Identifying effective psychological treatments for insomnia: A meta-analysis.

Abstract

Insomnia is a debilitating and widespread complaint. Concern over the iatrogenic effects of pharmacological therapies has led to the development of several psychological treatments for insomnia. To clarify the effects of these treatments, 66 outcome studies representing 139 treatment groups were included in a meta-analysis. The results indicated that psychological treatments produce considerable enhancement of both sleep patterns and the subjective experience of sleep. In terms of enhancing sleep onset, active treatments were all superior to placebo therapies but did not differ greatly in efficacy. Greater therapeutic gains were available for participants who were clinically referred and who were not regular users of sedative hypnotics. Future research directions are suggested.

Cited by (82)

1. Evaluating non-randomised intervention studies
   Deeks, J, Dinnes, J, D'Amico, R, Sowden, A, Sakarovitch, C, Song, F, Petticrew, M, Altman, D · 2003 · Health Technology Assessment
2. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs.
   Morris, Scott B., DeShon, Richard P. · 2002 · Psychological Methods
3. The consensus sleep diary: standardizing prospective sleep self-monitoring
   Carney, Colleen E., Buysse, Daniel J., Ancoli-Israel, Sonia, Edinger, Jack D., Krystal, Andrew D., Lichstein, Kenneth L., Morin, Charles M. · 2012 · Sleep
4. European guideline for the diagnosis and treatment of insomnia
   Riemann, Dieter, Baglioni, Chiara, Bassetti, Claudio, Bjorvatn, Bjørn, Dolenc Groselj, Leja, Ellis, Jason G., Espie, Colin A., Garcia‐Borreguero, Diego, Gjerstad, Michaela, Gonçalves, Marta et al. · 2017 · Journal of Sleep Research
5. The hyperarousal model of insomnia: A review of the concept and its evidence
   Riemann, Dieter, Spiegelhalder, Kai, Feige, Bernd, Voderholzer, Ulrich, Berger, Mathias, Perlis, Michael, Nissen, Christoph · 2010 · Sleep Medicine Reviews
6. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004)
   Morin, Charles M., Bootzin, Richard R., Buysse, Daniel J., Edinger, Jack D., Espie, Colin A., Lichstein, Kenneth L. · 2006 · Sleep
7. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits
   Glass, Jennifer, Lanctôt, Krista L, Herrmann, Nathan, Sproule, Beth A, Busto, Usoa E · 2005 · BMJ
8. Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial
   Morin, Charles M., Colecchi, Cheryl, Stone, Jackie, Sood, Rakesh, Brink, Douglas · 1999 · JAMA
9. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis
   Trauer, James M., Qian, Mary Y., Doyle, Joseph S., Rajaratnam, Shantha M.W., Cunnington, David · 2015 · Annals of Internal Medicine
10. Chronic insomnia
    Morin, Charles M, Benca, Ruth · 2012 · The Lancet
11. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature
    Smith, Michael T, Haythornthwaite, Jennifer A · 2004 · Sleep Medicine Reviews
12. Sleep and emotions: a focus on insomnia
    Baglioni, Chiara, Spiegelhalder, Kai, Lombardo, Caterina, Riemann, Dieter · 2010 · Sleep Medicine Reviews
13. Nonpharmacologic Treatment of Chronic Insomnia
    Morin, Charles M., Hauri, Peter J., Espie, Colin A., Spielman, Arthur J., Buysse, Daniel J., Bootzin, Richard R. · 1999 · Sleep
14. Comparative Meta-Analysis of Pharmacotherapy and Behavior Therapy for Persistent Insomnia
    Smith, Michael T., Perlis, Michael L., Park, Amy, Smith, Michelle S., Pennington, JaeMi, Giles, Donna E., Buysse, Daniel J. · 2002 · American Journal of Psychiatry
15. Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia
    Manber, Rachel, Edinger, Jack D., Gress, Jenna L., Pedro-Salcedo, Melanie G. San, Kuo, Tracy F., Kalista, Tasha · 2008 · Sleep
16. Insomnia in the Context of Cancer: A Review of a Neglected Problem
    Savard, Josée, Morin, Charles M. · 2001 · Journal of Clinical Oncology
17. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023
    Riemann, Dieter, Espie, Colin A., Altena, Ellemarije, Arnardottir, Erna Sif, Baglioni, Chiara, Bassetti, Claudio L. A., Bastien, Celyne, Berzina, Natalija, Bjorvatn, Bjørn, Dikeos, Dimitris et al. · 2023 · Journal of Sleep Research
18. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications
    Franzen, Peter L., Buysse, Daniel J. · 2008 · Dialogues in Clinical Neuroscience
19. Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis
    van Straten, Annemieke, van der Zweerde, Tanja, Kleiboer, Annet, Cuijpers, Pim, Morin, Charles M., Lancee, Jaap · 2018 · Sleep Medicine Reviews
20. 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
21. Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults
    Espie, Colin A. · 2002 · Annual Review of Psychology
22. Cognitive Behavioral Therapy vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults: A Randomized Controlled Trial
    Sivertsen, Børge, Omvik, Siri, Pallesen, Ståle, Bjorvatn, Bjørn, Havik, Odd E., Kvale, Gerd, Nielsen, Geir Høstmark, Nordhus, Inger Hilde · 2006 · JAMA
23. Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison
    Jacobs, Gregg D., Pace-Schott, Edward F., Stickgold, Robert, Otto, Michael W. · 2004 · Archives of Internal Medicine
24. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+years of age
    Irwin, Michael R., Cole, Jason C., Nicassio, Perry M. · 2006 · Health Psychology
25. The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review
    Espie, Colin A., Broomfield, Niall M., MacMahon, Kenneth M.A., Macphee, Lauren M., Taylor, Lynne M. · 2006 · Sleep Medicine Reviews
26. Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis
    Wu, Jade Q., Appleman, Erica R., Salazar, Robert D., Ong, Jason C. · 2015 · JAMA Internal Medicine
27. (Mis)perception of Sleep in Insomnia: A Puzzle and a Resolution
    Harvey, Allison G., Tang, Nicole K. Y. · 2012 · Psychological Bulletin
28. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies
    Riemann, Dieter, Perlis, Michael L. · 2009 · Sleep Medicine Reviews
29. Relationship of Sleep Hygiene Awareness, Sleep Hygiene Practices, and Sleep Quality in University Students
    Brown, Franklin C., Buboltz, Walter C., Soper, Barlow · 2002 · Behavioral Medicine
30. “Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment
    Espie, Colin A. · 2009 · SLEEP
31. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer
    Espie, Colin A., Fleming, Leanne, Cassidy, James, Samuel, Leslie, Taylor, Lynne M., White, Craig A., Douglas, Neil J., Engleman, Heather M., Kelly, Heidi-Louise, Paul, James · 2008 · Journal of Clinical Oncology
32. Prevalence and correlates of clinical insomnia co‐occurring with chronic back pain
    TANG, NICOLE K. Y., WRIGHT, KELLY J., SALKOVSKIS, PAUL M. · 2007 · Journal of Sleep Research
33. Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness
    Bootzin, Richard R., Stevens, Sally J. · 2005 · Clinical Psychology Review
34. Cognitive and Behavioural Therapy for Insomnia (CBT-I) in Psychiatric Populations: A Systematic Review
    Taylor, Daniel J., Pruiksma, Kristi E. · 2014 · International Review of Psychiatry
35. A meta-analysis of group cognitive behavioral therapy for insomnia
    Koffel, Erin A., Koffel, Jonathan B., Gehrman, Philip R. · 2015 · Sleep Medicine Reviews
36. Cognitive-behavioral therapy for primary insomnia
    Edinger, Jack D., Means, Melanie K. · 2005 · Clinical Psychology Review
37. Cognitive Behavioral Therapy in Persons with Comorbid Insomnia: A Meta-Analysis
    Geiger-Brown, Jeanne M., Rogers, Valerie E., Liu, Wen, Ludeman, Emilie M., Downton, Katherine D., Diaz-Abad, Montserrat · 2015 · Sleep Medicine Reviews
38. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia: CBT for insomnia: a meta-analysis
    OKAJIMA, Isa, KOMADA, Yoko, INOUE, Yuichi · 2011 · Sleep and Biological Rhythms
39. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: A randomized controlled trial
    Talbot, Lisa S., Maguen, Shira, Metzler, Thomas J., Schmitz, Martha, McCaslin, Shannon E., Richards, Anne, Perlis, Michael L., Posner, Donn A., Weiss, Brandon, Ruoff, Leslie et al. · 2014 · Sleep
40. Practice Parameters for the Nonpharmacologic Treatment of Chronic Insomnia
    Chesson, Andrew L., Anderson, W. McDowell, Littner, Michael, Davila, David, Hartse, Kristyna, Johnson, Stephen, Wise, Merrill, Rafecas, Jose · 1999 · Sleep
41. A systematic review of non-pharmacological therapies for sleep problems in later life
    Montgomery, P · 2004 · Sleep Medicine Reviews
42. Computerised Cognitive Behavioural Therapy for Insomnia: A Systematic Review and Meta-Analysis
    Cheng, Sammy K., Dizon, Janine · 2012 · Psychotherapy and Psychosomatics
43. Cognitive–behavioral treatment of insomnia secondary to chronic pain.
    Currie, Shawn R., Wilson, Keith G., Pontefract, Amanda J., deLaplante, Lori · 2000 · Journal of Consulting and Clinical Psychology
44. Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations
    Bastien, Célyne H., Morin, Charles M., Ouellet, Marie-Christine, Blais, France C., Bouchard, Sébastien · 2004 · Journal of Consulting and Clinical Psychology
45. Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions
    Blake, Matthew J., Sheeber, Lisa B., Youssef, George J., Raniti, Monika B., Allen, Nicholas B. · 2017 · Clinical Child and Family Psychology Review
46. Distinguishing rumination from worry in clinical insomnia
    Carney, Colleen E., Harris, Andrea L., Moss, Taryn G., Edinger, Jack D. · 2010 · Behaviour Research and Therapy
47. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety
    Belleville, Geneviève, Cousineau, Héloïse, Levrier, Katia, St-Pierre-Delorme, Marie-Ève · 2011 · Clinical Psychology Review
48. The evidence base of sleep restriction therapy for treating insomnia disorder
    Miller, Christopher B., Espie, Colin A., Epstein, Dana R., Friedman, Leah, Morin, Charles M., Pigeon, Wilfred R., Spielman, Arthur J., Kyle, Simon D. · 2014 · Sleep Medicine Reviews
49. Self-help therapy for insomnia: a meta-analysis
    van Straten, Annemieke, Cuijpers, Pim · 2009 · Sleep Medicine Reviews
50. Emerging research on the treatment and etiology of secondary or comorbid insomnia
    Stepanski, Edward J., Rybarczyk, Bruce · 2006 · Sleep Medicine Reviews
51. A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults.
    Rybarczyk, Bruce, Stepanski, Edward, Fogg, Louis, Lopez, Martita, Barry, Paulette, Davis, Andrew · 2005 · Journal of Consulting and Clinical Psychology
52. Treatment of sleep disturbance in Alzheimer's disease
    McCurry, Susan M., Reynolds, Charles F., Ancoli-Israel, Sonia, Teri, Linda, Vitiello, Michael V. · 2000 · Sleep Medicine Reviews
53. Who is at risk for dropout from group cognitive-behavior therapy for insomnia?
    Ong, Jason C., Kuo, Tracy F., Manber, Rachel · 2008 · Journal of Psychosomatic Research
54. Sleep: important considerations for the prevention of cardiovascular disease
    Grandner, Michael A., Alfonso-Miller, Pamela, Fernandez-Mendoza, Julio, Shetty, Safal, Shenoy, Sundeep, Combs, Daniel · 2016 · Current Opinion in Cardiology
55. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue
    Berger, Ann M., Kuhn, Brett R., Farr, Lynne A., Lynch, James C., Agrawal, Sangeeta, Chamberlain, Julie, Von Essen, Susanna G. · 2009 · Psycho-Oncology
56. Cognitive behaviour therapy for primary insomnia: Can we rest yet?
    Harvey, Allison G, Tang, Nicole K.Y · 2003 · Sleep Medicine Reviews
57. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors
    Epstein, Dana R., Dirksen, Shannon R. · 2007 · Oncology nursing forum
58. Is a Video-Based Cognitive Behavioral Therapy for Insomnia as Efficacious as a Professionally Administered Treatment in Breast Cancer? Results of a Randomized Controlled Trial
    Savard, Josée, Ivers, Hans, Savard, Marie-Hélène, Morin, Charles M. · 2014 · Sleep
59. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies
    Fernandez, Renae, Moore, Vivienne, Van Ryswyk, Emer, Varcoe, Tamara, Rodgers, Raymond, March, Wendy, Moran, Lisa, Avery, Jodie, McEvoy, Doug, Davies, Michael · 2018 · Nature and Science of Sleep
60. CBT-I Coach: A Description and Clinician Perceptions of a Mobile App for Cognitive Behavioral Therapy for Insomnia
    Kuhn, Eric, Weiss, Brandon J., Taylor, Katherine L., Hoffman, Julia E., Ramsey, Kelly M., Manber, Rachel, Gehrman, Philip, Crowley, Jill J., Ruzek, Josef I., Trockel, Mickey · 2016 · Journal of Clinical Sleep Medicine
61. Internet-delivered or mailed self-help treatment for insomnia?: a randomized waiting-list controlled trial
    Lancee, Jaap, van den Bout, Jan, van Straten, Annemieke, Spoormaker, Victor I. · 2012 · Behaviour Research and Therapy
62. Mindfulness-Based Stress Reduction for Chronic Insomnia in Adults Older than 75 Years: A Randomized, Controlled, Single-Blind Clinical Trial
    Zhang, Jia-xu, Liu, Xiao-hui, Xie, Xin-hui, Zhao, Dan, Shan, Mo-shui, Zhang, Xi-liang, Kong, Xiao-ming, Cui, Hong · 2015 · EXPLORE
63. Comparison of Sleep Condition and Sleep-Related Psychological Activity after Cognitive-Behavior and Pharmacological Therapy for Chronic Insomnia
    Wu, Rengang, Bao, Jinfeng, Zhang, Chungai, Deng, Jun, Long, Chunling · 2006 · Psychotherapy and Psychosomatics
64. A Pilot Randomized Controlled Trial of the Effects of Cognitive-Behavioral Therapy for Insomnia on Sleep and Daytime Functioning in College Students
    Taylor, Daniel J., Zimmerman, Marian R., Gardner, Christie E., Williams, Jacob M., Grieser, Emily A., Tatum, Jolyn I., Bramoweth, Adam D., Francetich, Jade M., Ruggero, Camilo · 2014 · Behavior Therapy
65. Cognitive Behavioral Therapy for Insomnia Outcomes in Women After Primary Breast Cancer Treatment: A Randomized, Controlled Trial
    Matthews, Ellyn E., Berger, Ann M., Schmiege, Sarah J., Cook, Paul F., McCarthy, Michaela S., Moore, Camille M., Aloia, Mark S. · 2014 · Oncology Nursing Forum
66. The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression
    Manber, Rachel, Rush, A. John, Thase, Michael E, Arnow, Bruce, Klein, Dan, Trivedi, Madhukar H., Korenstein, Susan G., Markowitz, John C., Dunner, David L., Munsaka, Melvin et al. · 2003 · SLEEP
67. Clinical significance and predictors of treatment response to cognitive-behavior therapy for insomnia secondary to chronic pain
    Currie, Shawn R., Wilson, Keith G., Curran, Dorothyann · 2002 · Journal of Behavioral Medicine
68. Non-Pharmacological Treatment of Insomnia
    Siebern, Allison T., Suh, Sooyeon, Nowakowski, Sara · 2012 · Neurotherapeutics
69. Perinatal Insomnia and Mental Health: a review of recent literature
    Swanson, Leslie M., Kalmbach, David A., Raglan, Greta B., O’Brien, Louise M. · 2020 · Current Psychiatry Reports
70. Benzodiazepines
    Howard, Paul, Twycross, Robert, Shuster, John, Mihalyo, Mary, Wilcock, Andrew · 2014 · Journal of Pain and Symptom Management
71. Predicting longer-term outcomes following psychological treatment for hypnotic-dependent chronic insomnia
    Morgan, Kevin, Thompson, Joanne, Dixon, Simon, Tomeny, Maureen, Mathers, Nigel · 2003 · Journal of Psychosomatic Research
72. Sleep disturbance in bereavement
    Monk, Timothy H., Germain, Anne, Reynolds, Charles F. · 2008 · Psychiatric Annals
73. Residual sleep beliefs and sleep disturbance following cognitive behavioral therapy for major depression
    Carney, Colleen E., Harris, Andrea L., Friedman, Joey, Segal, Zindel V. · 2011 · Depression and Anxiety
74. What do we really know about mindfulness and sleep health?
    Ong, Jason C, Moore, Cameron · 2020 · Current Opinion in Psychology
75. On the comparability of pharmacotherapy and behavior therapy for chronic insomnia
    Perlis, Michael L., Smith, Michael T., Cacialli, D.O., Nowakowski, S., Orff, Henry · 2003 · Journal of Psychosomatic Research
76. Examining insomnia and PTSD over time in veterans in residential treatment for substance use disorders and PTSD
    Colvonen, Peter J., Ellison, Jennifer, Haller, Moira, Norman, Sonya B. · 2019 · Behavioral Sleep Medicine
77. Are Changes in Worry Associated with Treatment Response in Cognitive Behavioral Therapy for Insomnia?
    Sunnhed, Rikard, Jansson-Fröjmark, Markus · 2014 · Cognitive Behaviour Therapy
78. Improving the Mental Health of Older Adults
    Knight, Bob G., Kaskie, Brian, Shurgot, Gia Robinson, Dave, Jennifer · 2006 · Handbook of the Psychology of Aging
79. Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders
    Ferracioli-Oda, Eduardo, Qawasmi, Ahmad, Bloch, Michael H. · 2018 · Focus
80. The effect of single‐component sleep restriction therapy on depressive symptoms: A systematic review and meta‐analysis
    Tse, Katrina Yan Kei, Maurer, Leonie Franziska, Espie, Colin Alexander, Kyle, Simon David · 2024 · Journal of Sleep Research
81. Cognitive Therapy for Insomnia
    Soehner, A., Kaplan, K., Kanady, J., Harvey, A.G. · 2013 · Encyclopedia of Sleep
82. Applicability of two brief evidence-based interventions to improve sleep quality in inpatient mental health care: APPLICABILITY OF SLEEP INTERVENTIONS
    de Niet, Gerrit, Tiemens, Bea, van Achterberg, Theo, Hutschemaekers, Giel · 2011 · International Journal of Mental Health Nursing