Cited by 676Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

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Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis

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van Straten, Annemieke, van der Zweerde, Tanja, Kleiboer, Annet, Cuijpers, Pim, Morin, Charles M., Lancee, Jaap·2018·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2017.02.001

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Abstract

Insomnia is a major public health problem considering its high prevalence, impact on daily life, co-morbidity with other disorders and societal costs. Cognitive behavioral treatment for insomnia (CBTI) is currently considered to be the preferred treatment. However, no meta-analysis exists of all studies using at least one component of CBTI for insomnia, which also uses modern techniques to pool data and to analyze subgroups of patients. We included 87 randomized controlled trials, comparing 118 treatments (3724 patients) to non-treated controls (2579 patients). Overall, the interventions had significant effects on: insomnia severity index (g = 0.98), sleep efficiency (g = 0.71), Pittsburgh sleep quality index (g = 0.65), wake after sleep onset (g = 0.63) and sleep onset latency (SOL; g = 0.57), number of awakenings (g = 0.29) and sleep quality (g = 0.40). The smallest effect was on total sleep time (g = 0.16). Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions. Otherwise the results seem to be quite robust (similar for patients with or without comorbid disease, younger or older patients, using or not using sleep medication). We conclude that CBTI, either its components or the full package, is effective in the treatment of insomnia.

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“If time allows and the sleep problem is severe, cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line intervention [100,101].”
Background
The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis
Brupbacher, G., Gerger, H., Zander-Schellenberg, T., Straus, D., Porschke, H., Gerber, M., von Känel, R., & Schmidt-Trucksäss, A. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101452 · Cited by 64
Mode of Delivery of Cognitive Behaviour Therapy for Insomnia: A Randomized Controlled Non-Inferiority Trial of Digital or Face-to-Face Therapy
Kallestad, H., Scott, J. L., Vedaa, Ø., Lydersen, S., Vethe, D., Morken, G., Stiles, T. C., Sivertsen, B., & Langsrud, K. (2020) · SLEEP · doi:10.1093/sleep/zsab185 · Cited by 64
“The lack of a third arm with a control group prohibits strong conclusions about the effects of each of the interventions, but there was a significant reduction in scores on all measures from baseline to follow-up for both interventions, and previous research has demonstrated that both FtF CBT-I and dCBT-I is effective…”
Result
The effect of cognitive behavioural therapy for insomnia on sedative-hypnotic use: A narrative review
Sweetman, A., Putland, S., Lack, L. C., McEvoy, R. D., Adams, R., Grunstein, R. R., Stocks, N. P., Kaambwa, B., Ryswyk, E. V., Gordon, C. J., et al. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101404 · Cited by 69
Non-pharmacological treatments for sleep disturbance in mild cognitive impairment and dementia: A systematic review and meta-analysis
Ó’Caoimh, R., Mannion, H., Sezgin, D., O’Donovan, M. R., Liew, A., & Molloy, D. W. (2019) · Maturitas · doi:10.1016/j.maturitas.2019.06.007 · Cited by 68
Isolating the role of time in bed restriction in the treatment of insomnia: a randomised, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularisation.
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Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: A systematic review and meta-analysis
Takaesu, Y., Utsumi, T., Okajima, I., Shimura, A., Kotorii, N., Kuriyama, K., Yamashita, H., Suzuki, M., Watanabe, N., & Mishima, K. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.101214 · Cited by 57
Sleep-Related Disorders in Neurology and Psychiatry
Rémi, J., Pollmächer, T., Spiegelhalder, K., Trenkwalder, C., & Young, P. (2019) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2019.0681 · Cited by 65
Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: a pilot RCT
Denis, D., Eley, T. C., Rijsdijk, F. V., Zavos, H. M. S., Keers, R., Espie, C. A., Luik, A. I., Badini, I., Derveeuw, S., Hodsoll, J. P., et al. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.10.007 · Cited by 61
Factors Affecting User’s Behavioral Intention and Use of a Mobile-Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Small-Scale UTAUT Analysis
Fitrianie, S., Horsch, C., Beun, R. J., Griffioen-Both, F., & Brinkman, W.-P. (2021) · Journal of Medical Systems · doi:10.1007/s10916-021-01785-w · Cited by 57
The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents
Blake, M. J., Schwartz, O., Waloszek, J. M., Raniti, M. B., Simmons, J. G., Murray, G., Blake, L. M., Dahl, R. E., Bootzin, R. R., McMakin, D. L., et al. (2017) · SLEEP · doi:10.1093/sleep/zsx061 · Cited by 64
Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive‐behavioral and mindfulness‐based group sleep intervention for at‐risk adolescents
Blake, M. J., Blake, L. M., Schwartz, O., Raniti, M. B., Waloszek, J. M., Murray, G., Simmons, J. G., Landau, E. R., Dahl, R. E., McMakin, D. L., et al. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12842 · Cited by 66
Hypnosis intervention effects on sleep outcomes: a systematic review
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Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans
Bramoweth, A. D., Lederer, L. G., Youk, A. O., Germain, A., & Chinman, M. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.02.002 · Cited by 59
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Eszopiclone for insomnia
Rösner, S., Englbrecht, C., Wehrle, R., Hajak, G., & Soyka, M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010703.pub2 · Cited by 62
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Self-citation
The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial
Maurer, L., Espie, C. A., Omlin, X., Emsley, R., & Kyle, S. D. (2021) · SLEEP · doi:10.1093/sleep/zsab223 · Cited by 59
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Digital Cognitive Behavioral Therapy for Insomnia in Women With Chronic Migraines
Crawford, M., Luik, A. I., Espie, C. A., Taylor, H. L., Burgess, H. J., Jones, A. L., & Ong, J. C. (2020) · Headache The Journal of Head and Face Pain · doi:10.1111/head.13777 · Cited by 51
Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition
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Prescription Drugs Used in Insomnia
Dujardin, S., Pijpers, A., & Pevernagie, D. (2020) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2020.02.002 · Cited by 52
The case for investigating a bidirectional association between insomnia symptoms and eating disorder pathology
Christensen, K. A., & Short, N. A. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23498 · Cited by 49
“For example, CBT for Insomnia (CBT-I) demonstrates strong evidence for reducing insomnia symptoms and maintaining treatment gains (van der Zweerde et al., 2019; van Straten et al., 2018).”
Background
The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia: A systematic review
Jansson‐Fröjmark, M., & Norell‐Clarke, A. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.05.001 · Cited by 49
Associations between insomnia and cardiovascular diseases: a meta-review and meta-analysis of observational and Mendelian randomization studies
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“66 A previous study found that the use of cognitive behavioral therapy for insomnia in patients with chronic HF combined with insomnia can alleviate insomnia symptoms, fatigue, excessive daytime sleepiness, and improved 6-minute walk distance, which has important prognostic implications for…”
Systematic review and meta-analysis on fully automated digital cognitive behavioral therapy for insomnia
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“Thispatternhasbeendocumentedinpriormeta-analysesondCBT-Ieffects onsleepbyZachariaeetal.,Tsaietal.,Dengetal.,andLeeetal.,aswellasin traditionalCBT-Istudies 25,27,37,38,70 .”
Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial
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“Although we did not compare directly MBTI with a CBT-I, the current frontline treatment for primary insomnia, our trial showed that the effect size of the reduction in ISI scores is comparable to those seen in studies of CBT-I (van Straten et al., 2018).”
ResultInfluential
Prospective Analyses of Cytokine Mediation of Sleep and Survival in the Context of Advanced Cancer
Steel, J. L., Terhorst, L. A., Collins, K. P., Geller, D. A., Yoram Vodovotz, B., Kim, J. E., Krane, A., Antoni, M. H., Marsh, J. W., Burke, L. E., et al. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000579 · Cited by 46
The Treatment of Sleep Dysfunction in Neurodegenerative Disorders
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Effectiveness of digital cognitive behavioral therapy for insomnia in young people: preliminary findings from systematic review and Meta-analysis
Tsai, H.-J., Yang, A. C., Zhu, J.-D., Hsu, Y.-Y., Hsu, T.-F., & Tsai, S.-J. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12030481 · Cited by 45
Effects and clinical feasibility of a behavioral treatment for sleep problems in adult attention deficit hyperactivity disorder (ADHD): a pragmatic within-group pilot evaluation
Jernelöv, S., Larsson, Y., Llenas, M., Nasri, B., & Kaldo, V. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2216-2 · Cited by 53
Very long-term outcome of cognitive behavioral therapy for insomnia: one- and ten-year follow-up of a randomized controlled trial
Jernelöv, S., Blom, K., Isacsson, N. H., Bjurner, P., Rosén, A., Kraepelien, M., Forsell, E., & Kaldo, V. (2022) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.2009019 · Cited by 45
“…al., 2018; Wu et al., 2015), and CBT-i is indeed effective whether the treatment is delivered face-to-face, one-on-one, as grouptherapy, as internet-delivered programs, or as self-help (Koffel et al., 2015; Seyffert et al., 2016; Van Straten et al., 2018; Ye et al., 2015; Zachariae et al., 2016).”
BackgroundInfluential
Comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combination for the treatment of adult insomnia: A systematic review and network meta-analysis
Zhang, Y., Ren, R., Yang, L., Zhang, H., Shi, Y., Shi, J., Sanford, L. D., Lü, L., Vitiello, M. V., & Tang, X. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101687 · Cited by 47

Authors: van Straten, A., van der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C. M., & Lancee, J.
Affiliations: Amsterdam Public Health (NL)
Université Laval (CA)
University of Amsterdam (NL)
ORCID: van Straten, Annemieke
Kleiboer, Annet
Cuijpers, Pim
Morin, Charles M.
Lancee, Jaap
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2018-04
Volume: 38
Pages: 3-16
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2017.02.001
OpenAlex: W2587695521
Semantic Scholar: 6c1b6f5159447dbff310c8cee6eabea911bf3c07
Cited by: 676
References: 158
Citations by year: 2026: 55 · 2025: 100 · 2024: 90 · 2023: 79 · 2022: 79 · 2021: 77 · 2020: 89 · 2019: 58 · 2018: 34
FWCI: 8.49
Type: journal article
Language: en
Open access: green
research.vu.nl
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
UvA-DARE (University of Amsterdam) (publishedVersion)
Pure Amsterdam UMC (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
VU Research Portal (publishedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
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
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Keywords: insomnia, cognitive behavioral therapy for insomnia, sleep efficiency, sleep quality, sleep latency, wake after sleep onset, number of awakenings, total sleep time, self-help intervention, number of treatment sessions, comorbid diseases, sleep medication use
MeSH terms: Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis

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