Cognitive Behavioral Therapy for Insomnia in Teens: What New Research Reveals

Sophie Mizrahi is Content and Events Producer at the Association for Child and Adolescent Mental Health (ACAMH). She holds a BSc in Psychology and a Postgraduate Diploma in Vocational and Career Development from Favaloro University in Buenos Aires, Argentina. Her career spans community-based programmes, where she led initiatives to support individuals, particularly young adults, in navigating transitions and making informed decisions about their personal and professional aspirations. She has also contributed to digital mental health projects and AI startups, with a focus on research and the development of mental health products. Her work consistently centres on expanding access to evidence-based mental health resources for professionals and the wider public.

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A 2024 systematic review and meta‑analysis by Galgut and colleagues highlights that cognitive behavioural therapy for insomnia (CBT‑I) markedly improves insomnia severity and, to a lesser extent, subjective sleep quality in teenagers. These findings strengthen the evidence for offering CBT‑I—delivered face‑to‑face or digitally—as a first‑line treatment for young people who struggle to sleep.

Why adolescent insomnia matters

Sleep problems are a common and persistent issue in adolescence, affecting approximately 8% to 24% of young people (Dohnt et al., 2012; Hysing et al., 2013). The presence of insomnia during these critical developmental years is associated with a range of adverse outcomes, including academic difficulties, emotional health problems, and increased risk for psychiatric disorders (Li et al., 2018; Lovato & Gradisar, 2014). While cognitive behavioural therapy for insomnia (CBT-I) is well-established as the first-line treatment for adults, its evidence base in adolescents has been comparatively limited. A new systematic review and meta-analysis by Galgut et al. (2024) addresses this gap, providing updated insights into how CBT-I interventions perform for adolescents aged 10 to 19.

teenage boy suffering from insomnia lying in bed at night.

Insomnia might affect up to one in four adolescents and can have lasting effects if left untreated.

What the new evidence shows

Cognitive behavioural therapy for insomnia (CBT-I) is a multicomponent intervention that integrates psychoeducation, behavioural strategies, and cognitive techniques. Behavioural components include stimulus control, sleep restriction, and relaxation training, while cognitive components target unhelpful beliefs and attitudes about sleep that contribute to worry and hyperarousal (Morin et al., 1999; Ree et al., 2017). This combination aims to break the vicious cycle that maintains insomnia symptoms.

Galgut et al. (2024) systematically reviewed five randomised controlled trials (RCTs) involving adolescents with insomnia and conducted a meta-analysis on four of them, including 527 participants. The studies varied in delivery format, ranging from face-to-face therapy to self-guided digital programmes. Despite these differences, CBT-I consistently demonstrated positive outcomes, with a large effect size for improving insomnia symptoms (Hedges’ g = 1.04) and a moderate effect size for improving subjective sleep quality (Hedges’ g = 0.4).

Importantly, all included trials compared CBT-I to a control condition. Control groups varied across studies and included waitlist, treatment as usual, sleep hygiene education, study skills training, or informational text messages. These comparisons support the conclusion that CBT-I offers greater improvements in insomnia symptoms and subjective sleep quality than no intervention or basic psychoeducation alone.

Methodologically, the review followed PRISMA guidelines and assessed risk of bias using the Cochrane RoB 2.0 tool. While the included studies varied in sample characteristics, intervention components, and outcome measures, the authors used appropriate meta-analytic methods to synthesise the data. However, some limitations were noted, including heterogeneity across studies and concerns regarding the reporting of pre-specified analysis plans.

Mad young african American woman wake up lying in bed feel down upset thinking of personal problem, angry black millennial girl awake from rest in white bedroom. Bad morning sleep concept

New evidence shows CBT-I significantly improves both insomnia symptoms and sleep quality in adolescents.

What this means for practice and future research

The findings reinforce CBT-I as an effective treatment for adolescents with insomnia, regardless of whether it is delivered face-to-face or digitally. This flexibility is particularly important for young people, who may prefer digital formats due to accessibility, autonomy, and stigma concerns.

However, the review also highlights key areas for future research. For instance, subjective sleep quality, while improved, often remained in the poor range after treatment. Understanding which specific components of CBT-I (e.g., sleep restriction, cognitive restructuring) drive the greatest improvements could help optimise interventions. Additionally, more longitudinal studies are needed to confirm the durability of effects beyond 12 months.

Clinically, the evidence suggests that mental health practitioners should consider CBT-I as a first-line treatment option for adolescent insomnia, mirroring current adult guidelines. Given that many clinicians lack training in CBT-I, there is a pressing need for wider education and dissemination efforts.

Black girl looking at cellphone screen at night lying in bed with bright blue light

CBT-I should be considered a first-line treatment for adolescent insomnia, with greater efforts needed to expand access and training.

Final thoughts

The systematic review and meta-analysis by Galgut et al. (2024) provides emerging and robust evidence supporting the effectiveness of cognitive behavioural therapy for improving insomnia symptoms and subjective sleep quality in adolescents. While further research is needed to refine delivery methods and evaluate long-term outcomes, these findings contribute meaningfully to the growing recognition of CBT-I as a valuable approach for supporting adolescent sleep health.

Young woman has a difficulty falling asleep. Girl with insomnia or headache cover her face with hand.

New evidence supports expanding the use of CBT-I to treat adolescent insomnia.

Where next?

This workshop, led by renowned expert child and adolescent psychiatrist Dr. Jess Shatkin for insights and guidance on managing insomina in children and young people. You’ll gain a comprehensive understanding of  the latest research and evidence-based practices, such as Cognitive Behavioral Therapy for Insomnia (CBT-I), which has been shown to effectively improve sleep quality and duration in adolescents. Plus practical strategies for assessing and treating insomnia, including establishing good sleep hygiene practices and addressing the impact of screen time on sleep.

Healthcare professionals attending will enhance their skills in diagnosing and treating sleep disorders, gain insights into how improving sleep can positively impact psychiatric functioning and overall wellbeing, and contributing to ongoing professional development.

Use the interactive programme below to gain an overview of the topic, meet the speaker, test your knowledge, and a whole lot more!

Conflict of interest: The author declares no conflicts of interest.

References

  • Galgut, Y., Hoyos, C., Kempler, L., Aji, M., Grunstein, R. R., Gordon, C. J., & Bartlett, D. J. (2024). Cognitive and behavioural therapy for insomnia in the treatment of adolescent insomnia: A systematic review and meta-analysis of randomised controlled trials. Journal of Sleep Research. https://doi.org/10.1111/jsr.14442
  • Dohnt, H., Gradisar, M., & Short, M. A. (2012). Insomnia and its symptoms in adolescents: Comparing DSM‐IV and ICSD‐II diagnostic criteria. Journal of Clinical Sleep Medicine, 8(3), 295–299. https://doi.org/10.5664/jcsm.1918
  • Hysing, M., Pallesen, S., Stormark, K. M., Lundervold, A. J., & Sivertsen, B. (2013). Sleep patterns and insomnia among adolescents: A population‐based study. Journal of Sleep Research, 22(5), 549–556. https://doi.org/10.1111/jsr.12055
  • Li, Y. I., Starr, L. R., & Wray‐Lake, L. (2018). Insomnia mediates the longitudinal relationship between anxiety and depressive symptoms in a nationally representative sample of adolescents. Depression and Anxiety, 35(6), 583–591. https://doi.org/10.1002/da.22764
  • Lovato, N., & Gradisar, M. (2014). A meta‐analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice. Sleep Medicine Reviews, 18(6), 521–529. https://doi.org/10.1016/j.smrv.2014.03.006
  • Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., & Bootzin, R. R. (1999). Nonpharmacologic treatment of chronic insomnia. An American Academy of sleep medicine review. Sleep, 22(8), 1134–1156. https://doi.org/10.1093/sleep/22.8.1134
  • Ree, M., Junge, M., & Cunnington, D. (2017). Australasian Sleep Association position statement regarding the use of psychological/behavioral treatments in the management of insomnia in adults. Sleep Medicine, 36(Suppl 1), S43–S47. https://doi.org/10.1016/j.sleep.2017.03.017

 

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