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Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies
Open accessAbstract
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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“Those that did report longer follow-ups generally found smaller effects (although still statistically significant), most likely due to the diminishing effects of interventions on sleep quality over time [91].”
From Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials (2021) · cites this paper as [91]
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Khullar, A., & Swainson, J. (2024) · Canadian Primary Care Today · doi:10.58931/cpct.2024.2336 · Cited by 1
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“Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective (van der Zweerde et al., 2019; Wu et al., 2015) and first-line treatment for insomnia (Morin et al., 2023).”
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Morin, C. M., & Kyle, S. D. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197602751.013.19
Sarfan, L. D., Milner, A. E., Tiab, S. S., Tuli, D., & Harvey, A. G. (2025) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2025.102049
How do I stop my mind racing and get some sleep?
Sweetman, A. (2023) · doi:10.64628/aa.mx354rvf4
How can I get some sleep? Which treatments actually work?
Sweetman, A., Grivell, N., & Walsh, J. H. (2023) · doi:10.64628/aa.3pq9vkfxc
Saleem, A. M. (2025) · Journal of Lifestyle and SDGs Review · doi:10.47172/2965-730x.sdgsreview.v5.n07.pe07478
Digital and telehealth sleep health interventions
Brombach, R. K., & Dietch, J. R. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-13954-3.00053-x
Rauwerda, N. L., Knoop, H., Pot, I., van Straten, A., Rikkert, M., Zondervan, A., Timmerhuis, T. P. J., Braamse, A. M. J., & Boss, H. M. (2021) · Figshare · doi:10.6084/m9.figshare.17163071
Duncan, M. J., Rayward, A. T., Holliday, E. G., Brown, W. J., Vandelanotte, C., Murawski, B., & Plotnikoff, R. C. (2021) · Figshare · doi:10.6084/m9.figshare.14314151
Metadata
- 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)
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 48
- Pages
- 101208
- ISSN
- 1087-0792 (ISSN-L)
- 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
- 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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