Effects of cognitive-behavioural therapy for insomnia on cognitive and emotional functioning in adults with insomnia: behavioural and neuroimaging evidence
Year: 2026
Type: preprint
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Study Objectives To characterize neural correlates of memory and emotion reactivity in individuals with insomnia disorder (INS) compared to good sleepers (GS) and to investigate associated short- and long-term changes following cognitive-behavioural therapy for insomnia (CBTi). Methods This randomized controlled trial included 56 INS and 20 GS. At baseline, participants underwent resting-state and task-based functional magnetic resonance imaging, including working memory, emotion reactivity, and face-name associative memory tasks. They filled out sleep diaries and self-report questionnaires about sleep, cognition, and emotions, and underwent in-lab polysomnography. Subsequently, participants with INS were randomized to either the 3-month treatment group (TX) or wait-list control group (WL). Both TX and WL groups repeated baseline assessments at three months post-randomization and completed sleep diaries and questionnaires one year after finishing CBTi. Results At baseline, the INS group reported higher insomnia severity, greater subjective cognitive impairment, and perceived sleep-related stimuli as more negative than GS. Contrasting with these subjective evaluations, no group differences were found in memory performance, task-based brain activity, or resting-state functional connectivity. At three months post-randomization and one-year follow-up, CBTi significantly improved subjective, but not objective, cognitive functioning and sleep in adults with INS. No significant treatment-related changes were observed in valence ratings of sleep images, task-based brain activity, or resting-state functional connectivity. Conclusions Beyond its primary role in improving insomnia symptoms, CBTi may have long-term benefits for individuals with INS who experience concerns about their cognitive functioning, even in the absence of objective changes in neural processing of cognitive and emotional tasks. Clinical trial Impact of Insomnia Treatment on Brain Responses During Resting-state and Cognitive Tasks. ClinicalTrials.gov identifier: NCT04024787 ; https://clinicaltrials.gov/study/NCT04024787 Statement of Significance Insomnia disorder impairs sleep, cognitive, and emotional functioning, imposing a significant clinical burden and highlighting the need for effective interventions to address these impairments. Our study used self-reports, task performance, and neuroimaging techniques to comprehensively investigate the effectiveness of cognitive-behavioural therapy for insomnia on subjective and objective measures of sleep, cognitive, and emotional functions in adults with insomnia disorder. Our findings show that this treatment has long-lasting benefits on subjective, but not objective, cognitive functioning and sleep measures. No changes were found in valence ratings of sleep images, memory performance, or brain function. Future research should identify neural substrates and psychological processes underlying these subjective cognitive deficits as well as the dissociation between subjective and objective cognitive functioning in insomnia.
Source: medRxiv
Institutions: Institut Universitaire de Gériatrie de Montréal, Santé Québec Centre-Sud-de-l’Île-de-Montréal – Universitaire, Concordia University, Université de Montréal, Woolcock Institute of Medical Research, Macquarie University, Binghamton University, Université Laval, Centre de recherche du CHU de Québec-Université Laval, University of Geneva
Language: English
Topic: Sleep and related disorders
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7221130801