Comparative efficacy of brief behavioral therapy for insomnia: a systematic review and network meta-analysis

Background: The comparative efficacy of brief behavioral therapy for insomnia (BBTI) remains unclear. Aims: This systematic review and network meta-analysis examined the effectiveness of different BBTI approaches and compared BBTI with other nonpharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I). Methods: Three databases were searched from inception to December 27, 2024. Primary outcomes were insomnia severity and sleep quality. Secondary outcomes included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and daytime sleepiness. A frequentist network meta-analysis with random-effects modeling was conducted. Heterogeneity was assessed using the I² statistic. Results: Eighteen randomized controlled trials involving 1104 participants (mean age: 52.6 years) were included. Compared with usual care, BBTI significantly reduced insomnia severity (mean difference [MD] = −4.79; 95% confidence interval [CI = −6.05, −3.53]; I² = 0%) and improved sleep quality (MD = −3.45; 95% CI [−4.97, −1.94]; I² = 0%). BBTI also shortened sleep onset latency (MD = −19.81 min; 95% CI = −30.64, −8.98; I² = 17%) and wake after sleep onset (MD = −15.51 min; 95% CI [−22.75, −8.27]; I² = 47%) and increased sleep efficiency (MD = 10.78%; 95% CI [7.67%, 13.89%]; I² = 8%). No significant differences were found in total sleep time or daytime sleepiness. Face-to-face BBTI and CBT-I demonstrated similar outcomes. Face-to-face BBTI ranked as the most effective approach based on the surface under the cumulative ranking curve. Linking Evidence to Action: Face-to-face BBTI is an optimal nonpharmacological option for improving sleep quality and efficiency and reducing insomnia severity, sleep onset latency, and wake after sleep onset. Trial Registration : PROSPERO number: CRD42021242589.