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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Influential
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“Differential treatment effects, depending on the outcome measure, are also found in the general population, with larger effect sizes of eCBT-I for insomnia severity (Hedges ’ s g 0.98 – 1.09 ) than for the sleep diary data (Hedges ’ s g 0.29 – 0.71 ) ( Van Straten et al., 2018).”
BackgroundInfluential
Therapist-Assisted Internet-Delivered Cognitive Behavioral Therapy for Insomnia: A Case Report
Landy, M. S. H., Newman, L., Carney, A. E., Donkin, V., Nicholls, J., Krol, S. A., & Farvolden, P. (2023) · Clinical Case Studies · doi:10.1177/15346501221145944 · Cited by 3
“Several meta-analyses to date have supported the effectiveness and durability of CBT-I on subjective sleep outcomes (Okajima et al., 2011; Trauer et al., 2015; van Straten et al., 2018); however, its use in clinical practice is strikingly low (Kathol & Arnedt, 2016; Schmitz, 2016).”
Method
Equivalent Improvements in Sleep Duration and Sleep Quality Regardless of Program Delivery Modality: The SLeep Education for Everyone Program (SLEEP)
Contreras, D. A., Williams, E., & Tucker, R. M. (2023) · Clocks & Sleep · doi:10.3390/clockssleep5020018 · Cited by 4
Failure to reduce benzodiazepine prescriptions through the implementation of a psychological intervention for insomnia in an Italian mental health service
D’Avanzo, B., Parabiaghi, A., Galbussera, A. A., Tettamanti, M., Monti, I., Gregorio, L. D., Zambello, F., Goglio, M. M., Recla, E., Napoli, W. A. R. D., et al. (2024) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-024-03677-7 · Cited by 2
Effectiveness of a guided digital self-help intervention to improve sleep and the biological clock in university students – Study protocol for a randomized controlled trial
Pape, L. M., van Straten, A., Struijs, S. Y., Spinhoven, P., & Antypa, N. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100763 · Cited by 2
“Although CBT-I interventions have been proven effective in adults (Van Straten et al., 2018), research in university students is still somewhat limited.”
BackgroundSelf-citation
Reducing Parkinson's disease incidence in patients with insomnia through acupuncture: A cohort study
Huang, C.-H., Lin, S., Lin, M., & Hung, S. (2024) · Integrative Medicine Research · doi:10.1016/j.imr.2024.101083 · Cited by 2
Protocol of a randomized controlled trial into guided internet-delivered cognitive behavioral therapy for insomnia in autistic adults (i-Sleep Autism)
Spaargaren, K. L., Begeer, S., Greaves‐Lord, K., Riper, H. M., & van Straten, A. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107704 · Cited by 3
Self-citation
Insônia e depressão: confluências neurobiológicas e tratamento
Zanini, M. A., Pinna, C. M. D. S., Lourenço, R. B., dos Reis, F. Z., Borges, D. G. S., Santana, G., Margis, R., & Júnior, A. R. T. (2025) · Debates em Psiquiatria · doi:10.25118/2763-9037.2025.v15.1332 · Cited by 2
Effectiveness of group-delivered cognitive behavioural therapy for insomnia in primary care: a pragmatic, multicentre randomised controlled trial
Hrozanova, M., Skarpsno, E. S., Follestad, T., Kallestad, H., Pallesen, S., Nordstoga, A. L., Møllerløkken, N. E., Rønning, A. S., & Meisingset, I. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106495 · Cited by 4
A social ecological perspective on interventions to address short sleep duration in adults with coronary heart disease
Rouleau, C. R., & Garland, S. N. (2025) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2025.05.003 · Cited by 2
The design process and development of MySleepSolutions - A sleep module for a lifestyle self-management app for low back pain
Roberts, K. E., Beckenkamp, P. R., Comachio, J., Castrillón, C. I. M., Cabral, A. M., Ho, E. K., Comis, J., Jensen, C., Gordon, C., & Ferreira, P. H. (2025) · Health Informatics Journal · doi:10.1177/14604582251340548 · Cited by 3
Predictors and moderators of cognitive therapy and behavior therapy for insomnia disorder
Sunnhed, R., Hesser, H., Carlbring, P., Harvey, A. G., & Jansson‐Fröjmark, M. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106611 · Cited by 2
Mediating role of sleep quality in the relationship between diabetes mellitus and visual function: a cross-sectional study
Yang, Y., Pei, X., Sun, J., Xia, M., Tian, L., Kang, Y., & Li, Z. (2025) · Scientific Reports · doi:10.1038/s41598-025-06641-2 · Cited by 2
“Interventions such as sleep hygiene education, cognitive-behavioral therapy for insomnia (CBT-I), and pharmacologic agents like melatonin may serve as adjunct strategies to prevent vision decline 36–38 .”
Who Benefits the Most from Sleep Hygiene Education? Findings from the SLeep Education for Everyone Program (SLEEP)
Tisdale, A., Kim, N., Contreras, D. A., Williams, E., & Tucker, R. M. (2025) · Clocks & Sleep · doi:10.3390/clockssleep7030040 · Cited by 2
“The most studied of these approaches is Cognitive Behavioral Therapy for Insomnia (CBT-I) [9–11].”
A Course on Cognitive and Behavioural Interventions for Sleep Disorders within a Master Degree Programme in Clinical and Health Psychology
Gomes, A. A. (2020) · Psychologica · doi:10.14195/1647-8606_63-2_8 · Cited by 2
“…treatment, given the robust research evidence from randomized controlled trials, meta-analyses and systematic reviews (e.g., Brasure et al., 2016; Van Straten et al., 2018; Zweerde et al., 2019), consistently supporting the efficacy and effectiveness of this treatment approach (cf. Morin et al.,…”
Background
Integration of cognitive behavioral therapy for insomnia.
Taylor, D. J., & Dietch, J. R. (2018) · Journal of Psychotherapy Integration · doi:10.1037/int0000133 · Cited by 2
Sleep and Social Behavior in Organizations: Implications for Job Performance
Rogers, A. P., Budnick, C. J., & Barber, L. K. (2019) · Springer eBooks · doi:10.1007/978-3-030-30628-1_10 · Cited by 3
Hypnotics: Guidelines and Current References
Bergemann, N. (2022) · Springer eBooks · doi:10.1007/978-3-030-62059-2_77 · Cited by 2
The effect of sleep quality on social anxiety among college students: mediating effects of regulatory emotional self-efficacy and dormitory interpersonal distress
Sun, A. (2023) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/978-2-38476-126-5_119 · Cited by 5
Sleep and Sleep–Wake Disorders
Abbott, S. M., Fiala, J. A., Mundt, J. M., Murray, J. M., & Standlee, J. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_62 · Cited by 2
The Successful Treatment of Insomnia in a Patient With a Complex Neurological History
Loveless, J. P., Russo, J. M., & Andersen, V. C. (2019) · Clinical Case Studies · doi:10.1177/1534650119890123 · Cited by 2
European Portuguese Validation of the Thought Control Questionnaire Insomnia-Revised (TCQI-R)
Nóbrega, C., Correia, A. L., Gomes, A. A., de Azevedo, M. H. P., & Marques, D. R. (2020) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-020-00377-w · Cited by 2
TACTICS OF PSYCHOLOGICAL TESTING AND PSYCHOTHERAPY OF SLEEP DISORDERS DURING THE COVID-19 PANDEMIC
Melehin, A. I. (2021) · PERSONALITY IN A CHANGING WORLD HEALTH ADAPTATION DEVELOPMENT · doi:10.23888/humj20213259-276 · Cited by 1
Patience required: increasing sleep duration in the months to years following CBT-ICommentary on Scott H, Cheung JMY, Muench A, et al. Does total sleep time substantially increase after cognitive behavioral therapy for insomnia? J Clin Sleep Med . 2022;18(7):1823–1829. doi: 10.5664/jcsm.10004
Bramoweth, A. D. (2022) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10044 · Cited by 2
“5,6 In this issue of the Journal of Clinical Sleep Medicine , the study by Scott et al 7 offers welcome news for patients and providers.”
The effects of a CBT-I based app-program on sleep quality, insomnia severity, psychological strain and quality of life: A first efficacy studyPreprint
Eigl, E., Hinterberger, A., Topalidis, P. I., & Schabus, M. (2023) · Research Square · doi:10.21203/rs.3.rs-3218498/v1 · Cited by 1
Effects of cognitive-behavioral therapy for insomnia during sedative-hypnotics withdrawal on sleep and cognition in older adultsPreprint
Barbaux, L., Cross, N. E., Perrault, A. A., et al. (2025) · medRxiv · doi:10.1101/2025.02.10.25322010 · Cited by 2
Insomnia and Sleep Disorders in Older Women
Desai, K. M., Paladine, H. L., & Pilipenko, N. (2021) · Springer eBooks · doi:10.1007/978-3-030-59058-1_8 · Cited by 1
Optimizing Behavior Strategies for Sleep
de Carvalho, L. B. C. (2021) · Springer eBooks · doi:10.1007/978-3-030-85074-6_31 · Cited by 1
Does cognitive behavioral therapy for insomnia produce a meaningful impact on quality of life?
Morin, C. M. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101671 · Cited by 1
Self-citation
Xiao-Yao-San Improves Sleep Quality in Insomnia Patients With and Without Moderate-to-Severe Obstructive Sleep Apnoea—A Pilot Polysomnography Study
Hsu, Y.-C., Zhu, Y.-H., Hsu, C.-Y., Chen, Y.-R., & Tsai, Y.-T. (2024) · Journal of Herbal Medicine · doi:10.1016/j.hermed.2024.100893 · Cited by 1
Insomnia: An Update on Epidemiology, Diagnosis and Non-pharmacological Management
Francis, A. (2024) · Indian Journal of Sleep Medicine · doi:10.5005/jp-journals-10069-0131 · Cited by 1
Harnessing the Power of Integrated Behavioral Health to Enhance Insomnia Intervention in Primary Care
Campbell, R. L., & Bridges, A. J. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13185629 · Cited by 1
“Despite the outstanding effectiveness of CBTi, the patients who would benefit most from this intervention often never make it to specialty care where it is commonly delivered [38,40].”
Background
Perceptions and Effectiveness of a Fully Automated Brief Behavioral Insomnia Therapy, Delivered by a Virtual Companion, in Older and Young Adults
Sagaspe, P., Sánchez-Ortuño, M. M., Dupuy, L., Pécune, F., Coelho, J., Micoulaud‐Franchi, J., Levavasseur, Y., de Sevin, É., Chanteclair, A., Philip, P., et al. (2024) · Innovation in Aging · doi:10.1093/geroni/igae086 · Cited by 1
“…in the older subjects group than in the younger group as the intervention unfolds This is in line with previous reviews of insomnia treatments highlighting that cognitive–behavioral therapy for insomnia is effective for younger and older adults (Morin et al., 2006; van Straten et al., 2018).”
Integrative Therapy for Insomnia: A Pilot Study to Test an Extended CBT-I Program
Kamp, J., Viaene, M. K., & Verhoeven, H. (2024) · Open Journal of Therapy and Rehabilitation · doi:10.4236/ojtr.2024.124023 · Cited by 1
Exploring risk factors for depression: a network analysis
Baños-Chaparro, J. (2024) · Revista Colombiana de Psiquiatría (English ed ) · doi:10.1016/j.rcpeng.2024.10.006 · Cited by 1
Impact of Integrated Psychiatric and Psychotherapeutic Treatment on Perceived Anxiety and Severity of Depressive Symptoms
Maślankowski, J., Wolska, A., Bliźniewska-Kowalska, K. M., Silczuk, A., Gujski, M., Szulc, A., Kunikowska, J., & Gałecka, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14072175 · Cited by 1
Association of Recreational Cannabis Legalization with Frequency of Using Cannabis for Sleep
Panchal, Z., Sakai, J. T., Ellingson, J. M., et al. (2025) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2025.2484379 · Cited by 1
The Effects of Cognitive Behavioral Therapy for Insomnia on Physical Activity Before and After Time in Bed Among Shift Workers
Sochal, M., Feige, B., Spiegelhalder, K., & Ell, J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14093206 · Cited by 1
Novel active-feedback device improves sleep quality in insomnia disorder: a randomized placebo-controlled trial
Ypsilanti, A., van de Werken, M., Robson, A., Examilioti, P., & Lazuras, L. (2025) · Frontiers in Sleep · doi:10.3389/frsle.2025.1452213 · Cited by 1
Same scale, different names? An assessment of the psychometric properties of three established scales that measure cognitive processes in insomnia, and the introduction of the sleep worry 7 questionnaire
Isaksson, S., Henriksson, V., Salim, O., Bäccman, C., & Norell, A. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106595 · Cited by 1
Effectiveness of Mobile Health‐Delivered Cognitive Behavioural Therapy for Insomnia in Adults: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials
Huang, Y., Yan, Y., Kwok, J. Y. Y., Chau, P. H., Ho, M., O’Connor, S., & Lee, J. J. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.17858 · Cited by 3
Insomnia Neurobiology and Therapy
Kane, A., & Salas, R. M. E. (2025) · Seminars in Neurology · doi:10.1055/a-2624-5696 · Cited by 2
Prise en charge de l’insomnie chronique : l’expérience du Réseau Morphée témoigne de l’écart préoccupant entre recommandations et réalité du terrain
Hartley, S., Dagneaux, S., Brion, A., & Launois, S. H. (2025) · Médecine du Sommeil · doi:10.1016/j.msom.2025.06.001 · Cited by 1
Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies
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
“Both CBT-F and CBT-I are effective interventions leading to a reduction of their target symptom following treatment (Adamson et al ., 2020; Castell et al ., 2011; Malouff et al ., 2008; van Straten et al ., 2018; Wiborg et al ., 2015).”
InfluentialSelf-citation
The “SleepWell” intervention for patients with insomnia and persistent pain: a study protocol for a randomised waiting-list controlled trial of a cognitive behavioural group therapy programme
Rosenvinge, J. H., Bergvik, S., Abeler, K., Tvedt, K., Berge, T., Lang, N., Wilhelmsen, M., Danielsson, L., Pettersen, G., & Friborg, O. (2025) · Trials · doi:10.1186/s13063-025-09041-z · Cited by 1
“There is strong evidence for the effects of CBT-i on self-reported enduring insomnia, but weaker evidence for objective markers of sleep onset and sleep efficiency [32].”
Study protocol for Project SHINE (Sleep Health INitiative for Equity): A community-based pilot RCT to promote sleep and physical activity among Black/African American adults
Wu, I. H. C., McNeill, L. H., Knutson, K. L., Li, Y., Balachandran, D. D., Jones‐Webb, R., Lutsey, P. L., Erickson, D., Bista, S., Price, R. M., et al. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101541 · Cited by 1
“The structure of the intervention limited to 4 sessions was based on a meta-analysis of 87 CBT-I randomized controlled trials (RCTs), which concluded that a minimum of 4 sessions was necessary for meaningful improvements in sleep outcomes compared to self-help interventions or fewer sessions [80].”

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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