Evaluating the effectiveness of Cognitive Behavioral Therapy for insomnia in school settings : a systematic review and meta-analysis

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Ewart, Catriona and Egan, Kieren J. and Henderson, Marion and McCrory, Stephanie and Fleming, Leanne (2025) Evaluating the effectiveness of Cognitive Behavioral Therapy for insomnia in school settings : a systematic review and meta-analysis. Behavioral Sleep Medicine, 23 (6). pp. 719-738. ISSN 1540-2010 (https://doi.org/10.1080/15402002.2025.2529856)

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Abstract

Purpose:  Poor sleep among adolescents is a significant public health concern. Delivering Cognitive Behavioral Therapy for insomnia (CBT-I) in schools may be an effective way to reach adolescents with poor sleep. This systematic review and meta-analysis examined the effectiveness of school-based CBT-I for improving sleep quality and/or duration among adolescents with insomnia symptoms or disorder. Methods:  A systematic search of studies between 2003 and 2025 was conducted in March 2025. Inclusion criteria were adolescents aged 10–19 years (population) with insomnia symptoms, school-based interventions using evidence-based CBT-I principles (intervention), randomized or non-randomized trials (comparator), and reported sleep quality and/or duration (outcome). Results:  Eight studies (n = 323; M age = 15.3 years; 62.57% female) from four countries were included. Meta-analysis of within sleep intervention condition groups (n = 8) found significant subjective improvements post-intervention: total sleep time (TST) increased by 23.87 minutes (p < .001), sleep onset latency (SOL) decreased by 8.34 minutes (p < .01), and sleep quality improved g = 0.376 (p = .001). Objective measures of TST increased by 20.91 minutes (p = 0.100), SOL decreased by 1.35 minutes (p = 0.202), and sleep efficiency rose by 0.50% (p = .792). Anxiety improved significantly g = 0.373 (p < .01), but depression did not g = 0.806 (p = .196). Discussion:  While sleep improvements were only observed for subjective sleep outcomes, this review suggests that school-based CBT-I may be an effective avenue to address adolescent insomnia. Given the limited evidence, we identify key methodological and implementation considerations to guide practice.

ORCID iDs

Ewart, Catriona, Egan, Kieren J. ORCID logoORCID: https://orcid.org/0000-0002-1639-4281, Henderson, Marion ORCID logoORCID: https://orcid.org/0000-0001-7582-9516, McCrory, Stephanie ORCID logoORCID: https://orcid.org/0000-0002-8072-7482 and Fleming, Leanne ORCID logoORCID: https://orcid.org/0000-0001-6197-9214;
CORE (COnnecting REpositories)