Cognitive-behavioral, acceptance-based, and mindfulness-based interventions for psychological and sleep-related symptoms during menopause: a systematic review

Abstract

Background: Menopause is frequently accompanied by psychological and sleep-related symptoms, including depression, anxiety, and insomnia, which significantly impair quality of life. Although pharmacological treatments are commonly prescribed, psychological interventions have gained increasing attention as nonpharmacological alternatives. Objective: To systematically synthesize the evidence on the effects of cognitive-behavioral therapy (CBT) and acceptance- and mindfulness-based interventions (ACT, MBSR) on depression, anxiety, and sleep-related outcomes during the menopausal transition. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, PsycInfo, Web of Science, and Scopus were searched for studies published between 2014 and December 8, 2024. Randomized and quasi-experimental studies evaluating CBT, ACT, or MBSR in peri- or postmenopausal women were included. Study quality was assessed using the PEDro scale. Due to methodological and clinical heterogeneity, a narrative synthesis was performed. Results: Twelve studies met the inclusion criteria. Most interventions were associated with reductions in depressive and anxiety symptoms and improvements in sleep-related outcomes. CBT and CBT-I showed the most consistent effects, particularly for insomnia, whereas acceptance- and mindfulness-based interventions demonstrated promising but more variable results. Overall methodological quality ranged from moderate to high; however, substantial heterogeneity was observed across intervention formats, outcome measures, and follow-up periods. Conclusions: The available evidence suggests that CBT and acceptance- and mindfulness-based interventions may be beneficial for psychological and sleep-related symptoms during menopause. Nevertheless, conclusions are limited by heterogeneity and the absence of a meta-analytic synthesis. Future high-quality trials with standardized outcomes and longer follow-up periods are warranted.