The DOI matches its Crossref record; 64 of the 65 references it cites were found in a registry or an index.
Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis
Abstract
IMPORTANCE: Cognitive behavioral therapy for insomnia (CBT-I) is the most prominent nonpharmacologic treatment for insomnia disorders. Although meta-analyses have examined primary insomnia, less is known about the comparative efficacy of CBT-I on comorbid insomnia. OBJECTIVE: To examine the efficacy of CBT-I for insomnia comorbid with psychiatric and/or medical conditions for (1) remission from insomnia; (2) self-reported sleep efficiency, sleep onset latency, wake after sleep onset, total sleep time, and subjective sleep quality; and (3) comorbid symptoms. DATA SOURCES: A systematic search was conducted on June 2, 2014, through PubMed, PsycINFO, the Cochrane Library, and manual searches. Search terms included (1) CBT-I or CBT or cognitive behavioral [and its variations] or behavioral therapy [and its variations] or behavioral sleep medicine or stimulus control or sleep restriction or relaxation therapy or relaxation training or progressive muscle relaxation or paradoxical intention; and (2) insomnia or sleep disturbance. STUDY SELECTION: Studies were included if they were randomized clinical trials with at least one CBT-I arm and had an adult population meeting diagnostic criteria for insomnia as well as a concomitant condition. Inclusion in final analyses (37 studies) was based on consensus between 3 authors' independent screenings. DATA EXTRACTION AND SYNTHESIS: Data were independently extracted by 2 authors and pooled using a random-effects model. Study quality was independently evaluated by 2 authors using the Cochrane risk of bias assessment tool. MAIN OUTCOMES AND MEASURES: A priori main outcomes (ie, clinical sleep and comorbid outcomes) were derived from sleep diary and other self-report measures. RESULTS: At posttreatment evaluation, 36.0% of patients who received CBT-I were in remission from insomnia compared with 16.9% of those in control or comparison conditions (pooled odds ratio, 3.28; 95% CI, 2.30-4.68; P < .001). Pretreatment and posttreatment controlled effect sizes were medium to large for most sleep parameters (sleep efficiency: Hedges g = 0.91 [95% CI, 0.74 to 1.08]; sleep onset latency: Hedges g = 0.80 [95% CI, 0.60 to 1.00]; wake after sleep onset: Hedges g = 0.68; sleep quality: Hedges g = 0.84; all P < .001), except total sleep time. Comorbid outcomes yielded a small effect size (Hedges g = 0.39 [95% CI, 0.60-0.98]; P < .001); improvements were greater in psychiatric than in medical populations (Hedges g = 0.20 [95% CI, 0.09-0.30]; χ2 test for interaction = 12.30; P < .001). CONCLUSIONS AND RELEVANCE: Cognitive behavioral therapy for insomnia is efficacious for improving insomnia symptoms and sleep parameters for patients with comorbid insomnia. A small to medium positive effect was found across comorbid outcomes, with larger effects on psychiatric conditions compared with medical conditions. Large-scale studies with more rigorous designs to reduce detection and performance bias are needed to improve the quality of the evidence.
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“In their meta-analysis, Wu and colleagues found that CBT-I was more effective for patients with mental comorbidity compared to medical comorbidity [17].”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [17]
In the citing paper
“In general, we replicate their finding that CBT-I is effective for patients with comorbid depression, and extend their findings by demonstrating that it is also effective for patients with PTSD, alcohol dependency, mixed comorbidities and potentially bipolar disorder and psychosis.”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [17]
In the citing paper
“although CBT-I improves subjective sleep quality [22]”
From The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis (2021) · cites this paper as [22]
Citations
Cites
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,415
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989) · Psychiatry Research · doi:10.1016/0165-1781(89)90047-4 · Cited by 35,234
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099
Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011) · Sleep · doi:10.1093/sleep/34.5.601 · Cited by 4,620
Meta-Analytic Procedures for Social Research.
Metcalfe, A., & Rosenthal, R. (1994) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2348600 · Cited by 4,249
The empirical status of cognitive-behavioral therapy: A review of meta-analyses
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.07.003 · Cited by 3,215
The consensus sleep diary: standardizing prospective sleep self-monitoring
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., Lichstein, K. L., & Morin, C. M. (2012) · Sleep · doi:10.5665/sleep.1642 · Cited by 2,172
Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27286 · Cited by 1,943
Hoffman, S. G., & Smits, J. A. J. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0415 · Cited by 1,420
Recommendations for a standard research assessment of insomnia
Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006) · Sleep · doi:10.1093/sleep/29.9.1155 · Cited by 1,206
Nonpharmacological 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 3×
“Publication Bias and Study Quality Several strategies were used to address potential publication bias: (1) conducting fail-safe N analyses18,20 to assess the robustness of ESs; (2) inspecting funnel plots to assess overrepresentation of positive and negative studies; and (3) using the trim-and-fill method to adjust ES…”
BackgroundMethodManber, R., Edinger, J. D., Gress, J. L., Pedro-Salcedo, M. G. S., Kuo, T. F., & Kalista, T. (2008) · Sleep · doi:10.1093/sleep/31.4.489 · Cited by 868
Comparative Meta-Analysis of Pharmacotherapy and Behavior Therapy for Persistent Insomnia
Smith, M. T., Perlis, M. L., Park, A., Smith, M. S., Pennington, J., Giles, D. E., & Buysse, D. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.5 · Cited by 863
An American Academy of Sleep Medicine Report, Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., Coleman, J., Kapur, V., Lee-Chiong, T., et al. (2006) · Sleep · doi:10.1093/sleep/29.11.1415 · Cited by 835
Identifying effective psychological treatments for insomnia: A meta-analysis.
Murtagh, D. R. R., & Greenwood, K. M. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.63.1.79 · Cited by 664
Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review
Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-40 · Cited by 617
Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults
Buysse, D. J., Germain, A., Moul, D. E., Franzen, P. L., Brar, L. K., Fletcher, M. E., Begley, A. E., Houck, P. R., Mazumdar, S., Reynolds, C. F., et al. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.535 · Cited by 561
Irwin, M. R., Cole, J. C., & Nicassio, P. M. (2006) · Health Psychology · doi:10.1037/0278-6133.25.1.3 · Cited by 537
Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2005) · Journal of Clinical Oncology · doi:10.1200/jco.2005.09.548 · Cited by 507
Smith, M. T., Huang, M. I., & Manber, R. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.004 · Cited by 453
Espie, C. A., Fleming, L., Cassidy, J., Samuel, L., Taylor, L. M., White, C. A., Douglas, N. J., Engleman, H. M., Kelly, H.-L., & Paul, J. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.13.9006 · Cited by 383
Taylor, D. J., & Pruiksma, K. E. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.902808 · Cited by 359
A meta-analysis of group cognitive behavioral therapy for insomnia
Koffel, E. A., Koffel, J. B., & Gehrman, P. R. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.05.001 · Cited by 356
Behavioral Insomnia Therapy for Fibromyalgia Patients: A Randomized Clinical Trial
Edinger, J. D., Wohlgemuth, W. K., Krystal, A. D., & Rice, J. R. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2527 · Cited by 330
Garland, S. N., Carlson, L. E., Stephens, A. J., Antle, M. C., Samuels, C., & Campbell, T. S. (2014) · Journal of Clinical Oncology · doi:10.1200/jco.2012.47.7265 · Cited by 329
OKAJIMA, I., KOMADA, Y., & INOUE, Y. (2011) · Sleep and Biological Rhythms · doi:10.1111/j.1479-8425.2010.00481.x · Cited by 306
Cognitive-behavioral treatment of insomnia secondary to chronic pain.
Currie, S. R., Wilson, K. G., Pontefract, A. J., & deLaplante, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.3.407 · Cited by 299
Ritterband, L. M., Bailey, E. T., Thorndike, F. P., Lord, H. R., Farrell‐Carnahan, L., & Baum, L. D. (2012) · Psycho-Oncology · doi:10.1002/pon.1969 · Cited by 296
Talbot, L. S., Maguen, S., Metzler, T. J., Schmitz, M., McCaslin, S. E., Richards, A., Perlis, M. L., Posner, D. A., Weiss, B., Ruoff, L., et al. (2014) · Sleep · doi:10.5665/sleep.3408 · Cited by 294
Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. D., Kirby, A. C., & Carney, C. E. (2009) · SLEEP · doi:10.1093/sleep/32.4.499 · Cited by 259
The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Jungquist, C. R., O’Brien, C., Matteson-Rusby, S., Smith, M. T., Pigeon, W. R., Xia, Y., Lu, N., & Perlis, M. L. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2009.05.018 · Cited by 256
Let's Face Facts: Common Factors Are More Potent Than Specific Therapy Ingredients
Messer, S. B. (2002) · Clinical Psychology Science and Practice · doi:10.1093/clipsy/9.1.21 · Cited by 242
Psychological treatment of secondary insomnia.
Lichstein, K. L., Wilson, N. M., & Johnson, C. T. (2000) · Psychology and Aging · doi:10.1037//0882-7974.15.2.232 · Cited by 234
Currie, S. R., Clark, S., Hodgins, D. C., & El‐Guebaly, N. (2004) · Addiction · doi:10.1111/j.1360-0443.2004.00835.x · Cited by 220
Insomnia in primary care patients.
Shochat, T., Umphress, J. L., Israel, A. G., & Ancoli‐Israel, S. (1999) · PubMed · Cited by 215
Ulmer, C. S., Edinger, J. D., & Calhoun, P. S. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.28042 · Cited by 207
Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: A meta-analysis.
Hofmann, S. G., Wu, J. Q., & Boettcher, H. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035491 · Cited by 191
Self-citationEfficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors
Dirksen, S. R., & Epstein, D. R. (2008) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2007.04560.x · Cited by 185
A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults.
Rybarczyk, B., Stepanski, E., Fogg, L., Lopez, M., Barry, P., & Davis, A. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.6.1164 · Cited by 172
Psychological treatment for insomnia in the regulation of long-term hypnotic drug use
Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2004) · Health Technology Assessment · doi:10.3310/hta8080 · Cited by 166
Rios Romenets, S., Creti, L., Fichten, C., Bailes, S., Libman, E., Pelletier, A., & Postuma, R. B. (2013) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2013.03.003 · Cited by 166
Vitiello, M. V., McCurry, S. M., Shortreed, S. M., Balderson, B. H., Baker, L. D., Keefe, F. J., Rybarczyk, B. D., & Von Korff, M. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12275 · Cited by 165
Margolies, S. O., Rybarczyk, B. D., Vrana, S. R., Leszczyszyn, D. J., & Lynch, J. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21970 · Cited by 163
Efficacy of two behavioral treatment programs for comorbid geriatric insomnia.
Rybarczyk, B. D., Lopez, M., Benson, R., Alsten, C. R., & Stepanski, E. J. (2002) · Psychology and Aging · doi:10.1037/0882-7974.17.2.288 · Cited by 162
Martínez, M. P., Miró, E., Sánchez, A. I., Díaz-Piedra, C., Cáliz, R., Vlaeyen, J. W. S., & Buela-Casal, G. (2014) · Journal of Behavioral Medicine · doi:10.1007/s10865-013-9520-y · Cited by 161
Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors
Epstein, D. R., & Dirksen, S. R. (2007) · Oncology nursing forum · doi:10.1188/07.onf.e51-e59 · Cited by 152
Arnedt, J. T., Conroy, D. A., Armitage, R., & Brower, K. J. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.003 · Cited by 147
Chen, H.-Y., Cheng, I.-C., Pan, Y.-J., Chiu, Y.-L., Hsu, S.-P., Pai, M.-F., Yang, J.-Y., Peng, Y.-S., Tsai, T.-J., & Wu, K.-D. (2011) · Kidney International · doi:10.1038/ki.2011.151 · Cited by 140
Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study
Pigeon, W. R., Moynihan, J., Matteson-Rusby, S., Jungquist, C. R., Xia, Y., Tu, X., & Perlis, M. L. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.07.005 · Cited by 134
Watanabe, N., Furukawa, T. A., Shimodera, S., Morokuma, I., Katsuki, F., Fujita, H., Sasaki, M., Kawamura, C., & Perlis, M. L. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06130gry · Cited by 132
Tang, N. K. Y., Goodchild, C. E., & Salkovskis, P. M. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.08.006 · Cited by 123
Matthews, E. E., Berger, A. M., Schmiege, S. J., Cook, P. F., McCarthy, M. S., Moore, C. M., & Aloia, M. S. (2014) · Oncology Nursing Forum · doi:10.1188/14.onf.41-03ap · Cited by 103
Prospective randomized study of patients with insomnia and mild sleep disordered breathing
Guilleminault, C., Davis, K., & Huynh, N. T. (2008) · SLEEP · doi:10.1093/sleep/31.11.1527 · Cited by 100
Comment: Assumptions and Procedures in the File Drawer Problem
Rosenthal, R., & Rubin, D. (1988) · Statistical Science · doi:10.1214/ss/1177013014 · Cited by 93
Miró, E., Lupiáñez, J., Martínez, M. P., Sánchez, A. I., Díaz-Piedra, C., Guzmán, M. A., & Buela-Casal, G. (2011) · Journal of Health Psychology · doi:10.1177/1359105310390544 · Cited by 87
Kapella, M. C., Herdegen, Perlis, Shaver, Larson, J. L., Law, & Carley (2011) · International Journal of COPD · doi:10.2147/copd.s24858 · Cited by 86
Wagley, J. N., Rybarczyk, B., Nay, W. T., Danish, S., & Lund, H. G. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.21927 · Cited by 85
Fiorentino, L., McQuaid, Liu, Natarajan, He, Cornejo, Lawton, Parker, Sadler, Ancoli‐Israel, S., et al. (2009) · Nature and Science of Sleep · doi:10.2147/nss.s8004 · Cited by 72
Cognitive-Behavioral Therapy for the Management of Insomnia Comorbid with Mental Disorders
Sánchez-Ortuño, M. M., & Edinger, J. D. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0312-9 · Cited by 61
Edinger, J., Fins, A., Sullivan, R. J., Marsh, G., Dailey, D., & Young, M. (1996) · Sleep · doi:10.1093/sleep/19.5.442 · Cited by 55
Morgan, K., Gregory, P., Tomeny, M., David, B. M., & Gascoigne, C. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04175.x · Cited by 52
Comparing results of large clinical trials to those of meta‐analyses
Moses, L. E., Mosteller, F. C., & Buehler, J. H. (2002) · Statistics in Medicine · doi:10.1002/sim.1098 · Cited by 35
Jansson‐Fröjmark, M., Linton, S. J., Flink, I. K., Granberg, S., Danermark, B., & Norell‐Clarke, A. (2012) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-011-9275-y · Cited by 33
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European guideline for the diagnosis and treatment of insomnia
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia‐Borreguero, D., Gjerstad, M., Gonçalves, M., et al. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12594 · Cited by 2,049
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6470 · Cited by 1,519
Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression
Itani, O., Jike, M., Watanabe, N., & Kaneita, Y. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.08.006 · Cited by 1,252
“[45] Wu JQ, Appleman ER, Salazar RD, Ong JC.”
BackgroundMental health in elite athletes: International Olympic Committee consensus statement (2019)
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., et al. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-100715 · Cited by 1,277
“Further, CBTI is effective in the presence of comorbidities, such as chronic pain, depression and sleep apnoea.(163) on D ecem er 9, 2022 by gest.”
Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment
Fang, H., Tu, S., Sheng, J., & Shao, A. (2019) · Journal of Cellular and Molecular Medicine · doi:10.1111/jcmm.14170 · Cited by 1,225
Metadata
- Authors
- Wu, J. Q., Appleman, E. R., Salazar, R. D., & Ong, J. C.
- Affiliations
- Boston University (US)
- Rush University Medical Center (US)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2015-09-01
- Volume
- 175
- Issue
- 9
- Pages
- 1461
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W1574691271
- Cited by
- 527
- References
- 65
- Citations by year
- 2026: 34 · 2025: 45 · 2024: 38 · 2023: 55 · 2022: 65 · 2021: 60 · 2020: 51 · 2019: 48 · 2018: 44 · 2017: 46 · 2016: 32 · 2015: 7
- FWCI
- 64.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy for insomnia, insomnia comorbidity, psychiatric comorbidity, comorbidities, insomnia remission, sleep efficiency, sleep latency, wake after sleep onset, subjective sleep quality, sleep restriction, stimulus control, relaxation training, paradoxical intention, risk of bias
- MeSH terms
- Mental Disorders, Humans, Sleep Initiation and Maintenance Disorders, Sleep, Cognitive Behavioral Therapy, Treatment Outcome
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