Guided digital cognitive-behavioral therapy for insomnia: A (cost-)effective intervention for people with insomnia and psychological distress? Results of a randomized controlled trial.

Authors

Joyce E Reesen, Savannah L C Ikelaar, Alex E van Keeken, Shanna van Trigt, Jeanne Leerssen, Roxanne E Bongers, Adriaan W Hoogendoorn, Judith E Bosmans, Neeltje M Batelaan, Jaap Lancee, Eus J W Van Someren

Published in

Journal of consulting and clinical psychology. Volume 94. Issue 7. Pages 437-451.

Abstract

Insomnia is common in anxiety, posttraumatic stress disorder (PTSD), and borderline personality disorder (BPD), but cognitive-behavioral therapy for insomnia (CBT-I) is understudied in these conditions. We evaluated the (cost-)effectiveness of CBT-I in adults with insomnia and symptoms of anxiety, PTSD, or BPD.
A total of 157 adults with insomnia and symptoms of anxiety, PTSD, or BPD were randomized to guided digital CBT-I or sleep diary control. Assessments at baseline, 2-month posttreatment, and 8-month follow-up included insomnia severity (Insomnia Severity Index), mental health symptoms, sleep diary measures, and positive health. Cost-effectiveness (Insomnia Severity Index-based) and cost-utility (quality-adjusted life years-based) were analyzed from a societal perspective.
At posttreatment, CBT-I produced large reductions in insomnia severity versus control (d = -1.04; p < .001) and small effects on symptoms of anxiety and BPD (ds = -0.28; -0.36) but not of PTSD. At follow-up, effects on insomnia severity remained large (d = -0.98; p < .001), but effects on anxiety and BPD were no longer significant. Most sleep diary measures showed small-to-moderate improvements; positive health changes were minimal. CBT-I did not significantly reduce societal costs (-€826, 95% CI [-3,797, 2,144]) but showed a 94% probability of cost-effectiveness at €450 per Insomnia Severity Index point and 71% at €20,000 per quality-adjusted life year.
CBT-I is a (cost-)effective treatment for insomnia with co-occurring anxiety, PTSD, or BPD symptoms, although effects on anxiety and BPD are small, and none were found for PTSD. These findings support integrating CBT-I into routine care, potentially alongside targeted interventions for co-occurring psychological distress. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:
42574103
Bibliographic data and abstract were imported from PubMed on 11 Aug 2026.

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