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Digital cognitive behavioural therapy for insomnia reduces insomnia severity in Armed Forces and Veteran populations

A systematic review and meta-analysis of 5 RCTs (n=309 intervention, n=249 control) found that digital CBT-I produced a statistically significant moderate-to-large reduction in insomnia severity compared to minimum contact controls, with substantial heterogeneity (I²=74%). Treatment gains were maintained up to 12 months, and three studies reported clinically meaningful ISI reductions of ≥6 points.

Last updated: Aug 26, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score49/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Efficacy of digital cognitive behavioural therapy for insomnia in Armed Forces and Veteran populations - A systematic review and meta-analysis of randomised controlled trials.

observational

Rawcliffe AJ, Pereira SIR · Sleep medicine (2026)

Participants: N/A
Duration: Up to 12 months follow-up
Intervention: Digital cognitive behavioural therapy for insomnia (digital CBT-I)
Outcome: Insomnia severity measured by Insomnia Severity Index (ISI) score change at post-treatment
Effect Size: Moderate-to-large (exact value not reported in abstract)
Population: Armed Forces personnel and veterans with insomnia (DSM-5 criteria or ISI ≥14)

Result:

PubMed: 42119336DOI: 10.1016/j.sleep.2026.108974

Mechanism Graph

Digital CBT-I delivered via online platform
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Participants engage in cognitive and behavioural modules targeting insomnia
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Therapy addresses sleep habits, thought patterns, and relaxation
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Result: Reduction in insomnia severity scores

Limitations

  • ⚠Limited number of included RCTs (n=5)
  • ⚠Overall risk of bias unclear or high due to limited reporting and attrition
  • ⚠Substantial heterogeneity driven by one study (Chao et al.)

Frequently Asked Questions

What is digital CBT-I?▼

Digital cognitive behavioural therapy for insomnia is an online or app-based version of CBT-I, which includes components like sleep restriction, stimulus control, cognitive restructuring, and relaxation training.

How effective is digital CBT-I for military populations?▼

The meta-analysis found a moderate-to-large reduction in insomnia severity, with effects maintained up to 12 months. Three of five trials reported clinically meaningful improvements (≥6 points on the Insomnia Severity Index).

What were the main limitations of the studies?▼

Limitations included small numbers of trials, unclear or high risk of bias due to poor reporting and high attrition, and substantial heterogeneity across studies.

Is digital CBT-I recommended as first-line treatment for insomnia in veterans?▼

While CBT-I is first-line, digital CBT-I is a scalable alternative. This review supports its efficacy, but the authors note that more research is needed to address engagement and attrition in military settings.

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References

  1. 1.Rawcliffe AJ, Pereira SIR. "Efficacy of digital cognitive behavioural therapy for insomnia in Armed Forces and Veteran populations - A systematic review and meta-analysis of randomised controlled trials.." Sleep medicine, 2026. PMID: 42119336 DOI: 10.1016/j.sleep.2026.108974
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.