Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer
Open accessAbstract
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment for insomnia that targets difficulties with initiating and/or maintaining sleep and is delivered over the course of six to eight sessions. The primary focus of CBT-I is to address the perpetuating factors (according to the three-factor model of insomnia) that contribute to the development of chronic insomnia. Chronic insomnia is the most prevalent sleep disorder, occurring in approximately 6–10% of the population, and is a risk factor for multiple medical and psychiatric disorders. Despite its prevalence and morbidity, the widespread dissemination of CBT-I is not commensurate with insomnia’s overall public health impact. This is particularly surprising given its large evidence base and recent recommendation as the first line intervention for insomnia. The primary goal of this article is to provide a primer or brief introduction to CBT-I that is intended to be accessible to all clinicians and researchers, including non-sleep experts. Core components of CBT-I (i.e., Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy), relapse prevention strategies, multicultural considerations, adjuvants to traditional interventions, treatment adherence issues, efficacy, and further training options are described. A session-by-session outline is also provided.
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Cognitive-behavioral strategies such as cognitive restructuring reduce maladaptive thinking patterns and pre-sleep worry, while relaxation-based interventions help downregulate sympathetic activity and promote parasympathetic dominance.
“Cognitive-behavioral strategies such as cognitive restructuring reduce maladaptive thinking pa erns and pre-sleep worry, while relaxation-based interventions, such as progressive muscle relaxation, diaphragmatic breathing, and mindfulness, help downregulate sympathetic activity and promote parasympathetic dominance [30].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [30]
The Cognitive Therapy section (page unavailable) describes restructuring dysfunctional sleep-related thoughts that contribute to pre-sleep arousal. Adjuvants to Traditional Interventions (page unavailable) lists deep breathing, progressive muscle relaxation, and mindfulness, but does not say these interventions reduce sympathetic activity or promote parasympathetic dominance. (LLM, conf=0.88)
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Clinical Management of Insomnia in Adults
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Stress reduction: a comparative analysis of watering indoor plants and computer work
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“High beta brain-wave activity is linked to enhanced concentration and mental acuity [74], while low beta brainwave activity, as seen during the computer task, can contribute to emotional instability or even insomnia [75].”
Hitching, R., Kluge, M. G., Walker, F. R., Gordon, C. J., & Lampe, L. A. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100624 · Cited by 2 · see citing works
“When treatment occurred, it typically consisted of psychoeducation; clinicians rarely reported using other CBTi components (e.g., stimulus control, sleep restriction) (Walker et al., 2022).”
van der Ham, M., Bijlenga, D., Molenaar, N. M., Starreveld, D. E. J., Böhmer, M. N., Wettstein, R., Dumont, G., Beekman, A. T. F., & Kooij, J. J. S. (2025) · Journal of Attention Disorders · doi:10.1177/10870547251379103 · Cited by 2 · see citing works
“CBT-I is the first-line non-pharmacological treatment for insomnia, targeting difficulties with sleep initiation, staying asleep, and nocturnal rumination by modifying maladaptive sleep-related behaviors and cognitions (Edinger et al., 2021; Walker et al., 2022).”
Lifestyle and Behavioral Enhancements of Sleep: A Review.
Seo, J., Oragun, R., Dennis, S., Elen, G., Fariha, H., Sherzai, D., & Roy, A. (2026) · American Journal of Lifestyle Medicine · doi:10.1177/15598276251410479 · Cited by 4 · see citing works
Sleep deprivation and memory: A neurobiological perspective
Adeniji, K. O., Igado, O. O., Olopade, F. E., & Femi-Akinlosotu, O. M. (2026) · IBRO Neuroscience Reports · doi:10.1016/j.ibneur.2026.01.010 · Cited by 3 · see citing works
Aakre, J. A., Bjorvatn, B., Gjestsen, M. T., Dalen, I., Ballard, C. G., & Testad, I. (2026) · JMIR Research Protocols · doi:10.2196/81542 · Cited by 1 · see citing works
“The advanced course will be developed according to established protocol for CBT-I, drawing on core components such as sleep restriction, stimulus control, cognitive restructuring, sleep-hygiene reinforcement, and relapse prevention [27].”
Hałabuda, Z., & Rynkiewicz, K. (2026) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.1(49).2026.4925 · Cited by 1 · see citing works
Roh, Y., Yoon, A. S., & Oh, H. (2026) · JMIR Formative Research · doi:10.2196/79242 · Cited by 1 · see citing works
“CBT-I is typically structured as a multicomponent treatment protocol that includes sleep restriction, stimulus control, sleep hygiene, and cognitive therapy [23].”
A review on orexin receptor antagonists in chronic insomnia: a revolutionary approach
Humbi, U., Reddy, S. K. M., Nalajala, A., Nerella, B., & Arumainathan, V. (2026) · International Journal of Basic & Clinical Pharmacology · doi:10.18203/2319-2003.ijbcp20260447 · Cited by 1 · see citing works
Personalizing sleep therapy: Integrating EEG neurofeedback into the sleep disorders management
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“It is important to emphasize that CBT-I remains the gold-standard non-pharmacological treatment for insomnia with extensive evidence from large-scale randomized controlled trials and meta-analyses [9,10].”
Lü, W., Huang, C., Wei, M., Bai, C., Fan, X., & Wu, D. (2026) · International Nursing Review · doi:10.1111/inr.70183 · Cited by 1 · see citing works
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“85 Beyond CBT-I, healthcare professionals should increase awareness of how other lifestyle behaviors can support sleep.”
Bouthillier, J. L., Ivers, H., & Morin, C. M. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70043 · Cited by 1 · see citing works
“prescribed bedtime and wake-up times, not getting out of bed during the night when unable to sleep, not staying out of bed long enough during the night for sufficient sleepiness to build up, and daytime napping (Walker et al. 2022).”
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Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice.
Song, S., Irfan, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00370-2
洪, 铭. (2023) · Advances in Social Sciences · doi:10.12677/ass.2023.1211854
Pharmacological Treatment of Primary Insomnia in Senior Citizens in Spain
Sáenz, M. F. (2024) · Revista de Investigación y Educación en Ciencias de la Salud (RIECS) · doi:10.37536/riecs.2024.9.1.403
“By binding to a specific site on the GABA receptor, benzodiazepines increase the affinity of the GABA neurotransmitter [22], resulting in increased GABAergic inhibitory transmission (Figure 3).”
BackgroundEating and Sleeping: The Basics – Or Are They?
Hayes, J. A. (2024) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-83549-194-220241009
Mirtazapine in Primary Insomnia: Case report and Literature review
Riaz, A., Shahid, Q., Yousaf, H. M., Gul, U., Shah, S. S., Hidayat, A., Hamid, T., Rahman, A. U., Usman, M., Khan, M. K., et al. (2024) · World Journal of Advanced Research and Reviews · doi:10.30574/wjarr.2024.23.1.2213
“9 While CBT-I is effective on its own, it can also be combined with pharmacological treatments, although CBT-I has been shown to have more durable effects than medication in the long term.”
Almutairi, M. H., Albazie, A. S., & Sufyani, D. S. A. (2024) · Cureus · doi:10.7759/cureus.71203
宋, 磊. (2025) · Advances in Psychology · doi:10.12677/ap.2025.154188
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Park, S. K., Song, E., & Park, K. Y. (2025) · Journal of Korean Academy of Psychiatric and Mental Health Nursing · doi:10.12934/jkpmhn.2025.34.2.211
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Addressing Depression and Insomnia in Cognitive Behavioral Therapy
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Mangar, S. A., Grandner, M. A., Airlodi, L., Cogo‐Moreira, H., & Dimitriou, D. (2025) · Psycho-Oncology · doi:10.1002/pon.70316
“Insomnia may be addressed a variety of pharmacological—such as Dual Orexin Receptor Antagonists [23], melatonin in those over the age of 55 [24], and non‐ pharmacological intervention such as Cognitive Behavioural Therapy for Insomnia [25].”
Dyspepsia as a Trigger for Sleep Disorders: A Case Study of Gut–Brain Axis Interaction
Damayanti, F. F., Algristian, H., & Ilahi, M. (2025) · Medicor Journal of Health Informatics and Health Policy · doi:10.61978/medicor.v4i1.1139
Insomnia as a Contributor to Hypertension and Somatic Distress: A Case Report
Nihazzatuzzain, Algristian, H., & Cahyono, B. (2025) · Psychosocia Journal of Applied Psychology and Social Psychology · doi:10.61978/psychosocia.v3i4.1138
“Functional gastrointestinal disorders such as reflux disease, irritable bowel syndrome, and dyspepsia frequently co-occur with insomnia(Sateia et al., 2021; Walker et al., 2022).”
Suwaryo, P. A. W., Kadir, F. B. M., Omar, A., Singh, S. K. D., & Bolong, M. F. B. (2025) · Malaysian Journal of Medicine and Health Sciences · doi:10.47836/mjmhs.21.s3.37
Brain Changes: Non-Pharmacological Interventions to Improve Sleep Following Traumatic Brain Injury
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EEG-based Neurofeedback Gaming: A Non-Invasive Approach to Improve Sleep in Insomnia
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“Among other approaches such as cognitive behavioral therapy (CBT-I), relaxation training, and mindfulness-based interventions the brain computer interface seems giving non-invasive adaptive method for regulating sleep [2].”
Sun, N., Zhi, Y., Feng, T., & Sheng, Y.-J. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1730432
“Access to CBT-I is often limited, and the majority of patients prefer complementary options with favorable safety profiles (15).”
Alyafei, A. A., Hussein, A. M., & Abdulla, S. T. A. (2026) · Cureus · doi:10.7759/cureus.105457
“These systems can deliver sleep prompts, recommendations, or behavioral nudges at the most relevant time, for example, cuing presleep wind-down activities during periods of increased physiological arousal or scheduling digital CBT-I modules following a bad night's sleep [10].”
InfluentialBehavioral Interventions for Health Behaviors in Primary Care
Jackson, K., Montgomery, M., Daniel, R. M., Botello, R., Mixco, G., Mosley, T., Porter, D., Sekula, M. K. K., Swanson, J., Roberman, S., et al. (2026) · Springer eBooks · doi:10.1007/978-3-032-09558-9_9 · Cited by 1 · see citing works
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“Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line recommended intervention for chronic insomnia, including in perimenopausal women, owing to its long-term effectiveness in modifying maladaptive sleep-related thoughts and behaviors (11–15).”
Wang, X., Dong, Y., & Yang, M. (2026) · Biological Rhythm Research · doi:10.1080/09291016.2026.2660307
“This pragmatic definition aligns with consensus discussions of treatment-resistant insomnia and current diagnostic standards for chronic insomnia (Sateia 2014; Akinnusi and El-Solh 2021; Walker et al. 2022).”
InfluentialTsai, C.-S., Szewczyk, W., Lee, H., Drerup, M. L., Blakeney, E. A., Greenlee, H., Heffner, J. L., Vasbinder, A. L., & Reding, K. W. (2026) · JMIR Formative Research · doi:10.2196/85386
“CBTi is a multicomponent intervention that is recommended as the first-line treatment for chronic insomnia disorder [14].”
Behavioral Sleep Interventions for Neurodivergent Youth: A Narrative Review
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Shang, X., Li, S., Luk, T. T., Lai, A. Y. K., & Wang, M. P. (2026) · Western Journal of Nursing Research · doi:10.1177/01939459261451229
“14,44 Our findings provide empirical grounding for delivering such non-pharmacological interventions to Chinese pregnant women.”
Zou, C., Lan, Y., Liu, X., & Zhu, X. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1804213
“Cognitive behavioral therapy for insomnia (CBT-I) is fi rst-line and produces durable clinical bene fi ts (8, 9); it can be delivered in person or via telehealth and adapted across settings (10).”
A scoping review on non-pharmacological sleep interventions among Asian undergraduate students
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Assessment of effect of guided meditation on sleep using EEG and HRV signals
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“However, SHE has been shown to have limited efficacy as monotherapy, and there is evidence indicating lower therapeutic efficacy compared to CBT-I [38].”
Research Progress on Sleep Disturbances and Intervention Strategies in Perioperative Patients
唐, 林. (2026) · Advances in Clinical Medicine · doi:10.12677/acm.2026.1672527
Circadian–immune crosstalk in insomnia disorder: mechanisms and therapeutic implications
Huang, Y., Wang, X., Chen, X., & Liu, Y. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1881195
“Its core components include stimulus control, sleep restriction, cognitive restructuring, relaxation training, and sleep hygiene education (Walker et al., 2022).”
Almrasy, A. A., Kamaly, O. M. A., Alnakhli, A. M., & Sayedahmed, M. (2026) · Analytical Biochemistry · doi:10.1016/j.ab.2026.116208
Sleep parameters associated with cardiometabolic health in older women: a cross-sectional study
Sibley, D., Rishis, E., Neil‐Sztramko, S., Gonze, B. D. B., Govette, A., Dojutrek, A., Small, S. L., Lee, O., Christensen, R. A. G., Sabiston, C. M., et al. (2026) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2026.104883
Bedtime Audiobook Listening Motives and Insomnia Status: Survey Study
Berglund, K., Meth, E. M. S., Xue, P., & Benedict, C. (2026) · JMIR Formative Research · doi:10.2196/95064
“Within stimulus control and conditioning frameworks, repeated pairing of a stable, meaningful environmental cue with sleep onset can strengthen associative links over time [23].”
Holland, B., Amofa, P., Stevenson, E. R., & McCrae, C. S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00393-9
Ashour, L., Abuqudaira, B., Jaber, S., Badran, L., Zaita, M., Alhawi, R., Jaber, A. D., Aburumman, S., Al-Shorman, M., Heramas, R., et al. (2026) · Physiology International · doi:10.1556/2060.2026.00867
Carroll, A., Benham, T., Naughton, E., Warren, S., Weir, K., Wollner, M., & Nordeck, J. (2026) · American Journal of Occupational Therapy · doi:10.1177/19437676261485843
“The CBT-I model includes components such as sleep restriction, stimulus control, and sleep hygiene (Walker et al., 2022).”
- Authors
- Walker, J., Muench, A., Perlis, M. L., & Vargas, I.
- Affiliations
- University of Arkansas at Fayetteville (US)
- University of Pennsylvania (US)
- Corresponding author
- Vargas, I.
- Venue
- Clinical Psychology and Special Education
- Published
- 2022-07-17
- Volume
- 11
- Issue
- 2
- Pages
- 123-137
- ISSN
- 2304-0394 (ISSN-L)
- PMC
- PMC10002474
- OpenAlex
- W4286540451
- Cited by
- 106
- References
- 35
- Citations by year
- 2026: 40 · 2025: 49 · 2024: 14 · 2023: 3
- FWCI
- 15.18
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Clinical Psychology and Special Education (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Journal of the Arkansas Academy of Science (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute on Aging (L30 AG060532)
- National Heart, Lung, and Blood Institute (K23HL141581)
- 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 › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy for insomnia, chronic insomnia, sleep restriction therapy, stimulus control therapy, sleep hygiene, cognitive therapy, relapse prevention, multicultural considerations, medication adherence, risk factors for insomnia
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