Comparative effectiveness of brief behavioral therapy for insomnia: a network meta-analysis of psychological outcomes

Purpose: To assess the comparative effectiveness of various delivery methods of brief behavioral therapy for insomnia (BBTI) and their efficacy relative to cognitive behavioral therapy for insomnia (CBTI) and other nonpharmacological treatments in improving psychological outcomes-specifically depression, anxiety, and fatigue-in adults with insomnia.

Methods: This is a systematic review and network meta-analysis (NMA) of randomized controlled trials design. A comprehensive search was conducted in PubMed, Embase, and Scopus databases from their inception to February 8, 2024. Studies included were randomized controlled trials involving adults aged 18 years or older with insomnia, comparing BBTI with other nonpharmacological interventions or usual care, and reporting outcomes on depression, anxiety, or fatigue 1 week postintervention. A frequentist random-effects NMA was performed, and treatments were ranked using the surface under the cumulative ranking curve. Meta-regression analyses examined the influence of age, sex, and comorbidity status on outcomes.

Findings: Fourteen randomized controlled trials were included, encompassing 549 participants for depression outcomes, 435 for anxiety, and 354 for fatigue. In-person BBTI significantly reduced depressive symptoms compared to sleep education 1 week postintervention. No significant differences were observed between in-person BBTI and CBTI across all outcomes. Treatment rankings indicated CBTI as most effective for fatigue, whereas in-person BBTI ranked highest for anxiety and was comparable to CBTI for depression. Meta-regression analyses found no significant moderating effects of age, sex, or insomnia type.

Implications: In-person BBTI is effective in alleviating depressive symptoms among adults with insomnia. These findings support the clinical utility of BBTI as a practical alternative to CBTI, particularly in settings where access to specialized care is limited. PROSPERO Registration Number: CRD420251032415.