Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial
Open accessAbstract
OBJECTIVE: To examine the unique contribution of behavior therapy (BT) and cognitive therapy (CT) relative to the full cognitive behavior therapy (CBT) for persistent insomnia. METHOD: Participants were 188 adults (117 women; M age = 47.4 years, SD = 12.6) with persistent insomnia (average of 14.5 years duration). They were randomized to 8 weekly, individual sessions consisting of BT (n = 63), CT (n = 65), or CBT (n = 60). RESULTS: Full CBT was associated with greatest improvements, the improvements associated with BT were faster but not as sustained and the improvements associated with CT were slower and sustained. The proportion of treatment responders was significantly higher in the CBT (67.3%) and BT (67.4%) relative to CT (42.4%) groups at post treatment, while 6 months later CT made significant further gains (62.3%), BT had significant loss (44.4%), and CBT retained its initial response (67.6%). Remission rates followed a similar trajectory, with higher remission rates at post treatment in CBT (57.3%) relative to CT (30.8%), with BT falling in between (39.4%); CT made further gains from post treatment to follow up (30.9% to 51.6%). All 3 therapies produced improvements of daytime functioning at both post treatment and follow up, with few differential changes across groups. CONCLUSIONS: Full CBT is the treatment of choice. Both BT and CT are effective, with a more rapid effect for BT and a delayed action for CT. These different trajectories of changes provide unique insights into the process of behavior change via behavioral versus cognitive routes.
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Sleep effort and cognitive arousal are modifiable perpetuating factors that can be influenced by cognitive behavioral therapy and mindfulness-based therapy for insomnia treatments.
“Additionally, sleep effort and cognitive arousal are modifiable perpetuating factors that can be influenced by cognitive behavioral therapy and mindfulness-based therapy for insomnia treatments [56–60].”
From Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms (2024) · cites this paper as [59]
The introductory passage labeled Abstract > Conclusions says CBT targets sleep-related worry and hyperarousal, and Method > Treatments describes therapy aimed at reversing cognitive processes that maintain insomnia. These passages support the cognitive-arousal aspect, but our copy does not establish the claim about sleep effort or mindfulness-based therapy; the trial compared CBT, cognitive therapy, and behavior therapy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe mean change on the Insomnia Severity Index in this study was d = 0.4, which is lower than the typical d = 2.0-2.5 found in treatment studies using behavioral or cognitive behavioral therapy for insomnia.
“This is particularly interesting because the mean change on the insomnia severity index was lower (d = 0.4) than what is typically found in treatment studies using behavioral or cognitive behavioral therapy for insomnia (d = 2.0-2.5)(e.g.(40)).”
From The role of insomnia in the treatment of chronic fatigue. (2015) · cites this paper as [40]
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- Authors
- Harvey, A. G., Bélanger, L., Talbot, L., Eidelman, P., Beaulieu-Bonneau, S., Fortier-Brochu, É., Ivers, H., Lamy, M., Hein, K., Soehner, A. M., Mérette, C., & Morin, C. M.
- Affiliations
- University of California, Berkeley (US)
- Université Laval (CA)
- University of California, San Francisco (US)
- University of Pittsburgh Medical Center (US)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2014-08
- Volume
- 82
- Issue
- 4
- Pages
- 670-683
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC4185428
- OpenAlex
- W2320158205
- Cited by
- 215
- References
- 69
- Citations by year
- 2026: 11 · 2025: 25 · 2024: 17 · 2023: 19 · 2022: 16 · 2021: 25 · 2020: 12 · 2019: 13 · 2018: 13 · 2017: 26 · 2016: 13 · 2015: 16 · 2014: 7 · 2013: 1
- FWCI
- 28.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health
- 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
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- chronic insomnia, behavior therapy, cognitive therapy, cognitive behavioral therapy, treatment efficacy, treatment response, remission, daytime functioning, behavior change, cognitive change
- MeSH terms
- Adult, Aged, Behavior Therapy, Chronic Disease, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Cognitive Behavioral Therapy, Treatment Outcome
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