Cited by 199Sleep and related disordersPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Adherence to cognitive behavioral therapy for insomnia: a systematic review

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Matthews, Ellyn E., Arnedt, J. Todd, McCarthy, Michaela S., Cuddihy, Leisha J., Aloia, Mark S.·2013·Sleep Medicine Reviews

Abstract

Chronic insomnia is a significant public health problem worldwide, and insomnia has considerable personal and social costs associated with serious health conditions, greater healthcare utilization, work absenteeism, and motor-vehicle accidents. Cognitive behavioral therapy for insomnia (CBTI) is an efficacious treatment, yet attrition and suboptimal adherence may diminish its impact. Despite the increasing use of CBTI, surprisingly little attention has been devoted to understanding the role of adherence. This review describes a comprehensive literature search of adherence to CBTI. The search revealed 15 studies that evaluated adherence to CBTI in adults using valid and reliable measures of sleep, and measure of adherence other than study withdrawals. The primary purposes of this review were to 1) synthesize current study characteristics, methodology, adherence rates, contributing factors, and impact on outcomes, 2) discuss measurement issues, and 3) identify future practice and research directions that may lead to improved outcomes. Strong patterns and inconsistencies were identified among the studies, which complicate an evaluation of the role of adherence as a factor and outcome of CBTI success. The importance of standardized adherence and outcome measures is discussed. In light of the importance of adherence to behavior change, this systematic review may better inform future intervention efforts.

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Crossref · 10.1016/j.smrv.2013.01.001

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  • CBT-I involves multiple components, each requiring significant commitment from the patient.

    “the intervention involves multiple components, each requiring significant commitment from the patient (115).”
  • White noise or relaxing soundscapes may improve sleep continuity in some individuals.

    “Controlled studies suggest white noise or relaxing soundscapes may improve sleep continuity in some individuals [57,58].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [58]

    The Introduction discusses relaxation techniques as part of cognitive behavioral therapy for insomnia, and the section on adherence and treatment outcome discusses sleep improvements associated with following therapy recommendations. Neither addresses white noise or relaxing soundscapes. Searches for those terms and for audio-based relaxation found no relevant passage in our copy. (LLM, conf=0.76)

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Authors
Matthews, E. E., Arnedt, J. T., McCarthy, M. S., Cuddihy, L. J., & Aloia, M. S.
Affiliations
  • University of Colorado Denver (US)
  • University of Michigan (US)
  • Pine Rest Christian Mental Health Services (US)
  • National Jewish Health (US)
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2013-12
Volume
17
Issue
6
Pages
453-464
ISSN
1087-0792 (ISSN-L)
OpenAlex
W2018449766
Cited by
199
References
76
Citations by year
2026: 17 · 2025: 11 · 2024: 27 · 2023: 26 · 2022: 22 · 2021: 15 · 2020: 15 · 2019: 13 · 2018: 8 · 2017: 19 · 2016: 4 · 2015: 13 · 2014: 9
FWCI
1.44
Type
journal article
Language
en
Open access
Locations
  • Sleep Medicine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Health
  • National Institute of Nursing Research (1K23NR010587, #2010-049)
  • American Nurses Foundation
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
cognitive behavioral therapy for insomnia, medication adherence, chronic insomnia, attrition, adherence measurement, behavior change, sleep outcomes, standardized outcome measures
MeSH terms
Adult, Humans, Sleep Initiation and Maintenance Disorders, Patient Compliance, Cognitive Behavioral Therapy

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