Cited by 625Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

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Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia: A Randomized Controlled Trial

Edinger, Jack D., Wohlgemuth, William K., Radtke, Rodney A., Marsh, Gail R., Quillian, Ruth E.·2001·JAMA

DOI 10.1001/jama.285.14.1856

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Abstract

CONTEXT: Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlled trials demonstrating effective behavioral therapy for sleep-maintenance insomnia are lacking. OBJECTIVE: To test the efficacy of a hybrid cognitive behavioral therapy (CBT) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial conducted at a single academic medical center, with recruitment from January 1995 to July 1997. PATIENTS: Seventy-five adults (n = 35 women; mean age, 55.3 years) with chronic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 years). INTERVENTIONS: Patients were randomly assigned to receive CBT (sleep education, stimulus control, and time-in-bed restrictions; n = 25), progressive muscle relaxation training (RT; n = 25), or a quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up conducted at 6 months. MAIN OUTCOME MEASURES: Objective (polysomnography) and subjective (sleep log) measures of total sleep time, middle and terminal wake time after sleep onset (WASO), and sleep efficiency; questionnaire measures of global insomnia symptoms, sleep-related self-efficacy, and mood. RESULTS: Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did RT or placebo treatment. For example, sleep logs showed that CBT-treated patients achieved an average 54% reduction in their WASO whereas RT-treated and placebo-treated patients, respectively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms than did the other groups with an average sleep time of more than 6 hours, middle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT-treated patients continued to report a middle WASO of 43.3 minutes and sleep efficiency of 78.8%. CONCLUSIONS: Our results suggest that CBT represents a viable intervention for primary sleep-maintenance insomnia. This treatment leads to clinically significant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.

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BackgroundMethod
Regensburg Insomnia Scale (RIS): a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; Study design: development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls
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Self-citation
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Background
Beliefs about sleep in disorders characterized by sleep and mood disturbance
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BackgroundMethodSelf-citation
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Background
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Background
Insomnia in women
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Background
Assessment and Management of Insomnia
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Background
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Background
Prevalence and Mental Health Correlates of Insomnia in First-Encounter Veterans with and without Military Sexual Trauma
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“The improvements in sleep found in this study may be both clinically important and comparable to the improvements achieved by current front-line interventions for child sleep problems (Edinger et al., 2001; Weiss et al., 2006).”
Result
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Background
Insomnia With Short Sleep Duration
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“28 Accordingly, the American College of Physicians recently recommended that “all adult patients receive CBT-I as the initial treatment for chronic insomnia disorder.””
Who is a candidate for cognitive-behavioral therapy for insomnia?
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“One study reported that clinically significant sleep improvements occurred within six weeks and lasted through six months of follow-up (Edinger et al., 2001).”
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Authors: Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E.
Affiliations: Durham VA Medical Center (US)
ORCID: Edinger, Jack D.
Radtke, Rodney A.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2001-04-11
Volume: 285
Issue: 14
Pages: 1856
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.285.14.1856
OpenAlex: W2090423345
Cited by: 625
References: 37
Citations by year: 2026: 7 · 2025: 14 · 2024: 21 · 2023: 19 · 2022: 16 · 2021: 29 · 2020: 25 · 2019: 29 · 2018: 22 · 2017: 29 · 2016: 37 · 2015: 38 · 2014: 40 · 2013: 43 · 2012: 20
FWCI: 28.87
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (R01MH48187, R01MH048187)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Keywords: cognitive behavioral therapy, chronic primary insomnia, sleep maintenance insomnia, progressive muscle relaxation, stimulus control, sleep education, wake after sleep onset, sleep efficiency, non-pharmacological treatment
MeSH terms: Adult, Aged, Double-Blind Method, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Surveys and Questionnaires, Relaxation Therapy, Cognitive Behavioral Therapy, Polysomnography

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Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia: A Randomized Controlled Trial

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