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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“Twenty of these were enrolled in our first CBT study (Edinger et al., 2001a) and received 6 weekly sessions of this intervention.”
BackgroundMethodInfluentialSelf-citation
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Self-citation
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Background
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Background
Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans
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MethodResult
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“However, several studies have employed a quasi-desensitization placebo condition which employs hierarchical imaginary exposure to sleep-related material.(123,156) These studies largely resulted in similar patterns of outcomes to those found in waitlist-controlled trials.”
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Background
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Background
Changes in Subjective-Objective Sleep Discrepancy Following Inpatient Cognitive Behavior Therapy for Insomnia
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Method
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Result
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Self-citation
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“[8,9]), strongly suggests that behavior therapy should be considered the first-line treatment for chronic primary insomnia.”
Background
A practical approach to the diagnosis and management of sleep disorders in patients with multiple sclerosis
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“While there is much support for the efficacy of CBT-I in improving sleep in the general population (Edinger & Means, 2005; Edinger et al., 2001; Irwin et al., 2006; Morin et al., 2006), and in some various disease populations, such as osteoarthritis (Vitiello, Rybarczyk, Von Korff, & Stepanski,…”
BackgroundMethodInfluential
Perceptions of Heavy-Drinking College Students About a Sleep and Alcohol Health Intervention
Fucito, L. M., DeMartini, K. S., Hanrahan, T. H., Whittemore, R., Yaggi, H. K., & Redeker, N. S. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2014.919919 · Cited by 37
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“The mean ages of our patients were 45.1 years (individual treatment) and 43.7 years (group treatment) compared to 64.4 years (Morin, Colecchi, et al., 1999) and 55.3 years (Edinger et al., 2001a).”
BackgroundResultInfluential
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Self-citation
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“Time in bed was estimated by calculating the time period between bedtime and rise-time for each night during a week (Edinger et al., 2001; Edinger et al., 2007; Edinger et al., 2009; Krystal and Edinger, 2010; Lichstein et al., 2001; Rybarczyk et al., 2002; Rybarczyk et al., 2005).”
Method
Long term benzodiazepine use for insomnia in patients over the age of 60: discordance of patient and physician perceptions
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“Furthermore, cognitive behavioural therapy (CBT) [ 17 ,18] shows promising results of long term sleep improvements, and would be a non-pharmacologic consideration where available.”
Background
Tratamento não farmacológico para a insônia crônica
Passos, G. S., Tufik, S., Santana, M. G. D., Poyares, D., & Mello, M. T. D. (2007) · Revista Brasileira de Psiquiatria · doi:10.1590/s1516-44462006005000045 · Cited by 32
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“variables relative to comparison groups [31], [32].”
Insomnia
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“These logs were used along with the Action W software (Edinger et al., 2001) to prepare the raw Actigraph data for analysis.”
BackgroundMethod
Sleep disturbance may impact treatment outcome in bipolar disorder: A preliminary investigation in the context of a large comparative effectiveness trial
Sylvia, L. G., Chang, W. C., Kamali, M., Tohen, M. F., Kinrys, G., Deckersbach, T., Calabrese, J. R., Thase, M. E., Reilly-Harrington, N. A., Bobo, W. V., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.08.056 · Cited by 31
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“• Cognitive behavior therapy for insomnia (CBT-I) [33,34].”
Background
Hypnotic use and fatigue in multiple sclerosis
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“Insomnia outside the context of MS is most commonly treated with cognitive behavioral therapy (CBT-I), which in multiple randomized controlled trials has shown effectiveness that equals and may outlast the benefit of hypnotics [32–34].”
Background
Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice
Garland, S. N., Trevino, K. M., Liou, K. T., Gehrman, P., Spiguel, E., MacLeod, J., Walker, D. A. H., Glosik, B., Seluzicki, C. M., Barg, F. K., et al. (2021) · Journal of Cancer Survivorship · doi:10.1007/s11764-021-01001-1 · Cited by 30
Cognitive Arousal, Unhelpful Beliefs and Maladaptive Sleep Behaviors as Mediators in Cognitive Behavior Therapy for Insomnia: A Quasi-Experimental Study
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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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