Perspective from Jennifer L. Martin, PhD
Disclosures: The authors report no relevant financial disclosures.
September 02, 2021
2 min read

Nonpharmacological sleep interventions reduce anxiety

Perspective from Jennifer L. Martin, PhD
Disclosures: The authors report no relevant financial disclosures.
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Nonpharmacological sleep interventions were effective in reducing anxiety and sleep-related thought processes, and these benefits were more substantial in patients with anxiety, according to a recent meta-analysis.

Prior to the pandemic, data from the National Institute of Mental Health showed that 19.1% of all U.S. adults had an anxiety disorder, with prevalence of these conditions more common in women than men (23.4% vs. 14.3%). Also, 31.9% of all U.S. adolescents have had an anxiety disorder, with a higher prevalence among girls than boys (38% vs. 26.1%). In a meta-analysis conducted during the early days of the pandemic — late 2019 until August 2020 — the pooled prevalence of anxiety among adults and children worldwide was 47% and 20.5%, respectively.

A vector image of a person sleeping  Text that reads about one-third of adults in Western countries experience a sleep problem at least once a week.
Reference: Staines AC, et al. J Sleep Res. 2021;doi:10.1111/jsr.13451.

Sleeping difficulties are also common, with about one-third of adults in Western countries experiencing a sleep problem at least once a week, Alex Catherine Staines, DClinPsy, MSc, of the department of clinical psychology at the Norwich Medical School at the University of East Anglia in the United Kingdom, and colleagues wrote. They noted that previous research efforts examining sleep interventions have limited their scope to cognitive behavioral therapy-insomnia (CBT-I).

These earlier meta-analyses also “often included measures of both anxiety and co-related anxiety processes such as worry or stress, and effects were not investigated for those from a mental health population,” they wrote in the Journal of Sleep Research.

Staines and colleagues reviewed 43 randomized clinical trials, 12 of which were conducted in the U.S., with 5,945 patients. The trials examined nonpharmacological sleep interventions such as:

  • CBT-I, either alone or in combination with mindfulness therapy;
  • face-to-face or telehealth appointments with a health care professional;
  • computer programs, either self-taught or by a health care professional;
  • exposure to bright light;
  • sleep hygiene;
  • bibliotherapy;
  • hypnotherapy for insomnia; and
  • brief behavioral therapy for insomnia.

Reflective of the previously established bi-directional relationship that exists among individuals of all ages between sleep problems and emotional difficulties such as stress and anxiety, the trials contained representatives from all age groups except children. The studied trials also had to include resolution of anxiety symptoms as an outcome.

According to Staines and colleagues, the combined effect size of nonpharmacological sleep interventions on anxiety symptoms was moderate, which signified a reduction in symptoms. Subgroup analyses found a moderate effect of these interventions among trial participants with additional physical or mental health difficulties and for those with elevated levels of anxiety at baseline. A secondary meta-analysis showed that nonpharmacological sleep interventions had a large effect on sleep-related thought processes.

“This review did not examine specific anxiety disorders or disorder-specific questionnaires; therefore, our results may have clinical implications for treating other disorders where anxiety may be high,” Staines and colleagues wrote. “These findings suggest sleep interventions may be offered in accessible cost-effective modalities. Clinically, this could improve access and waiting times in psychological services.”


Deng J, et al. Ann NY Acad Sci. 2021;doi:10.1111/nyas.14506.

National Institute of Mental Health. Any anxiety disorder. Accessed Sept. 1, 2021.

Staines AC, et al. J Sleep Res. 2021;doi:10.1111/jsr.13451.