The efficacy of cognitive and behavior therapies for insomnia on daytime symptoms: a systematic review and network meta-analysis
Open accessAbstract
Insomnia disorder, defined by nocturnal and daytime symptoms, is highly prevalent worldwide and is associated with the onset of mental illness. Although daytime symptoms are often the reason insomnia patients seek help, it is not clear whether recommended treatment is effective on daytime symptoms. We aimed to investigate the efficacy of cognitive and behavior therapies for insomnia (CBT-I) on all daytime symptoms explored in the literature using both direct and indirect data. 86 studies (15,578 participants) met inclusion criteria. Results showed significant effects of CBT-I administered face-to-face individually, in group and different self-help settings on depressive symptoms, anxiety, daytime sleepiness, fatigue, quality of life, daytime and social functioning and mental state, with Cohen's d's ranging from -0.52 and 0.81. Our results suggest that CBT-I is effective in the treatment of daytime symptoms, albeit with predominantly small to moderate effects compared to far stronger effects on the core symptoms of insomnia. Effects may be biased for depressive and anxiety symptoms, since many included studies excluded patients with severe levels of these complaints. Further, small to moderate effects may reflect that CBT-I, by improving nighttime symptoms, has a positive effect on daytime symptoms, but it does not target the daytime symptoms directly. Future studies may benefit from adding therapeutic techniques that address daytime symptoms more directly.
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Little research has investigated the effect of non-pharmacological sleep interventions other than CBT-I on anxiety symptoms.
“yet little research has investigated the effect of other sleep interventions on anxiety symptoms.”
From Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis (2022) · cites this paper as Benz et al., 2020
The results (Journal Pre-proof; page unavailable) report 47 studies measuring anxiety or worry, primarily in an analysis of CBT-I. The study-selection passage says the review included other interventions as comparators to CBT-I, but our copy does not establish how much research has investigated non-CBT-I sleep interventions for anxiety. Searched for statements about the number or scarcity of such studies. (LLM, conf=0.75)
Experimental — accuracy not yet measuredEffects in previous meta-analyses may be biased because many studies excluded participants with severe levels of anxiety.
“Additionally, this meta-analysis comments that effects may be biased given many studies excluded participants with severe levels of anxiety.”
From Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis (2022) · cites this paper as Benz et al., 2020
The Risk of bias section discusses randomization, reporting and attrition, while the Anxiety/worry section cautions that heterogeneity was high. Neither says that many studies excluded participants with severe anxiety or that such exclusions may have biased meta-analytic effects (searched: severe anxiety, excluded participants, anxiety severity). The indexed passages provide no page numbers. (LLM, conf=0.73)
Experimental — accuracy not yet measuredIn patients with insomnia without psychiatric comorbidity, CBT-I is highly effective for improving self-rated insomnia severity and several other sleep parameters, including daytime symptoms.
“In patients with insomnia without psychiatric comorbidity, CBT-I is highly effective for the improvement of self-rated insomnia severity and several other sleep parameters like for example sleep onset latency and wake time after sleep onset [9], including daytime symptoms [10].”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [10]
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- J o u r n a l P r e -p r o o f Journal Pre-proof 1. Corresponding Author: Fee Benz, PhD student in the research group of Prof. Riemann Department of Psychiatry and Psychotherapy, Medical Center -University of Freiburg, Faculty of Medicine, University of Freiburg Hauptstraße 5; 79104 Freiburg; GERMANY Phone: +49 761 270-69740; Fax: +49 761 270-66190
- E-Mail: ruecker@imbi.uni-freiburg.de Dr. Rücker holds a Master's degree in mathematics and works as a scientific assistant for statistics at the Institute of Medical Biometry and Statistics (IMBI) and Cochrane Germany. She has long-time expertise in the statistical methods of meta-analyses. She recently published a book on "Meta-analysis with R" (Schwarzer, Carpenter & Rücker, 2015) and she is an author of the R package "netmeta" created to perform network meta-analyses with R. J o u r n a l P r e -p r o o f Journal Pre-proof
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The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023
Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., Bassetti, C. L. A., Bastien, C., Berzina, N., Bjorvatn, B., Dikeos, D., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14035 · Cited by 834 · see citing works
“…on sleep-related outcomes, CBT-I also has positive effects on associated subclinical depressive symptoms, anxiety, daytime sleepiness and fatigue (Benz et al., 2020), dysfunctional cognitions related to sleep (Thakral et al., 2020), worry (Ballesio et al., 2021), and quality of life (Alimoradi…”
BackgroundHertenstein, E., Trinca, E., Wunderlin, M., Schneider, C. L., Züst, M. A., Fehér, K. D., Su, T., Straten, A. V., Berger, T., Baglioni, C., et al. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101597 · Cited by 391 · see citing works
Self-citationInsomnia disorder: State of the science and challenges for the future
Riemann, D. W., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., Leerssen, J., Wassing, R., Henry, A. L., Kyle, S. D., et al. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13604 · Cited by 368 · see citing works
“There is a strong probability that adequate insomnia treatment will reduce the incidence and recurrence of depressive episodes and anxiety disorders (Benz et al., 2020; Cheng et al., 2019; Irwin et al., 2022; Leerssen et al., 2021).”
BackgroundMarx, W., Manger, S., Blencowe, M., Murray, G., Ho, F. Y., Lawn, S., Blumenthal, J. A., Schuch, F. B., Stubbs, B., Ruusunen, A. A., et al. (2022) · The World Journal of Biological Psychiatry · doi:10.1080/15622975.2022.2112074 · Cited by 188 · see citing works
“Three recent systematic reviews have investigated the antidepressant effects of CBT-I amongst people diagnosed with insomnia and subsyndromal depressive symptoms (Ballesio et al. 2018; Benz et al. 2020; Ho et al. 2020).”
BackgroundThe sleep–circadian interface: A window into mental disorders
Meyer, N., Lok, R., Schmidt, C., Kyle, S. D., McClung, C. A., Cajochen, C., Scheer, F. A. J. L., Jones, M. W., & Chellappa, S. L. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2214756121 · Cited by 173 · see citing works
Morin, C. M., & Buysse, D. J. (2024) · New England Journal of Medicine · doi:10.1056/nejmcp2305655 · Cited by 169 · see citing works
Non-pharmacological Approaches for Management of Insomnia
Chan, N. Y., Chan, J. W. Y., Li, S. X., & Wing, Y. K. (2021) · Neurotherapeutics · doi:10.1007/s13311-021-01029-2 · Cited by 117 · see citing works
“Moreover, the positive improvements in sleep-related variables also resulted in beneficial effects on daytime symptoms including mood, daytime sleepiness, fatigue, and overall quality of life with small to medium effect sizes, while physical functioning showed no significant improvement [53].”
BackgroundBallesio, A., Bacaro, V., Vacca, M., Chirico, A., Lucidi, F., Riemann, D., Baglioni, C., & Lombardo, C. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101378 · Cited by 87 · see citing works
Kyle, S. D., Siriwardena, A. N., Espie, C. A., Yang, Y., Petrou, S., Ogburn, E., Begum, N., Maurer, L., Robinson, B., Gardner, C., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00683-9 · Cited by 87 · see citing works
Redeker, N. S., Yaggi, H. K., Jacoby, D. L., Hollenbeak, C. S., Breazeale, S., Conley, S., Hwang, Y., Iennaco, J. D., Linsky, S., Nwanaji-Enwerem, U., et al. (2021) · SLEEP · doi:10.1093/sleep/zsab252 · Cited by 83 · see citing works
Disturbed Sleep in PTSD: Thinking Beyond Nightmares
Lancel, M., van Marle, H. J. F., van Veen, M., & van Schagen, A. M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.767760 · Cited by 85 · see citing works
A meta-analysis on sleep quality in inflammatory bowel disease
Ballesio, A., Zagaria, A., Baccini, F., Micheli, F., Nardo, G. D., & Lombardo, C. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101518 · Cited by 67 · see citing works
Ahmadi, R., Rahimi, S., Olfati, M., Javaheripour, N., Emamian, F., Ghadami, M. R., Khazaie, H., Knight, D. C., Tahmasian, M., & Sepehry, A. A. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104850 · Cited by 67 · see citing works
Towards the neurobiology of insomnia: A systematic review of neuroimaging studies
Aquino, G., Benz, F., Dressle, R. J., Gemignani, A., Alfì, G., Palagini, L., Spiegelhalder, K., Riemann, D. W., & Feige, B. (2023) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2023.101878 · Cited by 61 · see citing works
Response to Placebo in Fragile X Syndrome Clinical Trials: An Initial Analysis
Luu, S., Province, H. S., Berry‐Kravis, E., Hagerman, R. J., Hessl, D. R., Vaidya, D. M., Lozano, R., Rosselot, H., Erickson, C. A., Kaufmann, W. E., et al. (2020) · Brain Sciences · doi:10.3390/brainsci10090629 · Cited by 40 · see citing works
“Meta-analyses were performed using the R “meta” package [36,37], while other statistical analyses were done using SPSS version 25 (IBM, Armonk, NY, USA).”
MethodSchuffelen, J., Maurer, L., Lorenz, N., Rötger, A., Pietrowsky, R., & Gieselmann, A. (2023) · SLEEP · doi:10.1093/sleep/zsad184 · Cited by 41 · see citing works
“While effects on daytime sleepiness are typically expected in the small range [71], effects on quality of life are mixed and seem to be depending on the presence of comorbid conditions (i.e. smaller effects for patients with insomnia and a comorbid disorder) and the choice of quality of life…”
BackgroundNetwork meta-analysis examining efficacy of components of cognitive behavioural therapy for insomnia
Steinmetz, L., Simon, L., Feige, B., Riemann, D. W., Johann, A. F., Ell, J., Ebert, D. D., Baumeister, H., Benz, F., & Spiegelhalder, K. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102507 · Cited by 40 · see citing works
Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis
Staines, A. C., Broomfield, N., Pass, L., Orchard, F., & Bridges, J. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13451 · Cited by 37 · see citing works
“Sleep, 30(3), 274– 280. https://doi.org/10.1093/sleep/ 30.3.274 Morris, J., Firkins, A., Millings, A., Mohr, C., Redford, P., & Rowe, A. (2016).”
BackgroundInfluentialTakano, Y., Ibata, R., Machida, N., Ubara, A., & Okajima, I. (2023) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2023.101839 · Cited by 37 · see citing works
Zhang, T., Ren, Z., Wakefield, C. E., Hui, B. P. H., Akechi, T., Shi, C., Du, X., Chen, W., Lai, L., Zhao, C., et al. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102520 · Cited by 41 · see citing works
Palagini, L., Manni, R., Liguori, C., Gennaro, L. D., Gemignani, A., Fanfulla, F., Ferri, R., Nobili, L., & Ferini‐Strambi, L. (2023) · Journal of Neurology · doi:10.1007/s00415-023-12112-3 · Cited by 34 · see citing works
Inflammatory hypotheses of sleep disturbance - depression link: Update and research agenda
Ballesio, A. (2023) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2023.100647 · Cited by 34 · see citing works
Ell, J., Brückner, H. A., Johann, A. F., Steinmetz, L., Güth, L. J., Feige, B., Järnefelt, H., Vallières, A., Frase, L., Domschke, K., et al. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14193 · Cited by 27 · see citing works
Psychological treatments for excessive gaming: a systematic review and meta-analysis
Kim, J., Lee, S., Lee, D., Shim, S. R., Balva, D., Choi, K., Chey, J., Shin, S.-H., & Ahn, W. (2022) · Scientific Reports · doi:10.1038/s41598-022-24523-9 · Cited by 28 · see citing works
Tadros, M., Newby, J. M., Li, S. H., & Werner‐Seidler, A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0317125 · Cited by 33 · see citing works
Vitiello, M. V., Zhu, W., Korff, M. V., Wellman, R., Morin, C. M., Yeung, K., & McCurry, S. M. (2021) · SLEEP · doi:10.1093/sleep/zsab231 · Cited by 27 · see citing works
“Tang et al.3 in their systematic review and meta-analysis examining nonpharmacological treatements of insomnia in patients with chronic pain conditions reported that, “nonpharmacological sleep treatments in chronic pain patients were associated with a large improvement in sleep quality,… small reduction in pain,… and…”
BackgroundResultInfluentialKjørstad, K., Sivertsen, B., Vedaa, Ø., Langsrud, K., Vethe, D., Faaland, P. M., Vestergaard, C. L., Lydersen, S., Smith, O. R. F., Scott, J. L., et al. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104083 · Cited by 22 · see citing works
Effect of Psychological and Medication Therapies for Insomnia on Daytime Functions
Morin, C. M., Chen, S., Ivers, H., Beaulieu‐Bonneau, S., Krystal, A. D., Guay, B., Bélanger, L., Cartwright, A., Simmons, B., Lamy, M., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.49638 · Cited by 20 · see citing works
Use of Daridorexant among Patients with Chronic Insomnia: A Retrospective Observational Analysis
Williams, S. G., & Rodriguez-Cué, D. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093240 · Cited by 19 · see citing works
Sleep, insomnia and anxiety–Bidirectional mechanisms and chances for intervention
Riemann, D. W. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101584 · Cited by 19 · see citing works
Benham, G. (2021) · Stress and Health · doi:10.1002/smi.3055 · Cited by 19 · see citing works
Symptom Cluster Profiles Among Adults with Insomnia and Heart Failure
Conley, S., Jeon, S., Breazeale, S., O’Connell, M., Hollenbeak, C. S., Jacoby, D. L., Linsky, S., Yaggi, H. K., & Redeker, N. S. (2022) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2060226 · Cited by 18 · see citing works
“…on individual daytime symptoms of fatigue, depressive symptoms, and daytime sleepiness as reported in a recent systematic review and meta-analysis (Benz et al., 2020) and our previous preliminary efficacy study and the study from which the current data were drawn (Redeker et al., 2015, 2022).”
MethodResultPeersmann, S. H. M., Grootenhuis, M. A., van Straten, A., Tissing, W. J. E., Abbink, F. C. H., de Vries, A. C. H., Loonen, J. J., van der Pal, H. J. H., Kaspers, G. J. L., & van Litsenburg, R. R. L. (2022) · Cancers · doi:10.3390/cancers14143316 · Cited by 16 · see citing works
“However, previous research has found that CBT-i is not as effective for the treatment of daytime symptoms [62], so adding fatigue management to insomnia treatment can also potentially optimize treatment outcomes.”
MethodAmpofo, J., Sun, B., Bentum-Micah, G., Li, Q., Changfeng, W., Guo-an, L., & Xusheng, Q. (2025) · Frontiers in Sleep · doi:10.3389/frsle.2025.1537997 · Cited by 15 · see citing works
Network analysis to estimate central insomnia symptoms among daytime workers at-risk for insomnia
Takano, Y., Ibata, R., Nakano, N., & Sakano, Y. (2023) · Scientific Reports · doi:10.1038/s41598-023-43802-7 · Cited by 15 · see citing works
“A meta-analysis of cognitive behavioral therapy for insomnia found that it moderately improved worry and difficulty staying asleep 24,25 .”
Tse, K. Y. K., Maurer, L. F., Espie, C. A., & Kyle, S. D. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14180 · Cited by 12 · see citing works
The Future of Insomnia Research—There's Still Work to Be Done
Dressle, R. J., Spiegelhalder, K., Schiel, J. E., Benz, F., Johann, A. F., Feige, B., Jernelöv, S., Perlis, M. L., & Riemann, D. W. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70091 · Cited by 12 · see citing works
“It has been convincingly demonstrated that CBT-I has positive effects on secondary outcomes that are related to psycho-pathology in general (e.g., depression or anxiety symptoms; Benz et al. 2020).”
Andersen, S. G., Sæterhagen, H., Pacheco, A. P., Pripp, A. H., Hrubos‐Strøm, H., Papageorgiou, C., Munkhaugen, J., & Dammen, T. (2025) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11656 · Cited by 13 · see citing works
“19,23 There is also some evidence for the effectiveness of CBT-I in the treatment of comorbid insomnia in general.”
Jacoby, R. J., Brown, M. L., Wieman, S. T., Rosenfield, D., Hoeppner, S. S., Bui, É., Hoge, E. A., Khalsa, S. B. S., Hofmann, S. G., & Simon, N. M. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13992 · Cited by 13 · see citing works
“…associated with a wide range of impairments (Bélanger et al., 2004; Brenes et al., 2009; Glidewell et al., 2015), including impaired concentration and memory, decreased occupational functioning, increased absenteeism, and increased use of medical services (Benz et al., 2020; Harvey et al., 2009).”
BackgroundFatigue in critical care survivors: multidisciplinary and self‐management strategies
Hosey, M. M., Needham, D. M., & Kudchadkar, S. R. (2021) · Anaesthesia · doi:10.1111/anae.15474 · Cited by 12 · see citing works
“insomnia has been associated with reductions in fatigue, increased sleep efficiency and reduced anxiety and depression in patients with cancer, multiple sclerosis, stroke and epilepsy [14].”
BackgroundDo Insomnia Treatments Improve Daytime Function?
Watson, N. F., Bertisch, S. M., Morin, C. M., Pelayo, R., Winkelman, J. W., Zee, P. C., & Krystal, A. D. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093089 · Cited by 12 · see citing works
“An additional meta-analysis of 86 studies was conducted in 2020, and concluded that CBT-I, by improving nighttime symptoms, has a small but positive effect on daytime symptoms, but does not target the daytime symptoms directly [20].”
BackgroundPrevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation
Tighe, C. A., Buysse, D. J., Weiner, D. K., Beehler, G. P., & Forman, D. E. (2022) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000694 · Cited by 11 · see citing works
Fernández‐Castilla, B., & Noortgate, W. V. D. (2022) · Behavior Research Methods · doi:10.3758/s13428-022-01905-5 · Cited by 10 · see citing works
Kragh, M., Dyrberg, H., Kristiansen, S. T., Speed, M. S., Pedersen, P., & Martiny, K. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70088 · Cited by 9 · see citing works
“The meta-analysis concluded that future studies may benefit from incorporating therapeutic techniques that more directly address daytime symptoms (Benz et al. 2020).”
Reesen, J. E., van der Zweerde, T., Batelaan, N. M., Fris, E., Hoogendoorn, A. W., Ikelaar, S. L. C., Lakbila‐Kamal, O., Lancee, J., Leerssen, J., van Marle, H. J. F., et al. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107122 · Cited by 9 · see citing works
Wu, F., Li, X., Guo, Y., Yan, L.-Z., He, R.-J., & Xu, Y. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116236 · Cited by 9 · see citing works
Leitlinie „Insomnie bei Erwachsenen“ – Update 2025 (AWMF-Registernummer 063-003)
Spiegelhalder, K., Baum, E., Becker, M., Cornaro, C., Crönlein, T., Frase, L., Harth, V., Hertenstein, E., Johann, A. F., Mertel, I., et al. (2025) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-025-00530-6 · Cited by 8 · see citing works
Simon, L., Terhorst, Y., Cohrdes, C., Pryss, R. C., Steinmetz, L., Elhai, J. D., & Baumeister, H. (2024) · Sleep Medicine X · doi:10.1016/j.sleepx.2024.100114 · Cited by 9 · see citing works
“Insomnia disorder is associated with a substantial personal [2,3] and societal burden [4,5].”
BackgroundTelephone-Guided Sleep Restriction for Insomnia: A Randomized Sleep Diary-Controlled Trial
Looman, M. I., Blanken, T. F., Schoenmakers, T. M., Reesen, J. E., Effting, M., Linnebank, F. E., van Straten, A., Kamphuis, J. H., & Lancee, J. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000545138 · Cited by 8 · see citing works
Huang, Y., Tang, I., Chin, W., Jang, L., Lee, C., Lin, C., Yang, C., & Cho, S.-L. (2022) · Nature and Science of Sleep · doi:10.2147/nss.s346941 · Cited by 8 · see citing works
“have a positive effect on daytime symptoms indirectly.(46) Similarly, the SR-sleep-device group in this study has a significant effect on the level of daytime sleepiness, which means that the SR may improve insomnia patients’ daytime quality of life (such as energy/fatigue, bodily pain, and mental health).”
BackgroundKlumpp, H., Chang, F., Bauer, B. W., & Burgess, H. J. (2023) · Brain Sciences · doi:10.3390/brainsci13020288 · Cited by 8 · see citing works
Miller‐Mendes, M., Castilho, P., Clara, M. I., Clemente, V., & Gomes, A. A. (2023) · New Ideas in Psychology · doi:10.1016/j.newideapsych.2023.101013 · Cited by 11 · see citing works
Ramfjord, L. S., Faaland, P. M., Scott, J. L., Saksvik, S. B., Lydersen, S., Vedaa, Ø., Kahn, N., Langsrud, K., Stiles, T. C., Ritterband, L. M., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13888 · Cited by 8 · see citing works
“Furthermore, although CBT-I does not target daytime fatigue directly, several studies demonstrate improvements in fatigue following this intervention (Benz et al., 2020; Vedaa et al., 2020).”
BackgroundInfluentialDaytime sleepiness in insomnia: Are we focusing on what truly matters?
Marques, D. R., Gomes, A. A., & de Azevedo, M. H. P. (2024) · Chronobiology International · doi:10.1080/07420528.2024.2378025 · Cited by 7 · see citing works
“In a meta-analysis by Benz et al. (2020), it was observed that CBT-I approaches (individual, group, and internet self-help treatment formats) have evidence of efficacy on daytime symptoms.”
Kyle, S. D., Bower, P., Yu, L., Siriwardena, A. N., Yang, Y., Petrou, S., Ogburn, E., Begum, N., Maurer, L., Robinson, B., et al. (2024) · Health Technology Assessment · doi:10.3310/rjyt4275 · Cited by 9 · see citing works
Zagaria, A., & Ballesio, A. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.09.020 · Cited by 9 · see citing works
Subtyping at‐risk adolescents for predicting response toward insomnia prevention program
Chen, S., Li, S. X., Zhang, J., Lam, S. P., Chan, J. W. Y., Chan, K. C. C., Li, A. M., Morin, C. M., Wing, Y. K., & Chan, N. Y. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13904 · Cited by 6 · see citing works
Ock, C.-M., Lee, H., Chae, J., & Kim, H. (2025) · Psychiatry Investigation · doi:10.30773/pi.2024.0358 · Cited by 6 · see citing works
Hyperbaric oxygen therapy for poststroke insomnia: a systematic review and meta-analysis protocol
Shi, R., Meng, W., Liu, Z., Chang, L., Lu, R., Chen, X., Xue, W., & Deng, Y. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-081642 · Cited by 6 · see citing works
“30 31 Nevertheless, the therapeutic approach’s technical adapt-ability may diverge contingent on the educational attainment of the recipient, potentially influencing treatment efficacy.”
BackgroundBallesio, A., Musetti, A., Zagaria, A., Manari, T., Filosa, M., & Franceschini, C. (2021) · Sleep Epidemiology · doi:10.1016/j.sleepe.2021.100019 · Cited by 6 · see citing works
Hypnotic Medications as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia.
Barkopoulos, P., & Cho, J. J. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2022.10.004 · Cited by 5 · see citing works
Maurer, L., Aust, F., & Lorenz, N. (2023) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-023-00422-7 · Cited by 6 · see citing works
Redefining insomnia: from neural dysregulation to personalized therapeutics
Arias-Carrión, Ó. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2564709 · Cited by 5 · see citing works
“This discrepancy may be partly due to the use of general health measures not explicitly designed to capture insomnia-related daytime dysfunction [193,194].”
Fiori, V., Lombardo, C., & Ballesio, A. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.108735 · Cited by 6 · see citing works
Chan, K. L., Pau, N. H. Y., Poon, S. F. O., Lam, B. L. H., Lam, C. B., & Chan, K. K. S. (2025) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.70047 · Cited by 5 · see citing works
“Finally, the intervention may help alleviate sleep-related impairments in social interactions and relationships (Benz et al., 2020).”
Trinca, E., Hertenstein, E., Wunderlin, M., Schneider, C. L., Züst, M. A., Fehér, K. D., Su, T., van Straten, A., Berger, T., Riemann, D. W., et al. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.05.311 · Cited by 5 · see citing works
Sleep and Daily Positive Emotions – Is Heart Rate Variability a Mediator?
Ballesio, A., Zagaria, A., Salaris, A., Terrasi, M., Lombardo, C., & Ottaviani, C. (2022) · Journal of Psychophysiology · doi:10.1027/0269-8803/a000315 · Cited by 5 · see citing works
Kognitive Verhaltenstherapie bei Insomnie
Weinhold, S. L., & Göder, R. (2022) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-022-00341-z · Cited by 5 · see citing works
Vallim, J. R. D. S., Pires, G. N., Bonaldi, R. R., Zanini, M. A., Soster, L. A., Garbuio, S. A., & Sousa, K. M. M. (2023) · Sleep Epidemiology · doi:10.1016/j.sleepe.2023.100061 · Cited by 5 · see citing works
Mindfulness and Insomnia Disorder
Baglioni, C. (2022) · doi:10.1002/9781119891192.ch17 · Cited by 5 · see citing works
Efficacy of Multicomponent CBT‐I and Its Single Components
Maurer, L., & Kyle, S. D. (2022) · Wiley eBooks · doi:10.1002/9781119891192.ch3 · Cited by 5 · see citing works
Maurer, L., Aust, F., & Lorenz, N. (2025) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-025-00502-w · Cited by 4 · see citing works
Sit, H. F., Cheung, F. T. W., Li, X., Chan, N., Chan, J. W. Y., Wing, Y. K., & Li, S. X. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100619 · Cited by 4 · see citing works
“Meanwhile, CBT-I has also been suggested as a promising intervention for improving fatigue among individuals with insomnia disorder (Benz et al., 2020).”
Pitfalls of insomnia management in the elderly: A narrative review
Rollo, E., Antonioni, A., & Lorenzo, F. D. (2026) · Neurological Sciences · doi:10.1007/s10072-025-08621-w · Cited by 4 · see citing works
Ewart, C., Egan, K. J., Henderson, M., McCrory, S., & Fleming, L. (2025) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2529856 · Cited by 4 · see citing works
“Furthermore, CBT-I has been shown to improve markers of mental health including anxiety and depression (Benz et al., 2020; Hertenstein et al., 2022).”
Jernelöv, S., & Blom, K. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70164 · Cited by 4 · see citing works
“While interventions like CBT-I produce robust and long-term effects on subjective sleep complaints and sleep parameters (Furukawa, Sakata, Furukawa, et al. 2024), their impact on daytime functioning tends to be smaller and more variable (Benz et al. 2020).”
InfluentialManagement of Sleep and Fatigue in Gastrointestinal Patients
Salwen‐Deremer, J. K., & Sun, M. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2022.07.007 · Cited by 4 · see citing works
Sleep Deficiency and Fatigue in Adults with Inflammatory Bowel Disease: A Systematic Review
Conley, S., Hwang, Y., Al-Saleh, S. A., Kamp, K., Cahalan, A., & Redeker, N. S. (2025) · Western Journal of Nursing Research · doi:10.1177/01939459251314941 · Cited by 4 · see citing works
“39,40 CBT-I is feasible and acceptable in people with IBD, 41 and a brief behavioral intervention based on CBT-I improves sleep quality and fatigue severity from baseline.”
Circadian and Sleep Modulation of Dreaming in Women with Major Depression
Birchler-Pedross, A., Frey, S., Cajochen, C., & Chellappa, S. L. (2022) · Clocks & Sleep · doi:10.3390/clockssleep4010012 · Cited by 4 · see citing works
“Meta-analyses show that insomnia symptoms can double the odds of developing depression [5,6], while cognitive behavioral therapy for insomnia can lower rates of depression recurrence [7,8].”
BackgroundMoulder, Z., Sweetman, A., Lovato, N., Micic, G., Lack, L. C., & Scott, H. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14142 · Cited by 4 · see citing works
“There are several individual components of CBTi, including sleep restriction, cognitive therapy, stimulus control therapy, sleep hygiene and psychoeducation, and relaxation (Benz et al., 2020).”
Jun, J., Park, C. G., Fritschi, C., Izci‐Balserak, B., Martyn-Nemeth, P. A., Kuna, S. T., & Kapella, M. C. (2023) · Heart & Lung · doi:10.1016/j.hrtlng.2023.11.001 · Cited by 3 · see citing works
Conley, S., Jeon, S., Wang, Z., Tocchi, C., Linsky, S., O’Connell, M., & Redeker, N. S. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14058 · Cited by 3 · see citing works
“Our results are consistent with a recent systematic review and meta-analysis that revealed that CBT-I improves individual daytime symptoms of depression, anxiety, fatigue, and daytime sleepiness in people with insomnia with and without medical conditions (Benz et al., 2020).”
Zhang, G., Wang, S., Ma, P., & Pan, J. (2024) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2311200 · Cited by 3 · see citing works
Khorzoghi, M. B., & Sajjadian, P. S. (2022) · Salmand · doi:10.32598/sija.2021.2111.3 · Cited by 3 · see citing works
Redeker, N. S. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101632 · Cited by 3 · see citing works
Dhaliwal, S. S., & Gehrman, P. (2023) · SLEEP · doi:10.1093/sleep/zsad192 · Cited by 3 · see citing works
Chen, S., Ivers, H., Dang‐Vu, T. T., Shapiro, C. M., Carney, C. E., Robillard, R., & Morin, C. M. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06878-1 · Cited by 2 · see citing works
“These patients often show elevated depressive and anxiety symptoms, increased worry about falling asleep and greater distress about daytime functioning (e.g., fatigue) [27, 33–35], which can be effectively addressed by CBT-I intervention [36, 37].”
Zhang, J.-Y., Luo, X., Chen, D.-N., & Zhou, Y.-Q. (2025) · Midwifery · doi:10.1016/j.midw.2025.104476 · Cited by 3 · see citing works
Lin, C., Cheng Ann, C. H. E. N., Xia, Y. Q., Wang, R., Zhang, L., Han, L., Hai, D., Dai, C., Dai, T., Cao, L., et al. (2025) · Sleep Medicine X · doi:10.1016/j.sleepx.2025.100157 · Cited by 2 · see citing works
“In patients with insomnia without psychiatric co-morbidities, CBT-I has demonstrated significant efficacy in improving subjective insomnia severity, shortening sleep latency, decreasing the time of awakening after sleep onset, and alleviating daytime symptoms [16 – 18].”
Insomnia – An outlook for the future
Riemann, D. W., & Spiegelhalder, K. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14061 · Cited by 2 · see citing works
“Moreover, we believe that it is likely that an early and adequate insomnia treatment reduces the incidence and recurrence of depressive episodes and anxiety disorders (Benz et al., 2020; Boland et al., 2023; Leerssen et al., 2021) .”
BackgroundShi, Y., Ren, R., Zhang, Y., Vitiello, M. V., & Tang, X. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14077 · Cited by 2 · see citing works
“The durability of D-CBT-I suggests that the patients exhibit sustained clinical gains after the formal six or eight intervention is discontinued (Benz et al., 2020).”
Hartley, S., Dagneaux, S., Palethorpe, C., Londe, V., Liane, M.-T., Decalf, L., Aussert, F., Francs, C. C. D., Leymarie, R., & Royant‐Parola, S. (2025) · Médecine du Sommeil · doi:10.1016/j.msom.2025.02.001 · Cited by 2 · see citing works
Faccini, J., Bayard, S., Madiouni, C., & Del-Monte, J. (2025) · Journal of American College Health · doi:10.1080/07448481.2025.2479693 · Cited by 3 · see citing works
“On the other hand, a meta-analysis 11 revealed that cognitive-behavioral sleep therapy is more effective in treating nocturnal symptoms than daily ones.”
Murri, M. B., Garza, C. K., Grassi, L. G., & Muskin, P. R. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_113 · Cited by 1 · see citing works
Sochal, M., Feige, B., Spiegelhalder, K., & Ell, J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14093206 · Cited by 1 · see citing works
“Because of this, the following actigraphy-derived PA parameters (continuous variables) were calculated for each day: average PA as well as minutes of >10 mg PA (see [14]) one and two hours before and one and two hours after time in bed (TIB).”
Zhao, C., Chen, X., Zhang, A., Huo, N., Yu, S., Lai, L., & Liu, J. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1535349 · Cited by 1 · see citing works
Faccini, J., Joshi, V., & Jonathan, D.-M. (2025) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2025.152625 · Cited by 1 · see citing works
Rauwerda, N. L., Kuut, T. A., Braamse, A. M. J., Nieuwkerk, P. T., Boss, H., Knoop, H., & van Straten, A. (2025) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465825100945 · Cited by 1 · see citing works
“CBT-F can lead to improvements in subjective sleep quality in patients with ME/CFS (Russell et al ., 2017) and CBT-I to moderate improvements in fatigue (Benz et al ., 2020).”
Perseverative Thinking in Depression and Insomnia
Ballesio, A., Zagaria, A., & Goldschmied, J. (2025) · CBT: science into practice · doi:10.1007/978-3-031-92265-7_3 · Cited by 1 · see citing works
Lai, Y., Chen, D., Tian, C., Huang, Y., Gan, D., Liu, L., & Yang, J. (2025) · International Journal of Women s Health · doi:10.2147/ijwh.s553524 · Cited by 1 · see citing works
“10,11 However, their efficacy is often limited in patients with diminished ovarian reserve (DOR), owing to the complex and intertwined nature of the comorbid symptomatology.”
- Authors
- Benz, F., Knoop, T., Ballesio, A., Bacaro, V., Johann, A. F., Rücker, G., Feige, B., Riemann, D., & Baglioni, C.
- Affiliations
- University of Freiburg (DE)
- Sapienza University of Rome (IT)
- Marconi University (IT)
- Corresponding author
- Benz, Fee
- ORCID
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 80
- Pages
- 101873
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W3033016172
- Cited by
- 142
- References
- 61
- Citations by year
- 2026: 21 · 2025: 37 · 2024: 20 · 2023: 30 · 2022: 21 · 2021: 11 · 2020: 2
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc-nd)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
- Funders
- Bundesministerium für Bildung und Forschung (01KG1703)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- insomnia, cognitive behavioral therapy for insomnia, daytime symptoms, daytime sleepiness, fatigue, depressive symptoms, anxiety, quality of life, daytime functioning, social functioning, self-help intervention, group therapy, individual psychotherapy
- MeSH terms
- Network Meta-Analysis, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Cognition, Depression, Fatigue, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Quality of Life, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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