Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.
Keywords: CBT-I; Cognitive behavioral therapy; DBAS; Dysfunctional beliefs about sleep; Insomnia; Sleep-related cognitions.
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Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure.Behav Sleep Med. 2019 May-Jun;17(3):342-354. doi: 10.1080/15402002.2017.1357120. Epub 2017 Aug 22. Behav Sleep Med. 2019. PMID: 28745520 Free PMC article.
Change in Dysfunctional Beliefs About Sleep in Behavior Therapy, Cognitive Therapy, and Cognitive-Behavioral Therapy for Insomnia.Behav Ther. 2016 Jan;47(1):102-15. doi: 10.1016/j.beth.2015.10.002. Epub 2015 Oct 19. Behav Ther. 2016. PMID: 26763501 Clinical Trial.
Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep?Sleep. 2001 Aug 1;24(5):591-9. doi: 10.1093/sleep/24.5.591. Sleep. 2001. PMID: 11480656 Clinical Trial.
Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis.Ann Intern Med. 2015 Aug 4;163(3):191-204. doi: 10.7326/M14-2841. Ann Intern Med. 2015. PMID: 26054060 Review.
Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies.Sleep Med Rev. 2019 Dec;48:101208. doi: 10.1016/j.smrv.2019.08.002. Epub 2019 Aug 12. Sleep Med Rev. 2019. PMID: 31491656 Review.