Adherence to Cognitive Behavior Therapy for Insomnia: An Updated Systematic Review

Sleep Med Clin. 2021 Mar;16(1):155-202. doi: 10.1016/j.jsmc.2020.11.002. Epub 2020 Dec 27.


This article discusses information extracted from 53 studies that have measured adherence to cognitive behavior therapy for insomnia. There has been an increase in more complex and less biased methods for assessing adherence that move beyond simply asking the patients whether they have adhered to the intervention or not. There is a need for a consensus around how to measure adherence, if clinicians want to arrive at an estimate of optimal adherence. Heterogeneity of studies, particularly in the way adherence is operationalized, prohibited conclusions about the relationship between adherence and outcome, as well as about predictors of adherence.

Keywords: Adherence; Cognitive behavior therapy; Compliance; Insomnia.

Publication types

  • Systematic Review

MeSH terms

  • Cognitive Behavioral Therapy*
  • Humans
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Randomized Controlled Trials as Topic
  • Sleep Initiation and Maintenance Disorders / therapy*