Cited by 336Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies

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van der Zweerde, Tanja, Bisdounis, Lampros, Kyle, Simon D., Lancee, Jaap, van Straten, Annemieke·2019·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2019.08.002

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Abstract

Cognitive behavioral therapy for insomnia (CBT-I) is a treatment with moderate to large effects. These effects are believed to be sustained long-term, but no systematic meta-analyses of recent evidence exist. In this present meta-analysis, we investigate long-term effects in 30 randomized controlled trials (RCTs) comparing CBT-I to non-active control groups. The primary analyses (n = 29 after excluding one study which was an outlier) showed that CBT-I is effective at 3-, 6- and 12-mo compared to non-active controls: Hedges g for Insomnia severity index: 0.64 (3 m), 0.40 (6 m) and 0.25 (12 m); sleep onset latency: 0.38 (3 m), 0.29 (6 m) and 0.40 (12 m); sleep efficiency: 0.51 (3 m), 0.32 (6 m) and 0.35 (12 m). We demonstrate that although effects decline over time, CBT-I produces clinically significant effects that last up to a year after therapy.

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“( Van der Zweerde et al., 2019) Reviews have also demonstrated more sustained improvements in sleep in those who received CBT-I versus pharmacologic intervention.”
BackgroundInfluential
Long-term effectiveness of a cognitive behavioural therapy (CBT) in the management of fatigue in patients with relapsing remitting multiple sclerosis (RRMS): a multicentre, randomised, open-label, controlled trial versus standard care
Gay, M. C., Cassedanne, F., Barbot, F., Vaugier, I., Thomas, S., Manchon, E., Bensmail, D., Blanchere, M., & Heinzlef, O. (2024) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2023-331537 · Cited by 22
Effects of chronic diseases on health related quality of life is mediated by sleep difficulty in middle aged and older adults
Wu, Y., Chen, Z., Cheng, Z., Yu, Z., Qin, K., Jiang, C., & Xu, J. (2025) · Scientific Reports · doi:10.1038/s41598-025-86420-1 · Cited by 24
The effect of group-based cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: a randomized controlled trial
Latocha, K. M., Løppenthin, K. B., Østergaard, M., Jennum, P., Hetland, M. L., Røgind, H., Lundbak, T., Midtgaard, J., Christensen, R., & Esbensen, B. A. (2022) · Rheumatology · doi:10.1093/rheumatology/keac448 · Cited by 26
Application and Mechanisms of Internet-Based Cognitive Behavioral Therapy (iCBT) in Improving Psychological State in Cancer Patients
Bai, P. (2023) · Journal of Cancer · doi:10.7150/jca.82632 · Cited by 24
Insomnia is common in inflammatory bowel disease (IBD) and is associated with mental health conditions as well as IBD activity
Barnes, A., Andrews, J. M., Mukherjee, S., Bryant, R. V., Bampton, P. A., Fraser, R. J., & Mountifield, R. E. (2023) · Intestinal Research · doi:10.5217/ir.2023.00028 · Cited by 23
“57,58 There has been a pilot trial of CBTi in an IBD population where it was found to be feasible and acceptable.”
Background
Efficacy of Face-to-Face Delivered Cognitive Behavioral Therapy in Improving Health Status of Patients With Insomnia: A Meta-Analysis
Xu, D., Cardell, E., Broadley, S., & Sun, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.798453 · Cited by 27
“Existing meta-analysis studies also found that CBT had a significant overall effect on sleep outcomes in patients with insomnia (12, 13), but these studies focused on sleep outcomes only, and subgroup analysis of CBT components was not included.”
Sleep Quality and Insomnia Severity among Italian University Students: A Latent Profile Analysis
Carpi, M., Marques, D. R., Milanese, A., & Vestri, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11144069 · Cited by 23
The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: A systematic review
McLaren, D. M., Evans, J. J., Baylan, S., Smith, S. A., & Gardani, M. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13843 · Cited by 30
“Despite being prescribed less frequently than hypnotic medications, CBT-I demonstrates efficacy comparable to or exceeding that of pharmacological interventions on insomnia symptoms (Riemann & Perlis, 2009), lasting up to a year post-treatment (van Der Zweerde et al., 2019), and recent evidence suggests it may also pr…”
Background
Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: a prospective analysis of timing and sex differences in the ECHO cohort
Lugo-Candelas, C. I., Hwei, T., Lee, S., Lucchini, M., Aizza, A. S., Kahn, L. G., Buß, C., O’Connor, T. G., Ghassabian, A., Padula, A. M., et al. (2023) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2023.100609 · Cited by 22
“31 Research on these interventions ’ effectiveness in pregnant populations has lagged, yet preliminary evidence supports their usefulness.”
Background
Prevalence and network structure of depression, insomnia and suicidality among mental health professionals who recovered from COVID-19: a national survey in China
Sun, H., Chen, P., Bai, W., Zhang, L., Feng, Y., Su, Z., Cheung, T. C. C., Ungvari, G. S., Cui, X., Ng, C. H., et al. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02918-8 · Cited by 22
Enhancing behavioral sleep care with digital technology: study protocol for a hybrid type 3 implementation-effectiveness randomized trial
Germain, A., Markwald, R. R., King, E. L., Bramoweth, A. D., Wolfson, M. D., Seda, G., Han, T. S., Miggantz, E. L., O’Reilly, B., Hungerford, L. D., et al. (2021) · Trials · doi:10.1186/s13063-020-04974-z · Cited by 22
“Importantly, improvements in insomnia are maintained over time [35].”
Background
Effect of a physical activity and sleep m-health intervention on a composite activity-sleep behaviour score and mental health: a mediation analysis of two randomised controlled trials
Duncan, M. J., Rayward, A. T., Holliday, E. G., Brown, W. J., Vandelanotte, C., Murawski, B., & Plotnikoff, R. C. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01112-z · Cited by 20
“, targeting improvements in insomnia symptoms) [19, 20]”
Effectivity of (Personalized) Cognitive Behavioral Therapy for Insomnia in Mental Health Populations and the Elderly: An Overview
Mijnster, T., Boersma, G. J., Meijer, E., & Lancel, M. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12071070 · Cited by 24
“Van der Zweerde et al., 2019 [17] 104 The Netherlands 46.0 ± 12.3 82% At least subclinical depressive symptoms (PHQ-9 > 4) and insomnia disorder (DSM-5) ICBT-I ‘i-Sleep’ Diary monitoringonly Subjective: ISI; sleep diary (SOL, TST, SE, WASO) 3-mo 6-mo Compared with the control condition, i-Sleep…”
BackgroundInfluential
Patterns of polysomnography parameters in 27 neuropsychiatric diseases: an umbrella review
Zhang, Y., Ren, R., Yang, L., Zhang, H., Shi, Y., Vitiello, M. V., Sanford, L. D., & Tang, X. (2022) · Psychological Medicine · doi:10.1017/s0033291722001581 · Cited by 25
Is cognitive behavioral therapy for insomnia effective for improving sleep duration in individuals with insomnia? A meta-analysis of randomized controlled trials
Chan, W. S., McCrae, C. S., & Ng, A. S.-Y. (2023) · Annals of Behavioral Medicine · doi:10.1093/abm/kaac061 · Cited by 20
A meta-analysis study evaluating the effects of sleep quality on mental health among the adult population
Li, Z., Zhong, T., & Meng, X. (2025) · BMC Public Health · doi:10.1186/s12889-025-23709-w · Cited by 27
“Extended follow-up studies usually revealed reduced effects (though statistically significant); this is most likely owing to the drugs’ fading impact on sleep quality over time [87].”
Using Alcohol and Cannabis as Sleep Aids: Associations with Descriptive Norms Among College Students
Graupensperger, S. A., Hultgren, B. A., Fairlie, A. M., Lee, C. M., & Larimer, M. E. (2022) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2040505 · Cited by 22
“…long-term risks of using substances as sleep aids, and/or integrated with existing interventions for sleep disorders and substance use (e.g., CognitiveBehavioral Therapy for Insomnia, Van der Zweerde et al., 2019; Personalized Feedback for Alcohol and Marijuana Prevention; Carey et al., 2020).”
Background
Acceptance and commitment therapy for insomnia and sleep quality: A systematic review and meta-analysis
Ruan, J., Chen, S., Liang, J., Mak, Y. W., Yee Ho, F. Y., Chung, K. F., Kwun Tong, A. K., Zhang, X. L., & Yeung, W. F. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.09.002 · Cited by 20
The efficacy of digital cognitive behavioral therapy for insomnia and depression: a systematic review and meta-analysis of randomized controlled trials
Lin, W., Li, N., Yang, L., & Zhang, Y. (2023) · PeerJ · doi:10.7717/peerj.16137 · Cited by 24
“Thus, dCBT-I appears to be a viable alternative to the traditional CBT-I treatment for insomnia and depression ( Van der Zweerde et al., 2019 ; Zhang et al., 2019a ; Oar, Johnco & Ollendick, 2017 ). dCBT-I, as an internet-based approach, allows individuals to communicate with their therapists at…”
Treatment of chronic primary sleep onset insomnia with Kundalini yoga: a randomized controlled trial with active sleep hygiene comparison
Khalsa, S. B. S., & Goldstein, M. R. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9320 · Cited by 23
“Atendofinterven-tion as well as 6-month follow-up, within-group effect sizes for SH are on par with average CBT-I outcomes 42,43 for SOL and ISI,withyogademonstratinglargereffects.”
Follow-Up Analyses From a Wait-List Controlled Trial of Occupational Therapist–Delivered Cognitive–Behavioral Therapy for Insomnia Among Veterans With Chronic Insomnia
Eakman, A. M., Schmid, A. A., Rolle, N. R., Kinney, A. R., & Henry, K. L. (2022) · American Journal of Occupational Therapy · doi:10.5014/ajot.2022.045682 · Cited by 21
“Notably, the mental health gains achieved at the end of REST were maintained at 3-mo follow-up, indicating the impact and durability of the intervention (van der Zweerde et al., 2019).”
The effects of cognitive behavioral therapy in women with polycystic ovary syndrome: A meta-analysis
Tang, R., Yang, J., Yu, Y., & Fang, Y. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.796594 · Cited by 19
“CBT has been successful in the treatment of various illnesses including obesity, depression, anxiety, eating disorders, insomnia, and other chronic disorders (Grilo et al., 2011; Reavell et al., 2018; Zweerde et al., 2019).”
Background
Bedtime repetitive negative thinking moderates the relationship between psychological stress and insomnia
Benham, G. (2021) · Stress and Health · doi:10.1002/smi.3055 · Cited by 19
Randomised Controlled Trial of a Behavioural Sleep Intervention, ‘Sleeping Sound’, for Autistic Children: 12-Month Outcomes and Moderators of Treatment
Pattison, E., Papadopoulos, N., Fuller-Tyszkiewicz, M., Sciberras, E., Hiscock, H., Williams, K. J., McGillivray, J., Mihalopoulos, C., Bellows, S., Marks, D., et al. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05809-3 · Cited by 19
“A recent meta-analysis of 29 RCTs examined the longterm effects of cognitive behavioural therapy for insomnia (CBT-I) in adults compared to non-active control groups (van der Zweerde et al., 2019).”
Method
Association between Shift Work and Neurocognitive Function among Firefighters in South Korea: A Prospective before–after Study
Kwak, K., Kim, B.-K., Jang, T. W., Sim, C. S., Ahn, Y., Choi, K., & Jeong, K. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17134647 · Cited by 18
Impact of cognitive behavior therapy on osteoarthritis-associated pain, insomnia, depression, fatigue, and physical function in patients with knee/hip osteoarthritis: A systematic review and meta-analysis of randomized controlled trials
Lin, H.-M., Hsieh, P.-S., Chen, N.-C., Tsai, C.-H., Kuo, W.-F., Lee, Y., & Hung, K.-C. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2022.1083095 · Cited by 17
Recent Advances in Diagnosis and Treatment of Insomnia Disorder
Kim, S. J. (2020) · 신경정신의학 · doi:10.4306/jknpa.2020.59.1.2 · Cited by 17
How sleep can help maximize human potential: The role of leaders
Teyhen, D. S., Capaldi, V. F., Drummond, S. P. A., Rhon, D. I., Barrett, A. S., Silvernail, J. L., & Boland, D. M. (2021) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2021.08.012 · Cited by 19
Effectiveness of Exercise, Cognitive Behavioral Therapy, and Pharmacotherapy on Improving Sleep in Adults with Chronic Insomnia: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Yu, D. J., Recchia, F., Bernal, J. D. K., Yu, A. P., Fong, D., Li, S. X., Chan, N. Y., Hu, X., & Parco Ming-fai, S. I. U. (2023) · Healthcare · doi:10.3390/healthcare11152207 · Cited by 21
Developing a culturally tailored digital health intervention for insomnia in Black women
Zhou, E. S., Revette, A. C., Ritterband, L. M., Bethea, T. N., Delp, L., Simmons, P. D., & Rosenberg, L. A. (2023) · Translational Behavioral Medicine · doi:10.1093/tbm/ibad056 · Cited by 18
Comparative effectiveness of non-pharmacological interventions on sleep in individuals with chronic musculoskeletal pain: A systematic review with network meta-analysis
Chang, J. R., Cheung, Y. K., Sharma, S., Li, S. X., Tao, R. R., Lee, J. L. C., Sun, E. R., Pinto, S. M., Zhou, Z., Fong, H. H. K., et al. (2023) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2023.101867 · Cited by 18
Sleep disturbance and menopause
Carmona, N. E., Solomon, N., & Adams, K. E. (2025) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000001012 · Cited by 18
“Studies are ongoing to assess its use in populations with sleep disturbance [98 ■ ]. objective insomnia symptoms, and more durable effects than pharmacological interventions [99–101], CBT-I is recommended as the first-line treatment for chronic insomnia [102–105].”
Mindfulness-based therapy for insomnia alleviates insomnia, depression, and cognitive arousal in treatment-resistant insomnia: A single-arm telemedicine trial
Kalmbach, D. A., Cheng, P., Ong, J. C., Reffi, A. N., Fresco, D. M., Fellman-Couture, C., Ruprich, M. K., Sultan, Z., Sagong, C., & Drake, C. L. (2023) · Frontiers in Sleep · doi:10.3389/frsle.2023.1072752 · Cited by 15
Challenging beliefs for quality sleep: A systematic review of maladaptive sleep beliefs and treatment outcomes following cognitive behavioral therapy for insomnia
Nielson, S. A., Perez, E., Soto, P. F., Boyle, J. T., & Dzierzewski, J. M. (2023) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2023.101856 · Cited by 17
Discrepancy between desired time in bed and desired total sleep time in patients with cancer: The DBST index and its relationship with insomnia severity and sleep onset latency
Cho, E., Song, J., Lee, J., Cho, I., Lee, D., Choi, H., Kim, H., & Chung, S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.978001 · Cited by 15
“Several studies have shown that CBT-I is effective in reducing sleep disturbance (4, 5) and the number of dysfunctional beliefs associated with sleep (6).”
BackgroundMethod
Treatment feasibility of a digital tool for brief self‐help behavioural therapy for insomnia ( FastAsleep )
Jernelöv, S., Forsell, E., Westman, H., Dufva, Y. E., Lindefors, N., Kaldo, V., & Kraepelien, M. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13759 · Cited by 16
“Although treatment gains are generally maintained after the end of CBT-I both in the short and long term (Jernelöv et al., 2022; van der Zweerde et al., 2019), some earlier studies have found continued improvement after the end of treatment in the short term (Jernelöv et al., 2012), whereas others…”
Background
Cognitive, Behavioral, and Circadian Rhythm Interventions for Insomnia Alter Emotional Brain Responses
Leerssen, J., Aghajani, M., Bresser, T., Rösler, L., Winkler, A. M., Foster‐Dingley, J. C., & Someren, E. J. W. V. (2023) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2023.03.007 · Cited by 15
Using Cannabis and CBD to Sleep: An Updated Review
Lavender, I., Garden, G., Grunstein, R. R., Yee, B. J., & Hoyos, C. M. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01564-7 · Cited by 16
Internet-Delivered Cognitive Behavioral Therapy for Insomnia
van der Zweerde, T., Lancee, J., Luik, A. I., & van Straten, A. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.04.002 · Cited by 14

Authors: van der Zweerde, T., Bisdounis, L., Kyle, S. D., Lancee, J., & van Straten, A.
Affiliations: University of Amsterdam (NL)
University of Oxford (GB)
PsyQ (NL)
ORCID: Bisdounis, Lampros
Kyle, Simon D.
Lancee, Jaap
van Straten, Annemieke
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2019-12
Volume: 48
Pages: 101208
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2019.08.002
OpenAlex: W2967986432
Cited by: 336
References: 79
Citations by year: 2026: 50 · 2025: 56 · 2024: 50 · 2023: 59 · 2022: 56 · 2021: 36 · 2020: 27 · 2019: 2
FWCI: 4.46
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
VU Research Portal (publishedVersion, other-oa)
UvA-DARE (University of Amsterdam) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders: National Institute for Health Research
Manchester Biomedical Research Centre
NIHR Oxford Biomedical Research Centre
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 › Psychotherapy Techniques and Applications
Keywords: cognitive behavioral therapy for insomnia, insomnia, long-term treatment outcomes, treatment durability, sleep latency, sleep efficiency, Insomnia Severity Index
MeSH terms: Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies

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