A scoping review of self-help cognitive behavioural therapy for insomnia

Uptake of cognitive behavioural therapy for insomnia (CBTI) as first-line therapy of chronic insomnia has been restricted by a shortage of trained therapists, access barriers, and limited awareness of self-help alternatives. Self-help CBTI has emerged as a practical alternative, offering ready access, convenience, and dissemination and scalability efficiency. Yet, evidence syntheses of limited data have suggested its effectiveness and acceptability may be inferior to face-to-face CBTI and others have questioned its fidelity with CBTI standards. We conducted a scoping review to map and characterize self-help CBTI research, focusing on its core components, delivery methods, use of coaching support, and growth. Our review included 174 reports of 145 unique studies, 106 of which were randomized trials, with 65 published since 2020. Findings revealed that self-help CBTI maintained the essential core components (time-in-bed restriction, stimulus control, relaxation techniques, cognitive therapy, and sleep hygiene/education) and structure of conventional CBTI with many, but not all, including different types and formats of coaching support. The expanding body of evidence suggests that self-help CBTI is an evolving field, warranting further analysis to delineate its role in filling the treatment gap for chronic insomnia.