Send to

Choose Destination
Sleep Med Rev. 2019 Nov 9;49:101230. doi: 10.1016/j.smrv.2019.101230. [Epub ahead of print]

Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis.

Author information

College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; University of Washington School of Nursing, Seattle, WA, USA. Electronic address:
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
University of Washington School of Nursing, Seattle, WA, USA.
School of Psychology, Université Laval, Quebec City, Quebec, Canada.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.


Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.


CBT-I; Cognitive behavioral therapy; DBAS; Dysfunctional beliefs about sleep; Insomnia; Sleep-related cognitions


Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center