efficacy than other active control treatment for insomnia in patients with medical or psychiatric comorbidities.

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Data will be provided by the corresponding author upon reasonable request.

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Contributors

Fu-Chun Zhou: Conceptualization, Data curation, Formal analysis, Writing - original draft, Validation. Yuan Yang: Conceptualization, Data curation, Formal analysis, Writing - original draft, Validation. Yuan-Yuan Wang, Wen-Wang Rao, and Shu-Fang Zhang: Data curation, Formal analysis. Liang-Nan Zeng and Wei Zheng: Data curation. Chee H. Ng: Writing - original draft, Validation. Gabor S. Ungvari: Writing - original draft, Validation. Ling Zhang: Writing - review and editing. Yu-Tao **ang: Conceptualization, Writing - original draft, Validation.

Funding Source

The study was supported by the University of Macau (MYRG2015-00230-FHS; MYRG2016-00005-FHS), the National Key Research & Development Program of China (No. 2016YFC1307200), the Bei**g Municipal Administration of Hospitals Incubating Programme (No. PX2016028), Bei**g Municipal Administration of Hospitals' Youth Programme (QML20161902), and the Bei**g Municipal Administration of Hospitals’ Ascent Plan (No. DFL20151801).

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Author notes

  1. Fu-Chun Zhou, Yuan Yang, Yuan-Yuan Wang, Wen-Wang Rao and Shu-Fang Zhang contributed equally to this work.

Authors and Affiliations

  1. The National Clinical Research Center for Mental Disorders & Bei**g Key Laboratory of Mental Disorders, Bei**g Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Bei**g, China

    Fu-Chun Zhou & Ling Zhang

  2. Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China

    Yuan Yang, Wen-Wang Rao, Liang-Nan Zeng & Yu-Tao **ang

  3. Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, China

    Yuan Yang

  4. Faculty of Health and Life Sciences, De Montfort University, Leicester, UK

    Yuan-Yuan Wang

  5. Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China

    Shu-Fang Zhang

  6. Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Liang-Nan Zeng

  7. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China

    Wei Zheng

  8. Department of Psychiatry, The Melbourne Clinic and St Vincent’s Hospital, University of Melbourne, Melbourne, Victoria, Australia

    Chee H. Ng

  9. University of Notre Dame Australia / Graylands Hospital, Perth, Australia

    Gabor S. Ungvari

  10. Division of Psychiatry, University of Western Australia Medical School, Perth, Australia

    Gabor S. Ungvari

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  1. Fu-Chun Zhou
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Correspondence to Ling Zhang or Yu-Tao **ang.

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Zhou, FC., Yang, Y., Wang, YY. et al. Cognitive Behavioural Therapy for Insomnia Monotherapy in Patients with Medical or Psychiatric Comorbidities: a Meta-Analysis of Randomized Controlled Trials. Psychiatr Q 91, 1209–1224 (2020). https://doi.org/10.1007/s11126-020-09820-8

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