Cognitive Behavioral Therapy helps improve symptoms of insomnia as well as depression, stress, and anxiety. However, previous studies have shown reduced effectiveness on insomnia in people with comorbid psychiatric conditions and symptoms of stress, anxiety, and depression.

A study published in Sleep Medicine found Cognitive Behavioral Therapy for insomnia (CBTi) was associated with moderate-to-large improvement of depression, anxiety, and stress in patients with insomnia.

The researchers conducted a retrospective chart review of 455 patients with chronic insomnia treated in an outpatient CBTi program. The patients attended a program in Adelaide, South Australia, between February 2004 and November 2015. The researchers examined the effects of depression, anxiety, and stress on the effectiveness of the CBTi program.

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Insomnia treatment and measurement included sleep diaries and the Insomnia Severity Index (ISI) score. Depression, anxiety, and stress symptoms were measured by the Depression, Anxiety and Stress Scale-21 (DASS-21).

 “In a large sample of patients with chronic insomnia treated at an outpatient insomnia

treatment program, comorbid symptoms of depression, anxiety, and stress before treatment did not impair the effectiveness of CBTi in treating insomnia symptoms,” the researchers wrote.

“Although we observed a greater rate of ‘clinically significant insomnia’ among patients in the ‘severe’ than the ‘low’ depression group at post-treatment, this difference was no longer present by three-month follow-up. Instead, CBTi was associated with moderate-to-large improvements in depression, anxiety, and stress symptoms by three-month follow-up.”

At the 3-month follow up, depression, anxiety, and stress symptoms were reduced by 41-43%.

Limitations include missing data due to collection over a 12-year time period. In addition, changes in insomnia could have been due to other effects.

Disclosure: Several study authors declared industry affiliations. Please see the original reference for a full list of authors’ disclosures.


Sweetman A, Lovato N, Micic G, et al. Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia. Sleep Medicine 2020;75:401-410 doi: 10.1016/j.sleep.2020.08.023