Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis
Abstract
BACKGROUND: Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia. PURPOSE: To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia. DATA SOURCES: Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening. STUDY SELECTION: Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia. Studies of insomnia comorbid with medical, sleep, or psychiatric disorders were excluded. DATA EXTRACTION: Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). DATA SYNTHESIS: Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64% female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95% CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE% improved by 9.91% (CI, 8.09% to 11.73%). Changes seemed to be sustained at later time points. No adverse outcomes were reported. LIMITATION: Narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and accuracy of estimates at later time points was less clear. CONCLUSION: CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes. PRIMARY FUNDING SOURCE: None. (PROSPERO registration number: CRD42012002863).
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Cognitive behavioral therapy for insomnia has become a first-line treatment for insomnia because of its relative efficacy and clinically meaningful effect sizes.
“cognitive behavioral therapy for insomnia [CBT-i]), have become first-line therapies for the treatment of insomnia due to their relative efficacy and clinically meaningful effect sizes (Trauer, Qian, Doyle, Rajaratnam, & Cunnington, 2015).”
From Can Mindfulness Mechanistically Target Worry to Improve Sleep Disturbances? Theory and Study Protocol for App-Based Anxiety Program. (2020) · cites this paper as Trauer, Qian, Doyle, Rajaratnam, & Cunnington, 2015
In patients with insomnia without psychiatric comorbidity, CBT-I is highly effective for improving self-rated insomnia severity and several other sleep parameters, including daytime symptoms.
“In patients with insomnia without psychiatric comorbidity, CBT-I is highly effective for the improvement of self-rated insomnia severity and several other sleep parameters like for example sleep onset latency and wake time after sleep onset [9], including daytime symptoms [10].”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [9]
In this meta-analysis, effect sizes for insomnia severity in patients with comorbidity were moderate to large and comparable to those found in patients with primary insomnia.
“In this meta-analysis, the effect sizes for insomnia severity in patients with comorbidity were moderate to large and therefore comparable to those found in patients with primary insomnia [9].”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [9]
Brief Behavioral Treatment for Insomnia has proven similarly effective as the complete CBT-I program for patients with primary insomnia, somatic comorbidity, or minor psychiatric comorbidity.
“BBT-I has proven similarly effective as the complete program for patients with primary insomnia, somatic comorbidity, or minor psychiatric comorbidity [8].”
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- Authors
- Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D.
- Affiliations
- Burnet Institute (AU)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2015-08-04
- Volume
- 163
- Issue
- 3
- Pages
- 191-204
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1937224863
- Cited by
- 1,053
- References
- 100
- Citations by year
- 2026: 119 · 2025: 120 · 2024: 102 · 2023: 99 · 2022: 122 · 2021: 93 · 2020: 101 · 2019: 96 · 2018: 76 · 2017: 75 · 2016: 45 · 2015: 3 · 2014: 2
- FWCI
- 8.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy for insomnia, chronic insomnia, sleep latency, wake after sleep onset, total sleep time, sleep efficiency, sleep restriction, stimulus control, sleep hygiene, relaxation training
- MeSH terms
- Chronic Disease, Humans, Sleep Initiation and Maintenance Disorders, Relaxation Therapy, Time Factors, Cognitive Behavioral Therapy
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