Cited by 306Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia: CBT for insomnia: a meta-analysis

OKAJIMA, Isa, KOMADA, Yoko, INOUE, Yuichi·2011·Sleep and Biological Rhythms

DOI 10.1111/j.1479-8425.2010.00481.x

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“Analysing studies using actigraphy or PSG data, Okajima et al. (2011) ascertained medium to large effect sizes for changes in the total wake time, early morning awakening, WASO, and SE at post-treatment, as well as for SOL at follow-up.”
Cognitive behavioural therapy with behavioural analysis for pharmacological treatment-resistant chronic insomnia
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“3025549 (CBT-I) is a safe and effective insomnia treatment [47, 63].”
Background
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Common Questions About Cognitive Behavior Therapy for Psychiatric Disorders.
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CBT-I Cannot Rest Until the Sleepy Teen Can
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Background
Cognitive behavioural therapy for tinnitus-related insomnia: evaluating a new treatment approach
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“12 13 – 15 Patients also prefer behavioral interventions for insomnia over medication.”
A Pilot Study Testing the Efficacy of dCBT in Patients With Cancer Experiencing Sleep Problems
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“These figures are much higher than the reported 9%–12% of physically healthy adults who experience chronic sleep-related problems (Patel et al., 2009), and the problem typically continues as a chronic condition even after the termination of cancer treatment for some patients (Palesh et al., 2012).”
Background
Primary Care Psychology: An Opportunity for Closing the Gap in Mental Health Services for Older Adults
Rybarczyk, B. D., Shamaskin‐Garroway, A., Auerbach, S. M., Rodríguez, V. M., Lord, B. D., & Sadock, E. (2013) · Clinical Gerontologist · doi:10.1080/07317115.2013.767870 · Cited by 12
Advances in the management of insomnia
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“The most efficacious non-pharmacologic insomnia treatment, however, is a multi-component intervention referred to as cognitive behavioral therapy for insomnia (CBT-I), which typically combines sleep psychoeducation, stimulus control, sleep restriction therapy, sleep hygiene, cognitive therapy and relaxation training […”
Background
A Scoping Study of Insomnia Symptoms in School Teachers
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“The effect sizes for the sleep improvements found in these studies are comparable to those for CBT-I alone, presented in various formats, including digital (Kaldo et al., 2015; Koffel et al., 2015; Okajima et al., 2011).”
Result
Self-help therapy for sleep problems in hospital nurses in Japan: a controlled pilot study
Morimoto, H., Tanaka, H., Ohkubo, R., Mimura, M., Ooe, N., 市川, あ., & Yukitoshi, H. (2015) · Sleep and Biological Rhythms · doi:10.1007/s41105-015-0037-3 · Cited by 12
“For example, a typical course of CBT-I takes multiple sessions [9] which has a time cost for participants.”
Background
CBT-I and HT-I group therapy for adults with insomnia in comparison to those with insomnia and comorbid depression – a pilot study
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“1,3,33,35,43 A meta-analysis by Okajima et al reported that CBT-I was more effective than a control group regarding SOL, WASO, time in bed (TIB), and SE.”
Impact of Pharmacist-Led Cognitive Behavioural Therapy for Chronic Insomnia
Nurkowski, J., Elshorbagy, H., Halpape, K., Jensen, K., Lamb, D. A., Landry, E., Rémillard, A. J., & Jorgenson, D. J. (2020) · INNOVATIONS in pharmacy · doi:10.24926/iip.v11i3.3378 · Cited by 12
Effectiveness and Cost-Effectiveness of Internet-Based Cognitive Behavioral Therapy for Insomnia in Clinical Settings
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“This effect size was not found to be significantly different then effect sizes in individual or group CBT-I (17, 18).”
Result
The top 100 most cited papers in insomnia: A bibliometric analysis
Wan, Q., Liu, K., Wang, X., Luo, S., Yuan, X., Wang, C., Jiang, J., & Wu, W. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1040807 · Cited by 12
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“a moderate to large effect in treating insomnia [3].”
Background
Treating comorbid insomnia in patients enrolled in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy for anxiety and depression: A randomized controlled trial
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“I) is considered the first-line treatment for insomnia (Okajima et al., 2011) and has been found to be more effective than pharmacotherapy in the long-term (Rios et al., 2019).”
Background
Predictors of Psychotherapy Use among Community-Dwelling Older Adults with Depressive Symptoms
Gur‐Yaish, N., Dana, P., & Palgi, Y. (2015) · Clinical Gerontologist · doi:10.1080/07317115.2015.1124957 · Cited by 13
Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis
Kim, J. H., & Oh, P. J. (2016) · Korean Journal of Adult Nursing · doi:10.7475/kjan.2016.28.1.13 · Cited by 11
Treating insomnia in patients with comorbid psychiatric disorders: A focused review.
Garland, S. N., Vargas, I., Grandner, M. A., & Perlis, M. L. (2018) · Canadian Psychology/Psychologie canadienne · doi:10.1037/cap0000141 · Cited by 12
Baseline sleep characteristics are associated with gains in sleep duration after cognitive behavioral therapy for insomnia
Scott, H., Cheung, J. M. Y., Muench, A., Ivers, H., Grandner, M. A., Morin, C. M., & Perlis, M. L. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.01.009 · Cited by 14
Amount and quality of sleep: exploring the role of stress and work experience in a sample of obstetrician-gynecologists
Taouk, L. H., Farrow, V. A., & Schulkin, J. A. (2017) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/0167482x.2017.1320985 · Cited by 10
“Random samples of CARN have been shown to be representative of ACOG members [19], which includes more than 90% of board-certified ob-gyns in the US.”
Background
Telehealth versus face-to-face delivery of cognitive behavioural therapy for insomnia: A systematic review and meta-analysis of randomised controlled trials
Scott, A. M., Peiris, R., Atkins, T., Cardona, M., Greenwood, H., Clark, J., & Glasziou, P. (2025) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x231204071 · Cited by 11
“…to patients with insomnia is effective for a wide range of patient groups and contexts, including the general adult population with insomnia, 11,15 adults over 55 years old, 15 adults with pain conditions, 15 cancer survivors 26 patients with primary insomnia, 34 and when delivered in primary care.”
Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury
Dietch, J. R., & Furst, A. J. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.530273 · Cited by 11
Effects of mindfulness‐based therapy for insomnia and a sleep hygiene/exercise programme on subjective‐objective sleep discrepancy in older adults with sleep disturbances: Exploratory secondary analysis of a randomised clinical trial
Shaif, N. A. S., Doshi, K., & Lim, J. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13700 · Cited by 10
Ecstasy and sleep disturbance: Progress towards elucidating a role for the circadian system
Ogeil, R. P., Rajaratnam, S. M. W., & Broadbear, J. H. (2011) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2011.00510.x · Cited by 10
Healthy Sleep Practices (Sleep Hygiene) in Children With ADHD
Corkum, P. V., Rigney, G., Howlett, M., & Weiss, S. K. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814180-9.00005-3 · Cited by 9
The enigma of objective and subjective measurement of response to cognitive behavioral therapy for insomnia: Call to action
Dietch, J. R., & Taylor, D. J. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.08.003 · Cited by 11
A Pilot Randomized Trial of Combined Cognitive-Behavioral Therapy and Exercise Training Versus Exercise Training Alone for the Management of Chronic Insomnia in Obstructive Sleep Apnea
Cammalleri, A., Perrault, A. A., Hillcoat, A., Carrese‐Chacra, E., Tarelli, L., Patel, R. S., Baltzan, M., Chouchou, F., Dang‐Vu, T. T., Gouin, J., et al. (2024) · Journal of Sport and Exercise Psychology · doi:10.1123/jsep.2023-0139 · Cited by 9
Psychological Interventions for Sleep Problems Among Medical and Paramedical Students: A Systematic Review
Mariappan, V. A., & Mukhtar, F. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.23781 · Cited by 8
Leitlinie „Insomnie bei Erwachsenen“ – Update 2025 (AWMF-Registernummer 063-003)
Spiegelhalder, K., Baum, E., Becker, M., Cornaro, C., Crönlein, T., Frase, L., Harth, V., Hertenstein, E., Johann, A. F., Mertel, I., et al. (2025) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-025-00530-6 · Cited by 12
Unravelling the Prospective Associations Between Mixed Anxiety-Depression and Insomnia During the Course of Cognitive Behavioral Therapy
Thun, E., Sivertsen, B., Knapstad, M., & Smith, O. R. F. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000676 · Cited by 9
Feasibility and Preliminary Real-World Promise of a Manualized Group-Based Cognitive Behavioral Therapy for Insomnia Protocol for Veterans
Koffel, E., & Farrell‐Carnahan, L. (2014) · Military Medicine · doi:10.7205/milmed-d-13-00455 · Cited by 10
Special Considerations in the Adaptation of Cognitive Behavioral Therapy for Insomnia With Active-Duty U.S. Army Personnel
Pruiksma, K. E., Fina, B. A., Dietch, J. R., Dondanville, K. A., Williams, J. M., Wright, E. C., Molino, A. T. C., Hall‐Clark, B. N., Nicholson, K. L., Peterson, A. L., et al. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.12.007 · Cited by 9
Cognitive Behavior Therapy for Insomnia: state of the science or a stated science?
Ellis, J. G., & Barclay, N. L. (2014) · Sleep Medicine · doi:10.1016/j.sleep.2014.04.008 · Cited by 8
Investigating the effectiveness of electronically delivered cognitive behavioural therapy (e-CBTi) compared to pharmaceutical interventions in treating insomnia: protocol for a randomized controlled trial
Zhu, Y., Stephenson, C., Moghimi, E., Jagayat, J., Nikjoo, N., Kumar, A., Shirazi, A., Patel, C., Omrani, M., & Alavi, N. (2023) · PLOS ONE · doi:10.1371/journal.pone.0285757 · Cited by 7
Sleep Outcomes With Cognitive Behavioral Therapy for Insomnia Are Similar Between Older Adults With Low vs. High Self-Reported Physical Activity
Yeung, T., Martin, J. L., Fung, C. H., Fiorentino, L., Dzierzewski, J. M., Tapia, J. C. R., Song, Y., Josephson, K. R., Jouldjian, S., Mitchell, M. N., et al. (2018) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2018.00274 · Cited by 8
“Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be highly effective for treatment of chronic insomnia in a variety of populations, including among older adults (Okajima et al., 2011).”
Background
Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: protocol for a randomised controlled trial
Marks, E. M., Hallsworth, C. A., & McKenna, L. (2019) · Trials · doi:10.1186/s13063-019-3778-5 · Cited by 7
An investigation and replication of sleep‐related cognitions, acceptance and behaviours as predictors of short‐ and long‐term outcome in cognitive behavioural therapy for insomnia
Blom, K., Isacsson, N. H., Forsell, E., Rosén, A., Kraepelien, M., Jernelöv, S., & Kaldo, V. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13376 · Cited by 7
Standard cognitive behavioral therapy for insomnia (CBT-I)
Muench, A., Vargas, I., Posner, D. A., & Perlis, M. L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822872-2.00012-8 · Cited by 10
Cognitive behavioral therapy for the management of poor sleep in insomnia disorder
Kyle, S. D., Miller, C. B., & Espie, C. A. (2014) · ChronoPhysiology and Therapy · doi:10.2147/cpt.s54220 · Cited by 9
“46).(35,41,42) Objectively defined sleep variables (polysomnography and actigraphy) have also shown small-to-moderate effects after CBT-I in metaanalytical studies, including SOL (d=0.”
Treatment effect of cognitive-behavior therapy for insomnia combined with usual medication
Jan, Y.-W., Yang, C., Huang, S., & Lee, H. (2019) · Sleep and Biological Rhythms · doi:10.1007/s41105-019-00218-z · Cited by 7
Revealing sleep and pain reciprocity with wearables and machine learning
Kim, S., Zeitzer, J. M., Mackey, S., & Darnall, B. D. (2025) · Communications Medicine · doi:10.1038/s43856-025-00886-8 · Cited by 8
Efficacy of a Self-Guided Internet Intervention With Optional On-Demand Feedback Versus Digital Psychoeducation on Sleep Hygiene for University Students With Insomnia: Randomized Controlled Trial
Zarski, A., Bernstein, K., Baumeister, H., Lehr, D., Wernicke, S., Küchler, A., Kählke, F., Spiegelhalder, K., & Ebert, D. D. (2025) · Journal of Medical Internet Research · doi:10.2196/58024 · Cited by 9
On the Efficacy of a CBT-I-Based Online Program for Sleep Problems: A Randomized Controlled Trial
Eigl, E., Hauser, T., Topalidis, P. I., & Schabus, M. (2023) · Clocks & Sleep · doi:10.3390/clockssleep5040039 · Cited by 6
“Furthermore, our results correspond to the outcome of a meta-analysis from Okajima and colleagues [28], who also found medium effect sizes for an improvement in objective WASO ( d = 0.42) and SE ( d = 0.53) derived from PSG and/or actigraphy at the end of F2F CBT-I.”
ResultInfluential
Smartphone application‐delivered cognitive behavioural therapy for insomnia with telephone support for insomnia disorder compared to a waitlist control: a randomised clinical trial
Jansson‐Fröjmark, M., & Sunnhed, R. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14363 · Cited by 6
“Dropping out from internet-delivered CBT-I trials has been estimated at 24.7%, and from face-to-face delivered CBT-I trials, between 0.0% to 33% (Okajima et al., 2010; Zachariae et al., 2016).”
Influential
Development of a new benzodiazepine hypnotics withdrawal symptom scale
Kobayashi, M., Okajima, I., Narisawa, H., Kikuchi, T., Matsui, K., Inada, K., Ishigooka, J., & Inoue, Y. (2018) · Sleep and Biological Rhythms · doi:10.1007/s41105-018-0151-0 · Cited by 6
Cognitive behavioural therapy monotherapy for insomnia: A meta-analysis of randomized controlled trials
Wang, Y.-Y., Yang, Y., Rao, W., Zhang, S.-F., Zeng, L., Zheng, W., Ng, C. H., Ungvari, G. S., Zhang, L., & Xiang, Y. (2019) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2019.10.008 · Cited by 6
“Several meta-analyses of CBTI assessed the effects of CBTI on insomnia (Cheng and Dizon, 2012; Okajima et al., 2011; Ren et al., 2016).”
BackgroundMethod
Cognitive–behavioral factors in tinnitus-related insomnia
Barry, G., & Marks, E. M. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.983130 · Cited by 6
“A high-quality meta-analysis of RCTs using CBTi in insomnia (Okajima et al., 2011) found it to be effective, with medium to large effect sizes.”
Background
Uso terapêutico do canabidiol nos transtornos de ansiedade e insônia
Rodrigues, B. B., Alvarenga, L. C. R., & Aguiar, C. (2022) · Brazilian Journal of Development · doi:10.34117/bjdv8n12-152 · Cited by 6
EFFICACY OF A COGNITIVE-BEHAVIORAL TREATMENT FOR INSOMNIA AMONG AFGHANISTAN AND IRAQ (OEF/OIF) VETERANS WITH PTSD
Ochsner, M. S. (2011) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/d9s2-vq28 · Cited by 6
“the large effect sizes, are in line with those reported in the most recent meta-analysis of CBTI (Okajima et al., 2011).”
BackgroundResultInfluential
Outcomes from a combined cognitive behavioral therapy for insomnia (CBT-I) and sleep-related medication and substance use reduction treatment.
Gutierrez, G., Chowdhary, A., Hartogensis, W., Soltani, S., Chao, M. T., & Mason, A. E. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.108696 · Cited by 5

Authors: OKAJIMA, I., KOMADA, Y., & INOUE, Y.
Affiliations: Tokyo Medical University (JP)
Corresponding author: INOUE, Yuichi
ORCID: OKAJIMA, Isa
KOMADA, Yoko
INOUE, Yuichi
Venue: Sleep and Biological Rhythms
Publisher: Springer Science and Business Media LLC
Published: 2010-11-28
Volume: 9
Issue: 1
Pages: 24-34
ISSN: 1446-9235 (ISSN-L)
DOI: 10.1111/j.1479-8425.2010.00481.x
OpenAlex: W1896419572
Cited by: 306
References: 47
Citations by year: 2026: 6 · 2025: 21 · 2024: 15 · 2023: 23 · 2022: 27 · 2021: 20 · 2020: 27 · 2019: 29 · 2018: 24 · 2017: 27 · 2016: 21 · 2015: 26 · 2014: 20 · 2013: 9 · 2012: 8
FWCI: 0.80
Type: journal article
Language: en
Open access: closed
Licence: doi.wiley.com/10.1002/tdm_license_1 (tdm, 1738 d)
Locations: Sleep and Biological Rhythms (publishedVersion)
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, primary insomnia, treatment effectiveness, relapse prevention, follow-up outcomes, sleep diary, self-rating scale, publication bias

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A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia: CBT for insomnia: a meta-analysis

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