How Effective Is Cognitive Behavioral Therapy For Insomnia?
Recent meta-analysis of all studies using at least one component of CBTi finds cbt for insomnia to be effective
How effective is cognitive behavioral therapy for insomnia? Does CBT for insomnia work? It’s the question we’re asked most often (other than “why the hell can’t I sleep” & “why does nothing work”?!?).
Finding an effective treatment for insomnia can seem a pretty hopeless task for insomnia sufferers.
We get it.
Most of our clients have visited their GP, tried any number of sleeping pills, over the counter remedies & herbal treatments for insomnia (which are basically placebos with no evidence that they work), tried alternative therapies, and some have been to other sleep clinics that claim to offer brief CBTi but really don’t (tip: read a sleep clinic’s reviews before deciding to use them).
But there is hope.
A recent meta-analysis (that’s a study that puts together all the studies they can find) has looked at the effectiveness of CBT for insomnia using the most up to date statistical techniques and looked at all studies that had at least one component of CBT for insomnia (this hadn’t been done before).
The meta-analysis looked at 87 randomized controlled trials (RCTs are the strongest possible trials you can run) comparing 118 treatments with 3724 patients and 2579 non-treated control patients.
Is CBT For Insomnia Effective?
The study found that CBTi is effective and the size of the effect is large (that’s scientist speak for “it’s pretty darn effective”).
In fact, the study found that cognitive behavioral therapy of insomnia, either its components or the full package is effective in the treatment of insomnia.
The largest treatment effects were for the insomnia severity index or ISI which is the gold standard measure of how bad your insomnia is and it’s used in most research studies of insomnia.
(BTW the insomnia severity index is the insomnia quiz you can take online on our site).
Large insomnia treatment effects were also found for:
Pittsburgh Sleep Quality Index (it’s another questionnaire about sleep, not as short & focused on insomnia as the ISI)
Sleep efficiency (that’s a measure of sleep quality and basically means you fall asleep fast and don’t wake up for very long if you do wake up);
Sleep Onset Latency (this is basically how fast you fall asleep)
Wake after sleep onset (that’s how long you’re awake after falling asleep)
Moderate to small treatment effects were found for:
Night Awakenings (that’s total number of awakenings at night)
Sleep Quality
Total Sleep Time (that’s the total amount of sleep you get)
The study also found that self-help treatments were not as effective as one-to-one treatments with a psychologist.
The study authors stated:
"The treatment format was significantly related to all studied sleep outcomes. More specifically: self-help interventions seem to perform worse than face-to-face interventions, especially on sleep efficiency and Insomnia Severity Index”.
The study also found that having more treatment sessions resulted in greater insomnia treatment effectiveness than fewer treatment sessions. Somewhere around 4+ sessions being the required for greater treatment effects:
“Since Edinger and colleagues concluded that four sessions were optimal, and we have indications that five or more sessions are more effective, we conclude that one to three session treatments seem to be less effective than longer treatments.”
The study authors concluded:
“Face-to-face treatments and treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions”.
And the really good news here is that the treatment results are good across different kinds of patients, with the authors stating:
“the results seem to be quite robust and similar for patients with or without comorbid disease, younger or older patients, using or not using sleep medication” (our note: comorbid disease means co-occuring physical or mental health conditions).
This is not the first meta-analysis to find that cognitive behavioral therapy for insomnia is effective. In fact, there are several systematic reviews and meta-analyses that have found that CBTI is effective in primary insomnia and comorbid insomnia and CBTI is at least as effective as pharmacotherapy.
As a result, both the American Academy of Sleep Medicine and the American College of Physicians recently recommended CBTI as the initial treatment for all adults with insomnia.
Find out more about insomnia and our cognitive behavioral therapy for insomnia treatment.
The study was published in Sleep Medicine Reviews (van Straten et al., 2018).
