Acceptance and Commitment Therapy, Combined with Bedtime Restriction, versus Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Pilot Trial
Abstract
Introduction: Cognitive behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia. However, rates of nonresponse and nonremission are high and effects on quality of life are only small to moderate, indicating a need for novel treatment developments. We propose that Acceptance and Commitment Therapy (ACT) addresses core pathophysiological pathways of insomnia. ACT therefore has the potential to improve treatment efficacy when combined with bedtime restriction, the most effective component of CBT-I. The aim of this study was to compare the efficacy of ACT for insomnia combined with bedtime restriction (ACT-I) and CBT-I in improving insomnia severity and sleep-related quality of life. Methods: Sixty-three patients with insomnia disorder (mean age 52 years, 65% female, 35% male) were randomly assigned to receive either ACT-I or CBT-I in a group format. The primary outcomes were insomnia severity (Insomnia Severity Index) and sleep-related quality of life (Glasgow Sleep Impact Index). Outcomes were assessed before randomization (T0), directly after treatment (T1), and at 6-month follow-up (T2). Results: The results indicated significant, large pre-to-post improvements in both groups, for both primary and secondary outcomes. Improvements were maintained at the 6-month follow-up. However, there was no significant group by time interactions in linear mixed models, indicating an absence of differential efficacy. On a subjective treatment satisfaction scale, patients in the ACT-I group indicated significantly greater satisfaction with their improvement of several aspects of health including their energy level and work productivity. Conclusions: The results suggest that ACT-I is feasible and effective, but not more effective than CBT-I for the improvement of insomnia severity and sleep-related quality of life. Future studies are needed to assess whether ACT-I is noninferior to CBT-I and to shed light on mechanisms of change in both treatments.
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Three studies did not specify whether outcome assessors were blinded.
“Three studies did not specify whether outcome assessors were blinded [28, 46, 63].”
From Blinding outcome assessors in randomised controlled trials of psychological interventions: how is it done? A narrative review (2026) · cites this paper as [46]
White noise or relaxing soundscapes may improve sleep continuity in some individuals.
“Controlled studies suggest white noise or relaxing soundscapes may improve sleep continuity in some individuals [57,58].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [57]
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- Authors
- Hertenstein, E., Trinca, E., Schneider, C. L., Fehér, K. D., Johann, A. F., & Nissen, C.
- Affiliations
- University of Geneva (CH)
- University of Bern (CH)
- University of Freiburg (DE)
- Corresponding author
- Hertenstein, Elisabeth
- ORCID
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2024
- Volume
- 93
- Issue
- 2
- Pages
- 114-128
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W4392243591
- Semantic Scholar
- 9d25ace8a1c77f3f4653c439e507fa07e38e67e0
- Cited by
- 19
- References
- 41
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 4
- FWCI
- 7.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- acceptance and commitment therapy, cognitive behavioral therapy for insomnia, insomnia, insomnia severity, sleep-related quality of life, treatment satisfaction, group therapy, treatment efficacy
- MeSH terms
- Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Pilot Projects, Quality of Life, Cognitive Behavioral Therapy, Treatment Outcome, Acceptance and Commitment Therapy
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