Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: a systematic review of randomized and non-randomized trials
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Acceptance and commitment therapy (ACT) is an effective treatment option for insomnia.
“Acceptance and commitment therapy (ACT) is an effective treatment option for insomnia, suggesting that inflexibility acts in some way on the severity of insomnia (Paulos-Guarnieri et al., 2022;Ruan et al., 2022).”
From Psychological inflexibility as a predictor associated with insomnia (2024) · cites this paper as Paulos-Guarnieri et al., 2022
This study supports the applicability of ACT for insomnia and is consistent with recent studies indicating that ACT is a useful treatment for insomnia.
“Clinically, this study supports the applicability of ACT for insomnia and is consistent with recent studies indicating that ACT is a useful treatment for insomnia (e.g. Paulos‐Guarnieri et al., 2022; Rafihi‐Ferreira et al., 2024).”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as Paulos‐Guarnieri et al., 2022
ACT significantly reduced insomnia symptoms.
“We also found that ACT significantly reduced insomnia symptoms, and thereby equally replicated newer findings (Paulos-Guarnieri et al., 2022;Salari et al., 2020).”
From Effects of mindfulness meditation and Acceptance and commitment therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study (2023) · cites this paper as Paulos-Guarnieri et al., 2022
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Cognitive factors and processes in models of insomnia: A systematic review
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“, 2018) and detect which dimensions of psychological flexibility are most associated with improvement in insomnia (Paulos-Guarnieri et al., 2022) There are some important limitations in our study.”
BackgroundInfluential2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association
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“55,68 When compared with CBT-I, ACT showed no differences in subjective sleep parameters.”
BackgroundMethodInfluentialSelf-citationThe relationships between insomnia, nightmares, and dreams: A systematic review
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“…dysfunctional beliefs about sleep such as cognitive behavior therapy for insomnia (CBT-I) (Eidelman et al., 2016; Thakral et al., 2020) and on expanding psychological flexibility such as ACT-I (El Rafihi-Ferreira et al., 2020; El Rafihi-Ferreira et al., 2022; Paulos-Guarnieri et al., 2022).”
BackgroundPsychological inflexibility as a predictor associated with insomnia
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“Acceptance and commitment therapy (ACT) is an effective treatment option for insomnia, suggesting that inflexibility acts in some way on the severity of insomnia (Paulos-Guarnieri et al., 2022; Ruan et al., 2022).”
Self-citationAssociations between psychological inflexibility processes, pre‐sleep arousal and sleep quality.
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“The results of other systematic review showed that ACT is an effective in improving sleep patterns and insomnia severity [25].”
Novel psychotherapies for insomnia
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“In 2022, a systematic review on the efficacy of ACT-I was published (Paulos-Guarnieri et al., 2022).”
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“The authors conclude that ACT as monotherapy constitutes a ‘ possibly ef fi cacious ’ treatment for insomnia, while the combination of ACT with behavioral components, including sleep restriction and stimulus control, constitutes a ‘ probably ef fi cacious ’ treatment for insomnia (92).”
Mechanisms of change in an online acceptance and commitment therapy intervention for insomnia
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“The DBAS as an instrument is useful in identifying dysfunctional cognitions related to sleep 57 , but does not explore their functions 21 .”
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“…patients who do not respond to this type of intervention (Morin et al., 2009; Ritterband et al., 2017), so new therapeutic proposals, such as acceptance and commitment therapy for insomnia (ACT-I), have also been tested in the search for more intervention options (Paulos-Guarnieri et al., 2022).”
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“The effectiveness of ACT on sleep disturbances is in line with findings from systematic reviews by Paulos-Guarnieri et al. (2022) and Lappalainen et al. (2019), which indicated that ACT leads to improvements in sleep patterns and decreased severity of insomnia, although these studies were conducted…”
Assar, A., Walker, J. L., Egeler, M. E., Floyd, V., Dickens, H., & Vargas, I. (2026) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2610674 · Cited by 2 · see citing works
“Current evidence supports the efficacy of multiple pharmacological, psychological, and behavioral interventions for reducing insomnia symptoms (Mitchell et al., 2012; Paulos-Guarnieri et al., 2022; Smith et al., 2002).”
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A clinical algorithm for diagnosis and treatment of insomnia in adults: an updated review
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“96 The results of another study indicated that ACT reduces the symptoms of insomnia.”
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“27).”
Personality traits and insomnia: direct and anxiety‐mediated associations
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“This model advances existing cognitive and behavioural models of insomnia and deepens knowledge about the mechanisms of insomnia worked on in ACT, which has been studied as a new option for the treatment of insomnia (Paulos-Guarnieri et al., 2022).”
Jiang, Y., Peng, T., Wang, N., Peng, J., Tan, X., & Liu, Y. (2026) · Scientific Reports · doi:10.1038/s41598-026-44776-y · Cited by 1 · see citing works
“Supporting the well-established literature, a significant negative correlation was observed between experiential avoidance and sleep quality, a finding that aligns with prior studies in this field 103–105 .”
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“13 Some studies have also shown that mindfulness interventions that target psychological flexibility, the theoretical model underlying acceptance and mindfulness interventions, to be effective in treating insomnia disorder.”
BackgroundMiller‐Mendes, M., Castilho, P., Clara, M. I., Clemente, V., & Gomes, A. A. (2026) · British Journal of Clinical Psychology · doi:10.1111/bjc.70077
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The role of psychological flexibility components in predicting anxiety and insomnia severityPreprint
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Evidence of Acceptance and Commitment Therapy-Based Therapies for Insomnia
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Brasil, I. S. P. S., & Hasan, R. (2024) · Springer eBooks · doi:10.1007/978-3-031-50710-6_6
Initial Interview in the Therapeutic Setting
Linares, I. M. P., & Ferreira, R. E. R. (2024) · Springer eBooks · doi:10.1007/978-3-031-50710-6_7
Self-citationFerreira, R. E. R. (2024) · Springer eBooks · doi:10.1007/978-3-031-50710-6_1
Insônia e traços de personalidade
Conway, B. A. (2024) · doi:10.11606/d.5.2024.tde-19062024-163230
Miguel, G. G. S., Woolley, M. G., Lee, E. B., Smith, B. M., Culianos, D., Levin, M. E., & Twohig, M. P. (2024) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2024-0002 · Cited by 1 · see citing works
Tian, T., Huang, Z., Zhou, J., Wang, D., Rahman, A., Li, X., & Yang, L. (2025) · Research Square · doi:10.21203/rs.3.rs-6144966/v1
The Sleep Acceptance Scale (SAS): Development, psychometric properties, and applications
Ferreira, R. E. R., Carmo, M., Paulos‐Guarnieri, L., & Pires, M. L. N. (2025) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2555864
“…widely investigated, recent clinical trials reported positive results of ACTs reducing insomnia symptoms (El Rafihi-Ferreira, Hasan, et al., 2024; El Rafihi-Ferreira et al., 2023; Martin et al., 2023; Paulos-Guarnieri et al., 2022; Zakiei et al., 2024; see also El Rafihi-Ferreira et al., 2023).”
Self-citationStress and Affective Dysregulation in Depression and Insomnia
Vargas, I., Walker, J. L., Campbell, R. L., & Veilleux, J. C. (2025) · CBT: science into practice · doi:10.1007/978-3-031-92265-7_4
Paulos‐Guarnieri, L., Linares, I. M. P., & Rafihi‐Ferreira, R. E. (2025) · CBT: science into practice · doi:10.1007/978-3-031-92265-7_7
Self-citationQiu, J., Zhang, M., & Tan, T. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.100991
Zakiei, A., Nikzadi, H., & Komasi, S. (2026) · Annals of Indian Psychiatry · doi:10.4103/aip.aip_5_25
Ronkainen, H., Kenttä, G., Lundgren, T., Ihalainen, J. K., Valtonen, M., & Lappalainen, R. I. (2026) · The Sport Psychologist · doi:10.1123/tsp.2025-0108
Richdale, A. L., Maria, F. R. D., & Morris, E. M. J. (2026) · British Journal of Clinical Psychology · doi:10.1111/bjc.70072
“…Acceptance and Commitment Therapy (ACT), which addresses PI processes, and therefore provide a rationale for investigating ACT adapted to address insomnia (i.e. ACT-I) in future clinical trials and studies examining its underlying change processes (Paulos-Guarnieri et al., 2022; Ruan et al., 2022).”
Behavioral Management of Chronic Insomnia: Foundations, Mechanisms, and Clinical Application
Cuddihy, L. J., Boyle, J. T., Nowakowski, S., Buda, K., Perlis, M. L., & Muench, A. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-29009-1.00139-6
Behavioral Sleep Interventions & Posttraumatic Stress Disorder in Adults
Cusack, D., Mahler, C., Muñoz, I. D. C., Martin, J. L., & Kelly, M. R. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00382-y
“…will have a higher likelihood of developing a non-judgmental observation and acceptance of unpleasant thoughts, feelings, and behaviors when faced with high sleep effort, increased body arousal, and the initial discomfort of behavior techniques such as stimulus control and sleep restriction [99].”
- Authors
- Paulos-Guarnieri, L., Linares, I. M. P., & El Rafihi-Ferreira, R.
- Affiliations
- Universidade de São Paulo (BR)
- Venue
- Journal of Contextual Behavioral Science
- Publisher
- Elsevier BV
- Published
- 2022-01
- Volume
- 23
- Pages
- 1-14
- ISSN
- 2212-1447 (ISSN-L)
- OpenAlex
- W3214712581
- Cited by
- 48
- References
- 64
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 13 · 2023: 9 · 2022: 4
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Contextual Behavioral Science (publishedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/19506\u20135, 2020/10748\u20136, 2019/25537\u20133)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- acceptance and commitment therapy, insomnia, psychological flexibility, cognitive behavioral therapy for insomnia, sleep restriction, stimulus control, treatment efficacy, sleep patterns, process approach
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