Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety

Clin Psychol Rev. 2011 Jun;31(4):638-52. doi: 10.1016/j.cpr.2011.02.004. Epub 2011 Feb 17.


Introduction: Concomitant anxiety and insomnia is a frequent problem encountered by mental health professionals.

Primary objective: To assess the impact of cognitive-behavior therapy for insomnia (CBT-I) on associated anxiety.

Method: Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses.

Results: Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318-0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once in the sample of studies.

Conclusions: CBT-I has only a moderate impact on anxiety in individuals who present insomnia with or without a comorbid anxiety disorder. A careful evaluation of residual anxiety should be conducted subsequent to CBT-I. Further research should focus on standardizing the assessment of anxiety in insomnia research.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anxiety / complications
  • Anxiety / therapy*
  • Clinical Trials as Topic
  • Cognitive Behavioral Therapy*
  • Humans
  • Sleep Initiation and Maintenance Disorders / complications
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Treatment Outcome