Evaluating the Effectiveness of Cognitive Behavioral Therapy for Insomnia in School Settings: A Systematic Review and Meta-Analysis.

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.