What does this research mean for the field?

Internet-based Acceptance and Commitment Therapy (iACT) significantly improves sleep quality and reduces insomnia symptoms in adults compared to passive controls, although current evidence is of low certainty. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 8, 2026Open Access

The effect of internet-based acceptance and commitment therapy on sleep quality and insomnia in adults: a systematic review and meta-analysis

JFJiaying FuHubei University of Chinese Medicine XZXiaohong ZhangHubei University of Chinese Medicine YQYufei QiuHubei University of Chinese Medicine

Key Points

To evaluate the effects of internet-based Acceptance and Commitment Therapy on sleep quality and insomnia-related outcomes in adults.
Systematic search conducted in PubMed, Web of Science, Cochrane Library, CINAHL, and Embase up to December 6, 2025.
Included randomized controlled trials focusing on iACT and validated sleep quality or insomnia outcomes.
Random-effects model applied for pooling standardized mean differences; risk of bias assessed via Cochrane Risk of Bias 2 tool.
iACT improved sleep quality compared to control (SMD = -0.92, 95% CI -1.45 to -0.38; p < 0.001).
iACT reduced insomnia symptoms compared to control (SMD = -0.40, 95% CI -0.64 to -0.16; p < 0.001).
Heterogeneous intervention characteristics affected outcomes, suggesting subgroup variations.

Abstract

Insomnia and poor sleep quality are common sleep-related problems in adults and are associated with impaired quality of life, psychological distress, and increased physical health burden. Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line non-pharmacological treatment for chronic insomnia, internet-based Acceptance and Commitment Therapy (iACT) has increasingly been explored as an alternative or complementary digital psychological intervention for improving sleep-related outcomes. To systematically evaluate the effects of iACT on sleep quality and insomnia-related outcomes in adults. PubMed, Web of Science, Cochrane Library, CINAHL, and Embase were systematically searched from inception to December 6, 2025. We included randomized controlled trials evaluating internet-based Acceptance and Commitment Therapy in adults that reported validated outcomes for sleep quality or insomnia. Standardized mean differences were pooled using a random-effects model, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Eight randomized controlled trials met the inclusion criteria. Five studies were included in the meta-analysis of sleep quality outcomes and three in the meta-analysis of insomnia outcomes. Compared with passive control conditions, iACT was associated with better sleep quality outcomes (SMD = - 0.92, 95% CI - 1.45 to - 0.38; p < 0.001) and reduced insomnia symptoms (SMD = - 0.40, 95% CI - 0.64 to - 0.16; p < 0.001). Exploratory subgroup analyses suggested possible variation in sleep quality outcomes according to intervention duration, participant characteristics, and delivery format, although these findings should be interpreted cautiously. iACT may have potential to improve sleep quality and insomnia-related outcomes in adults. However, the available evidence remains limited by heterogeneous populations, intervention characteristics, delivery formats, and overall low certainty of evidence. Therefore, the findings should be considered preliminary rather than definitive.

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