Long-term efficacy of cognitive behavioural therapy for insomnia (CBT-I) on depressive symptoms: A systematic review and meta-analysis of randomised controlled trials.

Valeria Fiori; Caterina Lombardo; Chiara Baglioni; Andrea Ballesio

doi:10.1016/j.smrv.2026.102339

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Long-term efficacy of cognitive behavioural therapy for insomnia (CBT-I) on depressive symptoms: A systematic review and meta-analysis of randomised controlled trials.

Valeria Fiori·Caterina Lombardo·Chiara Baglioni·Andrea Ballesio

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Abstract

Depressive symptoms are common in individuals with persistent insomnia. Previous meta-analyses of randomised controlled trials (RCTs) showed that cognitive behavioural therapy for insomnia (CBT-I) can reduce depressive symptoms at post-treatment. However, the long-term maintenance of these improvements has never been systematically examined. To fill-in this gap, we conducted a systematic review and meta-analysis of the long-term (≥3 months) effects of CBT-I on depressive symptoms. The review was registered in PROSPERO (CRD420251146061). Only RCTs in adults with insomnia were considered. Pubmed, Scopus, Psycinfo, CINAHL, and Medline were searched up to 12 September 2025 with no predefined time constraints. From 5359 records initially retrieved, we included 53 articles reporting on 13,608 individuals. After outliers removal, random effects meta-analysis showed that CBT-I was superior to control conditions in reducing depressive symptoms at 3 [k = 29, d = -.35, [95% CI: -.49 to -.21], p < .001], 6 [k = 29, d = -.32, [95% CI: -.59 to -.05], p = .018], and 12 [k = 10, d = -.25, [95% CI: -.39 to -.12], p < .001] months follow-ups. Results demonstrate that the effects of CBT-I on depressive symptoms are sustained throughout the year following treatment, although effects may decline over time.

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Humans Cognitive Behavioral Therapy Depression Randomized Controlled Trials as Topic Sleep Initiation and Maintenance Disorders Treatment Outcome Mental disorders Mood Psychopathology Psychotherapy Sleep Journal Article Meta-Analysis Systematic Review

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Valeria Fiori, Caterina Lombardo, Chiara Baglioni, Andrea Ballesio. 2026-07-09. Long-term efficacy of cognitive behavioural therapy for insomnia (CBT-I) on depressive symptoms: A systematic review and meta-analysis of randomised controlled trials.. https://doi.org/10.1016/j.smrv.2026.102339

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Journal Article; Meta-Analysis; Systematic Review resource Cognitive Behavioral Therapy subject Depression subject Humans subject Journal Article subject Meta-Analysis subject Systematic reviews study

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