Acceptance and commitment therapy for insomnia: an updated meta-analysis of randomized controlled trials.

Authors

Douglas Barroso, Natanael de Paula Portilho, Alicja Garbacka-Struzik, Diogo Carrazzoni Godoi, Maurício Prätzel Ellwanger, Thaís Pereira Mendes, Vitor Expedito Alves Ribeiro, Victor Gonçalves Soares, Larissa C Hespanhol, Maria Luísa Siegloch, Ibrahim Radi Zahran, Victoria Stadler de Abreu, Helen Michaela de Oliveira, Brandon Peluffo, Eduardo Cerchi, Daniel B Kay, Renatha El Rafihi-Ferreira

Published in

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. Volume 22. Issue 1. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

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).
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.
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).
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.

PMID:
42547685
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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