Guided digital cognitive-behavioral therapy for insomnia (CBT-I) reduces insomnia severity in adults with insomnia and co-occurring anxiety, PTSD, or BPD symptoms
In a randomized controlled trial, guided digital CBT-I produced large reductions in insomnia severity compared to a sleep diary control at posttreatment (d = -1.04) and at 8-month follow-up (d = -0.98). Small effects were observed on anxiety and BPD symptoms at posttreatment, but not on PTSD symptoms, and these effects were not sustained at follow-up.
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Guided digital cognitive-behavioral therapy for insomnia (CBT-I) reduces insomnia severity in adults with insomnia and co-occurring anxiety, PTSD, or BPD symptoms The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
Guided digital cognitive-behavioral therapy for insomnia (CBT-I) reduces insomnia severity in adults with insomnia and co-occurring anxiety, PTSD, or BPD symptoms
This conclusion is most relevant to: Adults with insomnia and symptoms of anxiety, PTSD, or borderline personality disorder (BPD).
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Guided digital cognitive-behavioral therapy for insomnia: A (cost-)effective intervention for people with insomnia and psychological distress? Results of a randomized controlled trial. (Journal of consulting and clinical psychology, 2026) —
How It Works
The proposed biological pathway:
- ▸CBT-I targets insomnia by restructuring sleep behaviors and thoughts
- ▸Improved sleep may reduce emotional reactivity and psychological distress
- ▸Reduced insomnia severity may lead to small improvements in anxiety and BPD symptoms
- ▸Result: Large insomnia reduction, small transient effects on anxiety/BPD, no effect on PTSD
Who Might Benefit
Evidence fit by population:
- ▸Adults with insomnia and symptoms of anxiety, PTSD, or borderline personality disorder (BPD)
Recommended Dose
N/A
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Effects on anxiety and BPD symptoms were small and not sustained at 8-month follow-up
- ▸No significant effect on PTSD symptoms was found
- ▸Positive health changes were minimal
- ▸Societal cost reduction was not statistically significant
Frequently Asked Questions
Is CBT-I effective for people with PTSD?▼
In this study, CBT-I did not significantly reduce PTSD symptoms, although it did reduce insomnia severity in this population.
How long do the effects of CBT-I last?▼
The large effect on insomnia severity was maintained at 8-month follow-up, but effects on anxiety and BPD symptoms were no longer significant.
What is the cost-effectiveness of CBT-I?▼
CBT-I showed a 94% probability of being cost-effective at €450 per Insomnia Severity Index point and 71% at €20,000 per quality-adjusted life year, though it did not significantly reduce overall societal costs.
Who was included in this trial?▼
The trial included 157 adults with insomnia and symptoms of anxiety, PTSD, or borderline personality disorder.
References
- 1.Reesen JE, Ikelaar SLC, van Keeken AE, van Trigt S, Leerssen J, Bongers RE, Hoogendoorn AW, Bosmans JE, Batelaan NM, Lancee J, Van Someren EJW. “Guided digital cognitive-behavioral therapy for insomnia: A (cost-)effective intervention for people with insomnia and psychological distress? Results of a randomized controlled trial..” Journal of consulting and clinical psychology, 2026. PMID: 42574103 DOI: 10.1037/ccp0001020