Low-threshold group-delivered cognitive behavioural therapy for insomnia reduces insomnia severity
Dr. Maria Hrozanova
In my postdoc position at the Department of Public Health and Nursing (Norwegian University of Science and Technology), I am leading the research project ‘Non-pharmacological treatment of sleep problems in primary care’. I am also involved in other ongoing randomized controlled trials on treating insomnia among patients with musculoskeletal pain. I am passionate about science communication, and have held an appointment in the Digital Communications Committee at the ESRS.
Group-delivered CBT-I is a suitable low-threshold insomnia treatment in primary care.
Insomnia is the most common sleep disorder in the general population and clinical practice. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment for long-term alleviation of chronic insomnia, but its availability for patients is limited. The Norwegian Health Directorate has therefore developed a CBT-I-based treatment provided in primary care. The intervention is delivered in a group setting of up to 15 participants at a time in public, interdisciplinary Healthy Life Centres. It is a low-threshold treatment, where adults with insomnia sign up without a referral. We investigated the effectiveness of the group-delivered CBT-I among adults with insomnia in Norwegian primary care.
Watch a short movie about insomnia in Norway, documenting the group-delivered CBT-I:
The study was conducted as a pragmatic, multicentre randomised controlled trial at 26 primary care centres. Adults who signed up for the study were screened for the severity of their insomnia symptoms, using the Insomnia Severity Index (ISI). Those with an ISI score ≥ 12 were considered for participation. Untreated sleep apnea, ongoing cancer treatment, current attack of multiple sclerosis, psychotic, bipolar and personality disorders, and dementia or other neurodegenerative conditions were applied as exclusion criteria.
The measurement timepoints were:Â (1) Baseline, prior to intervention start, (2) Immediately post-intervention (4 weeks after baseline), (3) 3 months post-intervention (primary outcome measurement)Â and (4) 6 months post-intervention.
Participants receiving group-delivered CBT-I were compared with those on a waiting list to investigate whether the intervention reduces insomnia severity, and other outcomes such as self-reported sleep, fatigue, psychological distress, and health-related quality of life.
308 participants were included in the trial. Of these were 127 were randomised to the waiting list, and 181 to group-delivered CBT-I. Mean age of the sample was 49.5 (SD 13.2) years, and 75% of participants were female.
The main outcome was the difference between group-delivered CBT-I and waiting list in the severity of insomnia, measured with the ISI. At 3 months post-intervention, the estimated average difference in the degree of insomnia between the groups was 3.4 ISI points – group-delivered CBT-I participants had a score of 10.7 points, while the ISI score for the waiting list was 14.1 points (see Figure 1). At this timepoint, 34% of the group-delivered CBT-I participants had achieved clinically relevant improvement in insomnia (i.e., difference of at least 8 points on the ISI), while only 13% of those on the waiting list had achieved a similar improvement. These effects were maintained at 6 months post-intervention, indicating a good long-term effect of the treatment. Thus, participation in group-delivered CBT-I leads to less insomnia and can,as such, be considered a suitable low-threshold treatment for insomnia in primary care.
Figure 1:
For more details and results showing the effectiveness of group-delivered CBT-I on fatigue, psychological distress, health-related quality of life and self-reported sleep, read our peer-reviewed scientific article published in Sleep Medicine:
Recent publications from ESRSÂ members
- Chenini S, Barateau et al. (2025), Association of Sleep Disruption With Daytime Sleepiness in Patients With Restless Legs Syndrome. Neurology.
- Fostitsch AJ et al. (2025), The association between sleep quality and telomere attrition: A systematic review and meta-analysis comprising 400,212 participants. Sleep Med Rev.
- Bonsignore MR, et al. (2025), Management options for excessive daytime sleepiness in patients with obstructive sleep apnea. Expert Rev Respir Med.
- Parrino L, Rosenzweig I. (2025), The futuristic manifolds of REM sleep. J Sleep Res.
- Leitner C, et al. (2025), Sleep alterations in major depressive disorder and insomnia disorder: A network meta-analysis of polysomnographic studies. Sleep Med Rev.Â
- Mitolo, M., Pizza, F., Manners, D.N. et al. (2025), Pons metabolite alterations in narcolepsy type 1. Neurol SciÂ