Implementation of Online Cognitive Behavioral Therapy for Insomnia (CBT-i) in Malaysia: A Narrative Review

Norilani Ali, Shazli Ezzat Ghazali, Ponnusamy Subramaniam, Zaini Said, Noh Amit


Insomnia is a highly prevalent sleep disorder with a high burden of diseases and high comorbidity. Cognitive behavioral therapy for insomnia (CBT-i) is effective but is rarely offered due to the limited access, time constraints, and financial constraints. The inability to treat insomnia has the potential to leave a significant impact in life. Therefore, CBT-i delivered through internet is thought to be more feasible and accessible alternative. The current paper reviewed is based on the narrative review approach. The relevant articles were obtained through computerized searches of databases such as PubMed, SAGE, and ERIC. The findings of this paper highlight the effectiveness of CBT-i based on empirical evidence of previous studies. The focal variables are on sleep hygiene and education, stimulus control therapy, sleep restriction therapy, and relaxation techniques. Having a better understanding how online CBT-i works can provide more input for intervention management.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Publication.

Andersson, G., & Titov, N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry, 13(1), 4–11. doi:10.1002/wps.20083.

Axelsson, J., Ingre, M., Kecklund, G., Lekander, M., Wright Jr, K. P., & Sundelin, T. (2020). Sleepiness as motivation: a potential mechanism for how sleep deprivation affects behavior. Sleep, 43(6), zsz291.

Benca, R. M., Obermeyer, W. H., Thisted, R. A., & Gillin, J. C. (1992). Sleep and psychiatric disorders: a meta-analysis. Archives of general psychiatry, 49(8), 651-668.

Bootzin RR. 1972. Stimulus control treatment for insomnia. Proc. 80th Annu. Convention Am. Psychol. Assoc., 395–96. Honolulu, Hawaii.

Bootzin RR. 1977. Effects of self-control procedures for insomnia. In Behavioral Self-Management: Strategies and Outcomes, ed. R Stuart, 176–96. New York: Brunner/Mazel.

Bootzin, R. R., & Epstein, D. R. (2011). Understanding and Treating Insomnia. Annual Review of Clinical Psychology, 7(1), 435–458. doi:10.1146/annurev.clinpsy.3.022806.0.

Chaput, J. P., Dutil, C., Featherstone, R., Ross, R., Giangregorio, L., Saunders, T. J., Ian, J., Veronica, J.P., Michelle, E. K., Amanda, R., Sarah, Z., & Carrier, J. (2020). Sleep timing, sleep consistency, and health in adults: a systematic review. Applied Physiology, Nutrition, and Metabolism, 45(10), S232-S247.

Clarke, G., McGlinchey, E. L., Hein, K., Gullion, C. M., Dickerson, J. F., Leo, M. C., & Harvey, A. G. (2015). Cognitive-behavioral treatment of insomnia and depression in adolescents: A pilot randomized trial. Behaviour Research and Therapy, 69(1), 111–118. doi:10.1016/j.brat.2015.04.009.

Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. D., Kirby, A., & Carney, C. E. (2009). Cognitive Behavioral Therapy for Patients with Primary Insomnia or Insomnia Associated Predominantly with Mixed Psychiatric Disorders: a Randomized Clinical Trial. Sleep, 32(4), 499–510. doi:10.1093/sleep/32.4.499.

Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. L. (2012). A Randomized, Placebo-Controlled Trial of Online Cognitive Behavioral Therapy for Chronic Insomnia Disorder Delivered via an Automated Media-Rich Web Application. Sleep, 35(6), 769–781. doi:10.5665/sleep.1872.

Hauri, P. (1977). The sleep disorders. Current concepts. Kalamazoo, MI: Scope Publications, Upjohn.

Kuss, D., Griffiths, M., Karila, L., & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20(25), 4026-4052. doi:10.2174/13816128113199990617.

Lichstein, K. L., Taylor, D. J., McCrae, C. S., & Thomas, S. J. (2011). Relaxation for Insomnia. Behavioral Treatments for Sleep Disorders, 45–54. doi:10.1016/b978-0-12-381522-4.00004-3.

Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). Sleep, 29, 1398e1414.

Morin, C. M., & Espie, C. A. (2003). Insomnia: A Clinical Guide to Assessment and Treatment. New York: Plenum.

Rao, U., Hammen, C., & Poland, R. (2009). Risk Markers for Depression in Adolescents: Sleep and HPA Measures. Neuropsychopharmacology, 34(8), 1936-1945. doi: 10.1038/npp.2009.27.

Roberts, R. E., Ramsay Roberts, C., & Ger Chen, I. (2002). Impact of insomnia on future functioning of adolescents. Journal of Psychosomatic Research, 53(1), 561–569. doi:10.1016/s0022-3999(02)00446-4.

Ritterband, L. M., Thorndike, F. P., Ingersoll, K. S., Lord, H. R., Gonder-Frederick, L., Frederick, C., Quigg, M.S., Cohn, W.F., Morin, & C. M. (2017). Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up. JAMA Psychiatry, 74(1), 68. doi:10.1001/jamapsychiatry.2016.3249.

Sharma, M., & Andrade, C. (2012). Behavioral interventions for insomnia: Theory and practice. Indian Journal of Psychiatry, 54(4), 359. doi:10.4103/0019-5545.104825.

Shen, C., & Williams, D. (2011). Unpacking time online: Connecting Internet and massively multiplayer online game use with psychosocial well-being. Communication Research, 38(1), 123-149. doi: 10.1177/0093650210377196.

Suzuki, E., Tsuchiya, M., Hirokawa, K., Taniguchi, T., Mitsuhashi, T., & Kawakami, N. (2008). Evaluation of an Internet-Based Self-Help Program for Better Quality of Sleep among Japanese Workers: A Randomized Controlled Trial. Journal of Occupational Health, 50(5), 387–399. doi:10.1539/joh.l7154.

Spielman A.J., Saskin P., Thorpy M.J. (1987). Treatment of chronic insomnia by restriction of time in bed.

Tang, J., Liao, Y., Kelly, B. C., Xie, L., Xiang, Y.-T., Qi, C., Hao, W., Liu, T., Zhang, F., & Chen, X. (2017). Gender and Regional Differences in Sleep Quality and Insomnia: A General Population-based Study in Hunan Province of China. Scientific Reports, 7(1), 43690. doi:10.1038/srep43690.

Tsuno, N., Besset, A., & Ritchie, K. (2005). Sleep and Depression. The Journal of Clinical Psychiatry, 66(10), 1254-1269. doi: 10.4088/jcp.v66n1008.

Van Straten, A., Emmelkamp, J., de Wit, J., Lancee, J., Andersson, G., van Someren, E. J. W., & Cuijpers, P. (2013). Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial. Psychological Medicine, 44(07), 1521–1532. doi:10.1017/s0033291713002249.

Zailinawati, A. H., Ariff, K. M., Nurjahan, M. I., & Teng, C. L. (2008). Epidemiology of insomnia in Malaysian adults: A community-based survey in 4 urban areas. Asia-Pacific Journal of Public Health, 20(3). 224-233.

Zailinawati, A. H., Mazza, D., & Teng, C. L. (2012). Prevalence of insomnia and its impact o daily functioning amongst Malaysian primary care patients. Asia Pacific Family Medicine, 11(1), 9.


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