Evidence-Based Reviews

Cognitive-behavioral therapy for insomnia: A review of 8 studies

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The prevalence of insomnia in the general population is approximately 6% to 10%.1 In addition, an estimated 30% of the general population may have symptoms of insomnia without meeting the diagnostic criteria.2 As a disorder, insomnia is characterized by a persistent difficulty initiating or maintaining sleep, or early morning awakening with inability to return to sleep, that has been present for at least 3 months. Additionally, the sleep difficulties must occur at least 3 nights a week, result in impaired daytime functioning, and cause significant distress.1

Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment, supported by several systematic reviews and meta-analyses.3-5 In the short term, CBT-I is as effective as pharmacotherapy.6 However, CBT-I is the preferred treatment for chronic insomnia, according to recommendations in European and American guidelines.7,8

Here we review 8 recent studies that examined CBT-I. These studies are summarized in the Table.9-16

Cognitive-behavioral therapy for insomnia: 8 Studies

1. Cheng P, Kalmbach DA, Tallent G, et al. Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep. 2019;42(10):zsz150. doi: 10.1093/sleep/zsz150.

Although CBT-I is a first-line treatment for chronic insomnia, it is underutilized in clinical practice primarily due to limited availability. Because few clinicians are certified in CBT-I, it has become necessary to develop alternative modes of delivery for CBT-I, such as fully automated, internet-delivered approaches to reach more patients with insomnia. Digital CBT-I (dCBT-I) is comparable to in-person CBT-I in improving insomnia symptoms and reducing concurrent depressive symptoms with insomnia. It is unclear if unguided, internet-delivered CBT-I is effective for achieving remission from depression or preventing depression in the long term. Chen et al9 examined the efficacy of dCBT-I in reducing and preventing depression over a 1-year follow-up.

Study design

  • Participants from various centers in Southeastern Michigan were recruited between 2016 and 2017. Data was obtained from the Sleep to Prevent Evolving Affective Disorders (SPREAD) trial.
  • Participants who met DSM-5 criteria for chronic insomnia disorder were randomized to dCBT-I (n = 358) using the Sleepio digital CBT program via the internet or to online sleep education (n = 300).
  • The primary outcome was depression, measured using the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR-16) at 1-year follow-up. Depression incidence was also tested against insomnia treatment response.


  • The severity of depression was significantly lower at 1-year follow-up in the dCBT-I group compared with the control group.
  • The dCBT-I group showed a 51% higher remission rate than the control group at 1-year follow-up.
  • The incidence of moderate to severe depression in individuals with minimal to no depression at baseline was halved at 1 year after receiving dCBT-I treatment compared with the control group.

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