Efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I)


Cognitive Behavioral Therapy for Insomnia (CBT-I) has proven to be a brief and effective multicomponent treatment altering behaviors and thoughts associated with insomnia disorder. Various meta-analyses and reviews have consistently shown robust empirical support for CBT-I across a spectrum of insomnia and sleep outcomes.

  • Remission Rates and Insomnia Severity: Meta-analyses indicate a remission rate of 53% for adults with insomnia, with slightly lower rates when insomnia coexists with other conditions. There is a notable reduction in insomnia severity post-CBT-I, as evidenced by changes in the Insomnia Severity Index and the Pittsburgh Sleep Quality Index.
  • Subjective Sleep Parameters: CBT-I demonstrates significant improvements in subjective sleep parameters, including sleep onset latency, time awake after sleep onset, sleep efficiency, and subjective sleep quality.
  • Objective Sleep Parameters: Findings on objective sleep parameters, measured through polysomnography (PSG) and actigraphy, are more mixed. While some studies report moderate effect sizes for wakefulness after sleep onset and sleep efficiency, others show no significant effects on PSG-defined sleep and only modest reductions in total sleep time post-treatment.
  • Long-Term Efficacy: Positive effects of CBT-I on self-reported outcomes persist over time. Follow-up data indicate continued efficacy at 3, 6, and 12 months post-treatment, with some studies even demonstrating sustained gains over a 2-year to 10-year period.
  • Effectiveness in Different Populations: CBT-I is effective across various populations, including those with medical and psychiatric comorbidities, different age groups, cancer survivors, individuals with pain conditions, postmenopausal women, pregnant women, adults with depression, older adults, and potentially adolescents.
  • Impact on Other Symptoms: Beyond improving sleep, CBT-I has shown positive effects on depressive symptoms, anxiety, pain, fatigue, and quality of life. However, the effects on anxiety symptoms are relatively small, and further research is needed in populations with comorbid anxiety disorders.
  • Reduction in Hypnotic Medication Use: CBT-I, even without explicit focus on reducing hypnotic medications, is associated with a significant decrease in hypnotic medication use. Protocols that include a targeted medication taper component enhance the reduction, especially in the short term.
  • Dissemination and Implementation: Training programs, particularly in the Veterans Health Administration, have been successful in training mental health providers from different disciplines to deliver CBT-I. These programs use didactic and experiential learning, incorporating expert consultation and feedback. Digital CBT-I has also shown promise in improving accessibility.

Despite the effectiveness of CBT-I, challenges remain in its widespread adoption. The field is actively exploring strategies for increasing access, tailoring interventions to specific patient needs, and understanding the broader impact of CBT-I on overall well-being.

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