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Meta-analysis shows efficacy of CBT for insomnia, comorbid psychiatric disorders

Cognitive behavioral therapy for insomnia showed significant efficacy for insomnia and concomitant psychiatric disorders, according to results from a meta-analysis.

“Previous meta-analyses have found that [cognitive behavioral therapy for insomnia] improves sleep parameters and sleep quality at post treatment and follow-up for adults and older adults. Most of these studies selected individuals with primary insomnia, excluding patients with comorbid psychiatric and medical conditions. However, patients with insomnia who present to internists and primary care physicians are likely to report comorbid conditions associated with the sleep disturbance,” study researcher Jade Q. Wu, MA, of Boston University, and colleagues wrote in JAMA Internal Medicine.

To determine efficacy of cognitive behavioral therapy (CBT) for insomnia with comorbid psychiatric and/or medical conditions, Wu and colleagues conducted a meta-analysis of 37 randomized clinical trials with at least one CBT for insomnia arm and an adult cohort with insomnia and a concomitant condition.

At follow-up evaluations, 36% of patients who received CBT for insomnia were in remission from insomnia, compared with 16.9% of patients in control or comparison groups (P < .001).

Pre- and post-treatment controlled effect sizes were medium to large for sleep efficiency (Hedges g = 0.91; 95% CI, 0.74-1.08), sleep onset latency (Hedges g = 0.8; 95% CI, 0.6-1), wake after sleep onset (Hedges g = 0.68) and sleep quality (Hedges g = 0.84) (P < .001 for all), but not for total sleep time.

Comorbid outcomes had a small effect size (Hedges g = 0.39; 95% CI, 0.6-0.98; P < .001) and patients with psychiatric conditions experienced greater improvement than those with medical conditions (Hedges g = 0.2; 95% CI, 0.09-0.3; P < .001).

“Our findings indicate that [CBT for insomnia] can improve insomnia symptoms and sleep parameters when insomnia is comorbid with medical and psychiatric conditions. Furthermore, [CBT for insomnia] can affect symptoms associated with the comorbid conditions, with stronger effects observed in psychiatric conditions compared with medical conditions,” Wu and colleagues wrote. “These findings provide empirical support for the recommendation of using [CBT for insomnia] as the treatment of choice for comorbid insomnia disorders.” – by Amanda Oldt

Disclosure: Wu reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.