Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2026
Acceptance and commitment therapy for insomnia: an updated meta-analysis of randomized controlled trials.
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Barroso Douglas, de Paula Portilho Natanael, Garbacka-Struzik Alicja, Godoi Diogo Carrazzoni, Ellwanger Maurício Prätzel, Pereira Mendes Thaís, Alves Ribeiro Vitor Expedito, Soares Victor Gonçalves, Hespanhol Larissa C, Siegloch Maria Luísa, Zahran Ibrahim Radi, Stadler de Abreu Victoria, de Oliveira Helen Michaela, Peluffo Brandon, Cerchi Eduardo, Kay Daniel B, Rafihi-Ferreira Renatha El
Аннотация
PURPOSE: To evaluate the effects of acceptance and commitment therapy (ACT) for insomnia compared with waitlist/standard control conditions and cognitive behavioral therapy for insomnia (CBT-I).
METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted. We searched on PubMed, Embase, and the Cochrane Library for studies comparing ACT or ACT-based interventions with non-ACT conditions in patients with insomnia. Continuous outcomes were pooled using a restricted maximum likelihood random-effects model on R.
RESULTS: ACT showed moderate-to-large improvement in insomnia symptom severity compared with waitlist/standard controls (SMD - 0.67, 95% CI - 1.08 to - 0.25). We observed no significant difference in insomnia severity between ACT and CBT-I at posttreatment (SMD 0.21, 95% CI - 0.02 to 0.43) or at 6-month follow-up (SMD 0.14, 95% CI - 0.15 to 0.42). CBT-I showed significant improvement in remission (ISI < 8 at posttreatment) compared to ACT at posttreatment (RR 0.81; 95% CI 0.67 to 0.98), but not at follow-up (RR 0.78; 95% CI 0.47 to 1.29). Treatment response rates (> 7-point ISI reduction) did also not differ significantly. Compared with waitlist/standard control, ACT produced a small-to-moderate reduction in depression (SMD - 0.34, 95% CI - 0.57 to - 0.12) and anxiety symptoms (SMD - 0.42, 95% CI - 0.67 to - 0.17).
CONCLUSION: ACT can be an efficacious treatment for insomnia with particularly strong outcomes for its psychological symptoms. Nevertheless, CBT-I remains the gold standard due to its more extensive and consistent evidence base.
METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted. We searched on PubMed, Embase, and the Cochrane Library for studies comparing ACT or ACT-based interventions with non-ACT conditions in patients with insomnia. Continuous outcomes were pooled using a restricted maximum likelihood random-effects model on R.
RESULTS: ACT showed moderate-to-large improvement in insomnia symptom severity compared with waitlist/standard controls (SMD - 0.67, 95% CI - 1.08 to - 0.25). We observed no significant difference in insomnia severity between ACT and CBT-I at posttreatment (SMD 0.21, 95% CI - 0.02 to 0.43) or at 6-month follow-up (SMD 0.14, 95% CI - 0.15 to 0.42). CBT-I showed significant improvement in remission (ISI < 8 at posttreatment) compared to ACT at posttreatment (RR 0.81; 95% CI 0.67 to 0.98), but not at follow-up (RR 0.78; 95% CI 0.47 to 1.29). Treatment response rates (> 7-point ISI reduction) did also not differ significantly. Compared with waitlist/standard control, ACT produced a small-to-moderate reduction in depression (SMD - 0.34, 95% CI - 0.57 to - 0.12) and anxiety symptoms (SMD - 0.42, 95% CI - 0.67 to - 0.17).
CONCLUSION: ACT can be an efficacious treatment for insomnia with particularly strong outcomes for its psychological symptoms. Nevertheless, CBT-I remains the gold standard due to its more extensive and consistent evidence base.