The DOI matches its Crossref record; 36 of the 37 references it cites were found in a registry or an index.
Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia: A Randomized Controlled Trial
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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In the citing paper
“Furthermore, previous studies have found that CBT-i results in significantly greater insomnia improvements than a placebo control group [30].”
In the citing paper
“CBT is the standard of care for many psychiatric disorders including depression, anxiety disorders, eating disorders, addiction, chronic pain and sleeping disturbance (insomnia) across the spectrum of acuity.16–20”
In the citing paper
“The low levels of baseline SWS seen in our older participants—similar to other populations of older adults (28)—may have mitigated the detection of increases in those sleep stages.”
From Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints (2008) · cites this paper as [28]
Citations
Cites
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Ford, D. E. (1989) · JAMA · doi:10.1001/jama.262.11.1479 · Cited by 2,440
Credibility of analogue therapy rationales
Borkovec, T. D., & Nau, S. D. (1972) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(72)90045-6 · Cited by 1,553 · cited 1×
“Treatment credibility was assessed via responses (Likert ratings) to the 7-item Therapy Evaluation Questionnaire (TEQ).(50) The TEQ’s first 5 questions assess perceived logic of and confidence in a treatment, willingness to repeat the treatment, and likelihood the treatment will help others.”
MethodNonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.8.1172 · Cited by 1,098 · cited 1×
“Firstgeneration behavioral therapies, designed to correct sleep-disruptive habits (eg, stimulus control) or reduce bedtime arousal (eg, relaxation training [RT]), have proven very effective for treating sleep onset problems, but their results among the larger PPI subgroup reporting sleep maintenance complaints have be…”
BackgroundInsomnia and Its Treatment: Prevalence and Correlates
Mellinger, G. D. (1985) · Archives of General Psychiatry · doi:10.1001/archpsyc.1985.01790260019002 · Cited by 1,071
Psychotropic Drug Use and the Risk of Hip Fracture
Ray, W. A., Griffin, M. R., Schaffner, W., Baugh, D. K., & Melton, L. J. (1987) · New England Journal of Medicine · doi:10.1056/nejm198702123160702 · Cited by 1,006
Treatment of Chronic Insomnia by Restriction of Time in Bed
(1987) · Sleep · doi:10.1093/sleep/10.1.45 · Cited by 948
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Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & for the Clinical Guidelines Committee of the American College of Physicians* (2016) · Annals of Internal Medicine · doi:10.7326/m15-2175 · Cited by 1,965
The association of sleep and pain: an update and a path forward
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013) · The Journal of Pain · doi:10.1016/j.jpain.2013.08.007 · Cited by 1,620
Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004)
Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006) · Sleep · doi:10.1093/sleep/29.11.1398 · Cited by 1,345
Self-citationChu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., et al. (2017) · Psychological Bulletin · doi:10.1037/bul0000123 · Cited by 1,231
Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2841 · Cited by 1,053
“…67‡ 71 Canada ICSD§ C, S, R, H Waiting list – NIH Morin et al, 1999 (50) 36 65‡ 69 Canada DSM-IV and ICSD§ C, S, R, H Placebo tablets 3 and 12 mo NIH Edinger et al, 2001 (40) 50 56 48 United States DSM-III-R§ S, R, H Behavioral placebo – NIH Espie et al, 2001 (43) 139 51 68 United…”
Background
Metadata
- Authors
- Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E.
- Affiliations
- Durham VA Medical Center (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2001-04-11
- Volume
- 285
- Issue
- 14
- Pages
- 1856
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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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