The Impact of Cognitive-Behavior Therapy for Anxiety Disorders on Concomitant Sleep Disturbances: A Meta-Analysis
Abstract
Introduction Sleep disturbances are present in approximately 70% of individuals with an anxiety disorder (AD). Treatments for AD may alleviate associated sleep problems, but empirical support for this view is sparse. Objective To assess state of knowledge about the impact of CBT for AD on sleep disturbances. Method Systematic search for clinical trials of CBT for any AD in PsycINFO, MedLine, and Proquest Dissertations and Theses. Results Of 1205 studies, only 25 (2.07%) reported sleep data. The combined ES of CBT for AD on sleep was 0.527 [95%CI 0.306-0.748], indicating a moderate effect of anxiety treatment on concomitant sleep difficulties. The impact did not significantly differ according to study design, sleep variable or anxiety disorder. Conclusions Although substantial amounts of research documented the efficacy of CBT for AD, very few reported its effect on concomitant sleep problems. Current state of knowledge does not permit definitive conclusions and future research is needed.
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CBT and mindfulness-based interventions directed at either insomnia or anxiety have moderate effects on the co-occurrence of the other.
“cognitive behaviour therapy (CBT) and mindfulness‐based interventions directed at either disorder also have moderate effects on the co‐occurrence of the other (Belleville et al., 2010; Yook et al., 2008)”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as Belleville et al., 2010
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BackgroundAssociations between psychological inflexibility processes, pre‐sleep arousal and sleep quality.
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“…therapy (CBT) and mindfulness-based interventions directed at either disorder also have moderate effects on the co-occurrence of the other (Belleville et al., 2010; Yook et al., 2008), and a reduction in anxiety co-occurs with ACT-based insomnia treatment (Lawson et al., 2023; Shin et…”
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
“Accordingly, the positive effects of CBT for GAD on sleep may be in part due to targeting pathological worries (Belleville et al., 2010; Sánchez-Ortuño & Edinger, 2012), although this has not yet been directly tested.”
BackgroundResultInfluentialHagen, K., Nordahl, H., Launes, G., Kvale, G., Öst, L., Hystad, S. W., Hansen, B. K. A., & Solem, S. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.625631 · Cited by 11 · see citing works
Treating insomnia in patients with comorbid psychiatric disorders: A focused review.
Garland, S. N., Vargas, I., Grandner, M. A., & Perlis, M. L. (2018) · Canadian Psychology/Psychologie canadienne · doi:10.1037/cap0000141 · Cited by 11 · see citing works
Silva, R., Teixeira, A., Pinho, J. A., Marcos, P., & Santos, J. (2024) · Acute and Critical Care · doi:10.4266/acc.2023.01256 · Cited by 11 · see citing works
Hoyniak, C. P., Whalen, D. J., Barch, D. M., & Luby, J. L. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01641-1 · Cited by 10 · see citing works
Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial
Haugland, B. S. M., Hysing, M., Hoffart, A., Haaland, V. Ø., Bjaastad, J. F., Wergeland, G. J., & Baste, V. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01795-6 · Cited by 12 · see citing works
“, post-traumatic stress disorder, panic disorder with or without agoraphobia, and generalized anxiety disorder) [4].”
BackgroundThe Cognitive Attentional Syndrome is Associated With Sleep Difficulties in a Community Sample
Fergus, T. A., & Scullin, M. K. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1141771 · Cited by 8 · see citing works
“As noted, prevailing interventions for sleep disturbances only have a moderate effect on concurrent anxiety (Belleville et al., 2011) and prevailing anxiety interventions only have a moderate effect on concurrent sleep disturbances (Belleville et al., 2010).”
Backgroundde Dhaem, O. B., Seng, E. K., & Minen, M. T. (2017) · Pain Medicine · doi:10.1093/pm/pnx161 · Cited by 8 · see citing works
Sleep in Psychiatric Disorders
Ivanenko, A., Kushnir, J., & Alfano, C. A. (2014) · Elsevier eBooks · doi:10.1016/b978-1-4557-0318-0.00046-2 · Cited by 8 · see citing works
Doos Ali Vand, H., Gharraee, B., Asgharnejad Farid, A.-A., Ghaleh Bandi, M. F., & Habibi, M. (2018) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.14452 · Cited by 7 · see citing works
“Another meta-analysis has indicated that cognitive behavioral therapy for anxiety disorders have moderate effects on sleep problems (21).”
BackgroundEffects of Sleep Deficiency on Risk, Course, and Treatment of Psychopathology.
Atwood, M. (2022) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2022.02.010 · Cited by 6 · see citing works
Levrier, K., Leathead, C., Bourdon, D.-É., Lacerte, S., Marchand, A., & Belleville, G. (2016) · InTech eBooks · doi:10.5772/64224 · Cited by 7 · see citing works
“Information was extracted from each eligible record using a data extraction sheet adapted from previous meta-analyses [11, 20].”
BackgroundMethodSelf-citationWallsten, D., Norell‐Clarke, A., Alfonsson, S., Gryphon, D., Eriksson, H., & Tillfors, M. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000278 · Cited by 7 · see citing works
“However, social anxiety disorder was not included among other co-morbid anxiety disorders, and it remains unknown whether or how symptoms of insomnia are affected by CBT for social anxiety disorder (CBTS; Belleville et al., 2010).”
BackgroundSubjective and objective sleep disturbances following trauma-focused treatment
Porten, S., Friedmann, F., Schoofs, N., Barth, C., Meyer, K., Santangelo, P., Ebner‐Priemer, U., Müller‐Engelmann, M., Steil, R., Kleindienst, N., et al. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2542044 · Cited by 6 · see citing works
Grzegrzółka, J., McEvoy, P., & Mansell, W. (2019) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.33.2.140 · Cited by 6 · see citing works
Cassel, M., Blom, K., Gatzacis, J., Renblad, P., Kaldo, V., & Jernelöv, S. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04231-4 · Cited by 6 · see citing works
“For anxiety, there is some evidence that insomnia symptoms can improve after successful treatment of the anxiety disorder, especially in patients with GAD, but a significant portion of patients do not improve [14, 15].”
BackgroundBelleville, G., Boily, L.-A., Provencher, M. D., & Morin, C. M. (2020) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.03.011 · Cited by 5 · see citing works
Self-citationInsomnia in Patients With Unexplained Chest Pain
Belleville, G., Foldes‐Busque, G., Poitras, J., Chauny, J., Diodati, J. G., Fleet, R. P., & Marchand, A. (2013) · Psychosomatics · doi:10.1016/j.psym.2013.12.004 · Cited by 4 · see citing works
Self-citationZhang, B., Li, Y., Chu, W., Li, Y., Zhang, J., Lv, Z., Luo, Y., & Chen, Y. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1669888 · Cited by 3 · see citing works
Cognitive-Behavioral Therapy for Insomnia and Nightmares in PTSD
Belleville, G., & Dubé‐Frenette, M. (2015) · Springer eBooks · doi:10.1007/978-3-319-08613-2_38-1 · Cited by 2 · see citing works
Self-citationAnxiety and Depression During the COVID-19 Pandemic and Their Impact on Sleep
Maqbali, M. A. H. A. (2023) · Progress in Sleep Research · doi:10.1007/978-981-99-0240-8_3 · Cited by 2 · see citing works
Sleep in Psychiatric Disorders
So, C. J., Alfano, C. A., & Ivanenko, A. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-75566-5.00048-4 · Cited by 2 · see citing works
Do treatments for panic disorder improve sleep in patients with unexplained chest pain?
Belleville, G., Marchand, A., Poitras, J., Vadeboncœur, A., Chauny, J., Foldes‐Busque, G., Pelland, M., Lessard, M., Fleet, R. P., & Lavoie, K. (2015) · Archives of Scientific Psychology · doi:10.1037/arc0000018 · Cited by 2 · see citing works
Self-citationEffect of concentrated exposure and response prevention on symptoms of insomnia
Landrø, N. E. H., Pryser, S. H., Hagen, K., Hansen, B. K. A., Kvale, G., & Solem, S. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100891 · Cited by 1 · see citing works
Effects of Sleep Deficiency on Risk, Course, and Treatment of Psychopathology.
Atwood, M. E. (2024) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2024.07.010 · Cited by 1 · see citing works
Hodge, B., Richert, E., Schmitz, L., Íslind, A. S., Leppänen, T., McNicholas, W. T., Arnardóttir, E. S., & Pires, G. N. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.108676 · Cited by 1 · see citing works
A Systematic Review and Meta-Analysis of Psychotherapeutic Approaches for Recurring NightmaresPreprint
Dema, A., & Musaj, L. (2023) · doi:10.32388/gobjo7
Impact of Psychiatric Disorders
Carney, C. E., & Moss, T. G. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-378610-4.00210-2
Insomnia: an essential treatment target in psychotherapy for anxiety disorders
Belleville, G. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.03.003
“A systematic review of 1,205 trials of cognitive-behavior therapy (CBT) for anxiety disorders, 19 of which reported quantitative sleep data, demonstrated that sleep does not necessarily improve after treatment for anxiety in patients with comorbid anxiety disorders and insomnia [13].”
BackgroundSelf-citationCognitive-Behavioral Therapy for Insomnia and Nightmares in PTSD
Belleville, G., & Dubé‐Frenette, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-08359-9_38
“Empirical research indicates that, although psychological treatment for PTSD improves daytime PTSD symptoms, sleep disturbances often persist (Belleville et al. 2010; Galovski et al. 2009; Zayfert and DeViva 2004).”
BackgroundSelf-citationTreatment of Comorbid Sleep Problems in Anxious Children
Alfano, C. A., Gonzalez, R. D., & Meers, J. M. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108235655.010
Impact of psychological disorders
Carney, C. E., Moss, T. G., & Carney, A. E. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00074-8
Winston, H. R., & Nussbaum, A. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822963-7.00058-x
Insomnia Symptom Independently Predict Depression in the Patients With Panic Disorder
Choi, Y., Park, D., Ryu, S., Ha, J. H., & Jeon, H. J. (2023) · Chronobiology in Medicine · doi:10.33069/cim.2023.0011
McGrory, C. M., Fireman, G. D., Bottary, R. M., Lasko, N. B., Simon, N. M., Baker, A. W., Liverant, G. I., & Pace-Schott, E. F. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10664-4
Swearingen, K. M. V., Kumar, K., High, B., Levens, S. M., Chaudhary, N., Watrous, J. R., & Henson, S. J. S. (2025) · doi:10.2196/preprints.83492
Efficacy of transdiagnostic cognitive-behavioral treatment for anxiety disorders on insomnia
Provencher, M. D., Dubé, L., Norton, P. J., Carrier, N., & Roberge, P. (2026) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2026.103124
Swearingen, K. M. V., Kumar, K., High, B., Levens, S. M., Chaudhary, N., Watrous, J. R., & Henson, S. J. S. (2026) · JMIR Formative Research · doi:10.2196/83492
“Mental health interventions such as cognitive behavioral therapy [29] and mindfulness-based therapies [30] have shown promise in improving sleep quality, even when sleep was not the primary focus of treatment.”
Durães, R. S. S., Folquitto, C. T. F., & Serafim, A. D. P. (2020) · International Journal of Psychosocial Rehabilitation · doi:10.61841/fsgjtc04
Barrett, E. N., Alamo, F., Inness, B. E., Furtado, M., Stallwood, E., Frey, B. N., & Green, S. M. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108937
- Authors
- Belleville, G., Cousineau, H., Levrier, K., St-Pierre-Delorme, M.-È., & Marchand, A.
- Affiliations
- Université Laval (CA)
- Université de Montréal (CA)
- Université du Québec à Montréal (CA)
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2010-05
- Volume
- 24
- Issue
- 4
- Pages
- 379-386
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W137222816
- Cited by
- 80
- References
- 53
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 1 · 2016: 10 · 2015: 7 · 2014: 9 · 2013: 4 · 2012: 3
- FWCI
- 3.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- 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 › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, anxiety disorders, sleep disorders, insomnia
- MeSH terms
- Agoraphobia, Anxiety Disorders, Humans, Sleep Wake Disorders, Cognitive Behavioral Therapy
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