Cognitive behaviour therapy for primary insomnia: Can we rest yet?

Harvey, Allison G; Tang, Nicole K.Y

doi:10.1053/smrv.2002.0266

Cited by 158Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Cognitive behaviour therapy for primary insomnia: Can we rest yet?

Harvey, Allison G, Tang, Nicole K.Y·2003·Sleep Medicine Reviews

DOI 10.1053/smrv.2002.0266

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Abstract

Cognitive behaviour therapy (CBT) for chronic insomnia has been a topic of interest to researchers and clinicians for over forty years. Investment in this area has paid off. Two meta-analyses and one major review by the Standards of Practice Committee of the American Academy of Sleep Medicine have concluded, beyond doubt, that CBT is effective in the treatment of primary insomnia. In this paper we argue that it is timely to raise new questions of CBT for insomnia: namely, is there still room for improvement? and can we rest yet? Whilst significant progress has been made we argue that the field is not, as yet, at a point where patients can be offered a maximally effective psychological treatment. Two lines of argument are developed to support this conclusion. First, it is noted that whilst the effect size for CBT for insomnia is moderate, it is lower than the effect sizes reported for CBT for a range of other psychological disorders. Second, it is suggested that the large literature outlining optimal procedures for conducting randomised controlled trials (RCTs) need to be more fully adopted by research workers in this field. Directions for future research are outlined including (1) guidelines for improved RCT methodology and (2) suggestions for developing empirically grounded treatments.

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One study found that 19-26% of participants failed to show any response to treatment, and the overall reduction of insomnia symptoms averaged only 50-60%.
“One study found that 19-26% of participants failed to show any response to treatment, and the overall reduction of insomnia symptoms average only 50-60%.4”
From Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial (2021) · cites this paper as [4]
Adherence to stimulus control and sleep restriction techniques is difficult for many participants.
“Moreover, adherence to stimulus control and sleep restriction techniques is difficult for many participants,4”
From Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial (2021) · cites this paper as [4]

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“Such biomarkers could provide clues on the mechanisms and pathways that underlie the disorder and consequently provide the basis needed to develop rational and more effective treatments than presently available [3].”
Background
The caudate: a key node in the neuronal network imbalance of insomnia?
Stoffers, D., Altena, E., van der Werf, Y. D., Sanz‐Arigita, E., Voorn, T., Astill, R. G., STRIJERS, R. L. M., Waterman, D., & Someren, E. J. W. V. (2013) · Brain · doi:10.1093/brain/awt329 · Cited by 158 · see citing works
“Even though treatments for insomnia have statistically significant effects, they typically do not yield full remission (for a review, see Harvey and Tang, 2003).”
Background
The efficacy of cognitive and behavior therapies for insomnia on daytime symptoms: a systematic review and network meta-analysis
Benz, F., Knoop, T., Ballesio, A., Bacaro, V., Johann, A. F., Rücker, G., Feige, B., Riemann, D., & Baglioni, C. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101873 · Cited by 142 · see citing works
The Complex Role of Sleep in Adolescent Depression
Clarke, G. N., & Harvey, A. G. (2012) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2012.01.006 · Cited by 139 · see citing works
Insomnia in cancer patients
O’Donnell, J. F. (2004) · Clinical cornerstone · doi:10.1016/s1098-3597(05)80002-x · Cited by 134 · see citing works
Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia -a randomized controlled trial
Jernelöv, S., Lekander, M., Blom, K., Rydh, S., Ljótsson, B., Axelsson, J., & Kaldo, V. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-5 · Cited by 127 · see citing works
Sleep’s role in the development and resolution of adolescent depression
Gradisar, M., Kahn, M., Micic, G., Short, M. A., Reynolds, C. M., Orchard, F., Bauducco, S., Bartel, K., & Richardson, C. E. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-022-00074-8 · Cited by 129 · see citing works
Management of chronic insomnia in elderly persons.
Bain, K. (2006) · The American Journal of Geriatric Pharmacotherapy · doi:10.1016/j.amjopharm.2006.06.006 · Cited by 124 · see citing works
An Exploratory Study on the Effects of Tele-neurofeedback and Tele-biofeedback on Objective and Subjective Sleep in Patients with Primary Insomnia
Cortoos, A., Valck, E. D., Arns, M., BRETELER, M. H. M., & Cluydts, R. (2009) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-009-9116-z · Cited by 111 · see citing works
“Cognitive hyperarousal, in turn, is characterised by intrusive and often negative cognitions close to bedtime (Robertson et al. 2007) and during sleep onset, as well as during periods of wakefulness during the night (Libman et al. 1997; Wicklow and Espie 2000; Harvey and Tang 2003).”
Regensburg Insomnia Scale (RIS): a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; Study design: development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls
Crönlein, T., Langguth, B., Popp, R., Lukesch, H., Pieh, C., Hajak, G., & Geisler, P. (2013) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-11-65 · Cited by 109 · see citing works
Altering misperception of sleep in insomnia: Behavioral experiment versus verbal feedback.
Tang, N. K. Y., & Harvey, A. G. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.4.767 · Cited by 104 · see citing works
Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients
Forsell, E., Jernelöv, S., Blom, K., Kraepelien, M., Svanborg, C., Andersson, G., Lindefors, N., & Kaldo, V. (2019) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.18060699 · Cited by 100 · see citing works
Randomized controlled trials of psychological and pharmacological treatments for nightmares: A meta-analysis
Augedal, A. W., Hansen, K. S., Kronhaug, C. R., Harvey, A. G., & Pallesen, S. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2012.06.001 · Cited by 98 · see citing works
Self-citation
Mindfulness-Based Cognitive Therapy for Persistent Insomnia: A Pilot Study
Heidenreich, T., Tuin, I., Pflug, B., Michal, M., & Michalak, J. (2006) · Psychotherapy and Psychosomatics · doi:10.1159/000091778 · Cited by 97 · see citing works
The Role of Acceptance and Mindfulness in the Treatment of Insomnia
Lundh, L.-G. (2005) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.19.1.29.66331 · Cited by 112 · see citing works
We know CBT-I works, now what?
Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D. A., Bastien, C., Drummond, S. P. A., & Perlis, M. L. (2022) · Faculty Reviews · doi:10.12703/r/11-4 · Cited by 91 · see citing works
Assessing cognitive processes related to insomnia: a review and measurement guide for Harvey’s cognitive model for the maintenance of insomnia
Hiller, R. M., Johnston, A., Dohnt, H., Lovato, N., & Gradisar, M. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.11.006 · Cited by 90 · see citing works
Sleep and circadian rhythms in children and adolescents with bipolar disorder
HARVEY, A. G., MULLIN, B. C., & HINSHAW, S. P. (2006) · Development and Psychopathology · doi:10.1017/s095457940606055x · Cited by 88 · see citing works
“It can be effectively disseminated into the community and the effects endure to 24 months after the conclusion of the intervention ~for review, see Harvey & Tang, 2003!.”
Background
Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols
Hammer, B., Colbert, A. P., Brown, K. A., & Ilioi, E. C. (2011) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-011-9165-y · Cited by 86 · see citing works
“Furthermore, all patients in this study achieved post-treatment normal sleep, whereas most patients receiving CBT for insomnia disorder do not become good sleepers, and the effect sizes are smaller than those treated with CBT for other conditions (Harvey and Tang 2003).”
Background
Acceptance and commitment therapy (ACT) improves sleep quality, experiential avoidance, and emotion regulation in individuals with insomnia-results from a randomized interventional study
Zakiei, A., Khazaie, H., Rostampour, M., Lemola, S., Esmaeili, M., Dürsteler, K., Brühl, A., Sadeghi-Bahmani, D., & Brand, S. (2021) · Life · doi:10.3390/life11020133 · Cited by 84 · see citing works
“CBT interventions appeared to lead to medium [31] and clinically meaningful effect sizes [23], although risks of relapses were also reported [32].”
Background
Psychological mechanisms in the maintenance of insomnia: Arousal, distress, and sleep-related beliefs
Jansson‐Fröjmark, M., & Linton, S. J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.04.003 · Cited by 84 · see citing works
Is Disturbed Intracortical Excitability a Stable Trait of Chronic Insomnia? A Study Using Transcranial Magnetic Stimulation Before and After Multimodal Sleep Therapy
van der Werf, Y. D., Altena, E., van Dijk, K. D., STRIJERS, R. L. M., Rijke, W. D., Stam, C. J., & Someren, E. J. W. V. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.06.028 · Cited by 80 · see citing works
Overnight worsening of emotional distress indicates maladaptive sleep in insomnia
Wassing, R., Benjamins, J. S., Talamini, L. M., Schalkwijk, F., & Van Someren, E. J. W. (2019) · Sleep · doi:10.1093/sleep/zsy268 · Cited by 78 · see citing works
“CBT-I works in about 70% of the cases, yet ameliorates complaints only by about 30% [10, 11].”
Background
Neurophysiological aspects of primary insomnia: Implications for its treatment
Cortoos, A., Verstraeten, E., & Cluydts, R. (2006) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2006.01.002 · Cited by 69 · see citing works
Quality of Life Improvements after Acceptance and Commitment Therapy in Nonresponders to Cognitive Behavioral Therapy for Primary Insomnia
Hertenstein, E., Thiel, N., Lüking, M., Külz, A. K., Schramm, E., Baglioni, C., Spiegelhalder, K., Riemann, D., & Nissen, C. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000365173 · Cited by 63 · see citing works
Safety behaviors and dysfunctional beliefs about sleep: Testing a cognitive model of the maintenance of insomnia
Woodley, J., & Smith, S. S. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.03.002 · Cited by 63 · see citing works
“Considerable research evidence suggests that dysfunctional beliefs about sleep and maladaptive coping behaviors are influential factors in maintaining insomnia [3,6–18].”
Background
Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review
Madsen, M. T., Huang, C., Zangger, G., Zwisler, A., & Gögenür, I. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7684 · Cited by 62 · see citing works
“79,80 Both non-pharmacological (eg, cognitive behavioral therapy 81 ) and pharmacological (eg, hypnotics) treatment options are possible C o p y r i g h t © A m e r i c a n A c a d e m y o f S l ee p M e d i c i n e limitation of the literature is the minority of studies including healthy controls,…”
Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial
Madsen, M. T., Hansen, M. V., Andersen, L. T., Hageman, I., Rasmussen, L. S., Bokmand, S., Rosenberg, J., & Gögenür, I. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5490 · Cited by 62 · see citing works
“17 The primary recommended treatment of insomnia in a healthy population is cognitive behavioural therapy, 18 which has also been investigated in patients with breast cancer. both during oncological treatment 19 and in breast cancer survivors.”
Cognitive factors and processes in models of insomnia: A systematic review
Tang, N. K. Y., Saconi, B., Jansson‐Fröjmark, M., Ong, J. C., & Carney, C. E. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13923 · Cited by 66 · see citing works
“…opinion leaders recommend exploring ways to maximise treatment outcomes, identifying pathways that mediate treatment effect, and addressing factors associated with non-response (Harvey & Tang, 2003; Kyle et al., 2013; Manber et al., 2015; Muench et al., 2022; Vitiello et al., 2013b, 2013a).”
Background
Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context
Morris, J., Firkins, A., Millings, A., Möhr, C., Redford, P., & Rowe, A. (2015) · Anxiety Stress & Coping · doi:10.1080/10615806.2015.1058924 · Cited by 60 · see citing works
“Meta-analyses have found CBT to be effective at treating anxiety (Morin et al., 2006; Norton & Price, 2007) and insomnia (Harvey & Tang, 2003; Okajima, Komada, & Inoue, 2011) in a range of populations.”
Background
Incorporating principles from acceptance and commitment therapy into cognitive-behavioral therapy for insomnia: A case example
Dalrymple, K. L., Fiorentino, L., Politi, M. C., & Posner, D. (2010) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-010-9145-1 · Cited by 58 · see citing works
Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: effects on insomnia and circadian rhythm during chemotherapy: a phase II randomised multicentre controlled trial
Palesh, O. G., Scheiber, C., Kesler, S. R., Janelsins, M. C., Guido, J. J., Heckler, C. E., Cases, M. G., Miller, J. M., Chrysson, N. G., & Mustian, K. M. (2018) · British Journal of Cancer · doi:10.1038/s41416-018-0154-2 · Cited by 56 · see citing works
Insomnia identity
Lichstein, K. L. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.08.005 · Cited by 54 · see citing works
The effect of physical exercise interventions on insomnia: A systematic review and meta-analysis
Riedel, A., Benz, F., Deibert, P., Barsch, F., Frase, L., Johann, A. F., Riemann, D. W., & Feige, B. (2024) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2024.101948 · Cited by 55 · see citing works
Reduced dynamic functional connectivity between salience and executive brain networks in insomnia disorder
Wei, Y., Leerssen, J., Wassing, R., Stoffers, D., Perrier, J., & Someren, E. J. W. V. (2019) · Journal of Sleep Research · doi:10.1111/jsr.12953 · Cited by 53 · see citing works
“Cognitive-behaviour therapy is effective in reducing symptoms but still leaves room for improvement (Harvey & Tang, 2003).”
Background
A penny for your thoughts: Patterns of sleep-related beliefs, insomnia symptoms and treatment outcome
Sánchez-Ortuño, M. M., & Edinger, J. D. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.10.003 · Cited by 52 · see citing works
“Whatever the mechanism of change is, it is a matter of fact that not all patients respond optimally to this form of treatment (Harvey & Tang, 2003; Morin, Culbert, & Schwartz, 1994).”
Background
Intensive Sleep Retraining treatment for chronic primary insomnia: a preliminary investigation
Harris, J. K., Lack, L. C., WRIGHT, H., Gradisar, M., & Brooks, A. K. (2007) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2007.00595.x · Cited by 51 · see citing works
Actigraphy for measurements of sleep in relation to oncological treatment of patients with cancer: A systematic review
Madsen, M. T., Huang, C., & Gögenür, I. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.07.002 · Cited by 53 · see citing works
Telehealth-delivered CBT-I programme enhanced by acceptance and commitment therapy for insomnia and hypnotic dependence: A pilot randomized controlled trial
Chapoutot, M., Peter‐Derex, L., Schoendorff, B., Faivre, T., Bastuji, H., & Putois, B. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13199 · Cited by 47 · see citing works
Prevalence and Predictors of Prescription Sleep Aid Use among Individuals with DSM-5 Insomnia: The Role of Hyperarousal
Pillai, V., Cheng, P., Kalmbach, D. A., Roehrs, T., Roth, T. G., & Drake, C. L. (2016) · SLEEP · doi:10.5665/sleep.5636 · Cited by 49 · see citing works
Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: a systematic review of randomized and non-randomized trials
Paulos-Guarnieri, L., Linares, I. M. P., & El Rafihi-Ferreira, R. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.11.001 · Cited by 48 · see citing works
Treatment of insomnia in older adults
Nau, S. D., McCrae, C. S., Cook, K. G., & Lichstein, K. L. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.008 · Cited by 48 · see citing works
Nasal dilator strip therapy for chronic sleep-maintenance insomnia and symptoms of sleep-disordered breathing: A randomized controlled trial
Krakow, B., Melendrez, D., Sisley, B., Warner, T. D., Krakow, J., Leahigh, L., & Lee, S. (2006) · Sleep And Breathing · doi:10.1007/s11325-005-0037-7 · Cited by 45 · see citing works
Self-help treatment for insomnia through television and book: A randomized trial
van Straten, A., Cuijpers, P. J., Smit, F., Spermon, M., & Verbeek, I. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.07.050 · Cited by 45 · see citing works
“It incorporates several components which are known to be effective in a face-to-face setting [8].”
Background
Nonpharmacologic Therapy for Insomnia in the Elderly
Joshi, S. (2007) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2007.08.005 · Cited by 44 · see citing works
The Anxiolytic Effects of Cognitive Behavior Therapy for Insomnia: Preliminary Results from a Web-delivered Protocol.
Pillai, V., Anderson, J. R., Cheng, P., Bazan, L. F., Bostock, S., Espie, C. A., Roth, T. G., & Drake, C. L. (2015) · PubMed · Cited by 44 · see citing works
Mediators and treatment matching in behavior therapy, cognitive therapy and cognitive behavior therapy for chronic insomnia.
Harvey, A. G., Dong, L., Bélanger, L., & Morin, C. M. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000244 · Cited by 43 · see citing works
“Despite the impressive outcomes associated with CBT for insomnia, there is room for improvement (Buysse, 2013; Espie, Inglis, & Harvey, 2001; Harvey & Tang, 2003; Morin, Culbert, & Schwartz, 1994).”
Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial
van der Zweerde, T., Lancee, J., Slottje, P., Bosmans, J. E., Someren, E. J. W. V., Reynolds, C. F., Cuijpers, P. J., & van Straten, A. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0783-z · Cited by 40 · see citing works
“Therefore, CBT-I is considered the preferred treatment for insomnia [17, 20, 25–30] and is recommended in several insomnia guidelines (e.”
Background
Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial
El Rafihi-Ferreira, R., Morin, C. M., Toscanini, A. C., Lotufo Neto, F., Brasil, I. S., Gallinaro, J. G., Borges, D. S., Conway, S. G., & Hasan, R. (2021) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2020-0947 · Cited by 38 · see citing works
Cognitive Behavioral Therapy for Sleep Disorders
Babson, K. A., Feldner, M. T., & Badour, C. L. (2010) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.04.011 · Cited by 37 · see citing works
New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences
Lechat, B., Scott, H., Naik, G. R., Hansen, K. L., Nguyen, D. P., Vakulin, A., CATCHESIDE, P. G., & Eckert, D. J. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.751730 · Cited by 37 · see citing works
A Pilot Randomized Controlled Trial (RCT) of Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Chronic Insomnia
El Rafihi-Ferreira, R., Morin, C. M., Hasan, R., Brasil, I. S., Zago Ribeiro, J. H., & Cecília Toscanini, A. (2023) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2071272 · Cited by 31 · see citing works
“Furthermore, adherence to stimulus control and sleep restriction techniques is difficult for many individuals (Harvey & Tang, 2003).”
Background
Insomnia Subtypes Have Differentiating Deviations in Brain Structural Connectivity
Bresser, T., Blanken, T. F., de Lange, S. C., Leerssen, J., Foster‐Dingley, J. C., Lakbila‐Kamal, O., Wassing, R., Ramautar, J. R., Stoffers, D., van den Heuvel, M. P., et al. (2024) · Biological Psychiatry · doi:10.1016/j.biopsych.2024.06.014 · Cited by 32 · see citing works
Auricular Acupuncture and Cognitive Behavioural Therapy for Insomnia: A Randomised Controlled Study
Bergdahl, L., Broman, J., Berman, A. H., Haglund, K., von Knorring, L., & Markström, A. (2016) · Sleep Disorders · doi:10.1155/2016/7057282 · Cited by 31 · see citing works
“According to a review by Harvey and Tang [15] CBT seemed less effective for treating insomnia disorder compared to treating other psychological disorders.”
Background
The Experience of Poor Sleep and its Consequences: a Qualitative Study involving People referred for Cognitive-Behavioural Management of Chronic Insomnia
Green, A., Hicks, J., & Wilson, S. J. (2008) · British Journal of Occupational Therapy · doi:10.1177/030802260807100506 · Cited by 30 · see citing works
Enhancing CBT for Chronic Insomnia: A Randomised Clinical Trial of Additive Components of Mindfulness or Cognitive Therapy
Wong, M. Y., Ree, M. J., & Lee, C. W. (2015) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1980 · Cited by 30 · see citing works
Selecting a pharmacotherapy regimen for patients with chronic insomnia
Hassinger, A. B., Bletnisky, N., Dudekula, R., & El-Solh, A. (2020) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2020.1743265 · Cited by 32 · see citing works
“In addition, CBT drop-out rates range from 22% to 30% [24].”
Background
Internet-Delivered Cognitive Behavioral Therapy for Insomnia
van der Zweerde, T., Lancee, J., Luik, A. I., & van Straten, A. (2020) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2020.02.001 · Cited by 30 · see citing works
Combined Internet-Based Cognitive-Behavioral and Chronobiological Intervention for Insomnia: A Randomized Controlled Trial
Dekker, K., Benjamins, J. S., Maksimovic, T., Filardi, M., Hofman, W. F., van Straten, A., & Someren, E. J. W. V. (2019) · Psychotherapy and Psychosomatics · doi:10.1159/000503570 · Cited by 29 · see citing works
The effects of kiwi fruit consumption in students with chronic insomnia symptoms: a randomized controlled trial
Nødtvedt, Ø. O., Hansen, A. L., Bjorvatn, B., & Pallesen, S. (2017) · Sleep and Biological Rhythms · doi:10.1007/s41105-017-0095-9 · Cited by 27 · see citing works
Worry about COVID‐19 as a predictor of future insomnia
Brown, L. A., Hamlett, G. E., Zhu, Y., Wiley, J. F., Moore, T. M., DiDomenico, G. E., Visoki, E., Greenberg, D. M., Gur, R. C., Gur, R. E., et al. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13564 · Cited by 24 · see citing works
“This series of findings has implications for cognitive behavioural therapy, an evidence- based treatment for chronic worry (Covin, Ouimet, Seeds, & Dozois, 2008) that also results in significant improvements in insomnia symptoms (Harvey & Tang, 2003).”
Background
Complementary and alternative treatments for insomnia disorder: a systematic umbrella review
Ell, J., Schmid, S. R., Benz, F., & Spille, L. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13979 · Cited by 25 · see citing works
“First, studies suggest that around 20% – 40% of patients with insomnia disorder do not respond to CBT-I or may experience only partial improvement (Harvey & Tang, 2003; Morin et al., 2020; Morin & Benca, 2012), so this subgroup could profit from alternative treatments.”
Background
Examining the barriers and recommendations for integrating more equitable insomnia treatment options in primary care
Vargas, I., Egeler, M. E., Walker, J. L., & Benitez, D. E. D. (2023) · Frontiers in Sleep · doi:10.3389/frsle.2023.1279903 · Cited by 23 · see citing works
“CBT-I is a behavioral intervention that is highly eﬃcacious (Morin et al., 1994; Smith et al., 2002; Harvey and Tang, 2003; Irwin et al., 2006; Mitchell et al., 2012; Koﬀel et al., 2015; Seyﬀert et al., 2016) and has been named the ﬁrst-line treatment for chronic insomnia (Schutte-Rodin et al.,…”
When research leads to learning, but not action in high performance sport
ROSS, E. Z., Gupta, L., & Sanders, L. (2018) · Progress in brain research · doi:10.1016/bs.pbr.2018.08.001 · Cited by 24 · see citing works
Candidate Cognitive Processes in Psychophysiologic Insomnia
Broomfield, N. M., Gumley, A. I., & Espie, C. A. (2005) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.19.1.5.66328 · Cited by 22 · see citing works
Don't worry, be constructive: A randomized controlled feasibility study comparing behaviour therapy singly and combined with constructive worry for insomnia
Jansson‐Fröjmark, M., Lind, M., & Sunnhed, R. (2011) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.2011.02018.x · Cited by 22 · see citing works
Combined Insomnia and Poor CPAP Compliance: A Case Study and Discussion
Wickwire, E. M., Schumacher, J. A., Richert, A. C., Sinan Baran, A., & Roffwarg, H. P. (2008) · Clinical Case Studies · doi:10.1177/1534650107309187 · Cited by 21 · see citing works
“Yet the effect size for CBT-I, although moderate, is lower when compared to the treatments for other psychological disorders, suggesting that current CBT-I protocols are not yet maximally effective (Harvey & Tang, 2003).”
Result
NHG-Standaard Slaapproblemen en slaapmiddelen
Neven, A. K., Lucassen, P. L., Bonsema, K., Teunissen, H., Verduijn, M. M., & Bouma, M. (2009) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-6614-9_30 · Cited by 21 · see citing works
Management of insomnia in older adults
Sivertsen, B., & Nordhus, I. H. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.031278 · Cited by 21 · see citing works
“Future research should attempt to identify the mechanisms and specific processes involved in the development and maintenance of insomnia, as this condition is typically maintained by a range of cognitive processes regardless of any original trigger (Harvey & Tang, 2003).”
Background
Sleep: A behavioral account.
Blampied, N. M., & Bootzin, R. R. (2012) · American Psychological Association eBooks · doi:10.1037/13938-017 · Cited by 20 · see citing works
Acceptance and commitment therapy for insomnia and sleep quality: A systematic review and meta-analysis
Ruan, J., Chen, S., Liang, J., Mak, Y. W., Yee Ho, F. Y., Chung, K. F., Kwun Tong, A. K., Zhang, X. L., & Yeung, W. F. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.09.002 · Cited by 20 · see citing works
What predicts patients’ perceptions of improvement in insomnia?
Vincent, N., PENNER, S., & Lewycky, S. T. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00529.x · Cited by 19 · see citing works
“…therapy, stimulus control, sleep hygiene, relaxation training, and hypnotic medication withdrawal are considered to reflect the state of the art treatment for insomnia, we may have a ways to go in terms of improving the effectiveness of treatment (see Harvey and Tang, 2003 for a similar view).”
Background
Hormone replacement therapy in menopausal women: Past problems and future possibilities
Schmidt, J. W., Wollner, D. A., Curcio, J. J., Riedlinger, J. E., & Kim, L. S. (2006) · Gynecological Endocrinology · doi:10.1080/09513590600927017 · Cited by 18 · see citing works
“Non-drug alternatives such as behavior modification may successfully mitigate some vasomotor symptoms and correct sleep patterns for some women [8].”
Background
Towards quantitative cutoffs for insomnia: how current diagnostic criteria mischaracterize remission
Pillai, V., Roth, T. G., & Drake, C. L. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.01.013 · Cited by 17 · see citing works
“The emergence of safe and effective behavioral [28] and pharmacological [29] treatments further justifies casting a wide net to capture this debilitating disorder.”
Background
CBT-I Cannot Rest Until the Sleepy Teen Can
Gradisar, M., & Richardson, C. E. (2015) · SLEEP · doi:10.5665/sleep.5220 · Cited by 16 · see citing works
Cognitive behavioural therapy for tinnitus-related insomnia: evaluating a new treatment approach
Marks, E. M., McKenna, L., & Vogt, F. (2019) · International Journal of Audiology · doi:10.1080/14992027.2018.1547927 · Cited by 14 · see citing works
“Meta-analyses tend to report effect sizes as greater for SOL than TST (e.g. Harvey & Tang, 2003), and single RCTs of CBTi for illness-related insomnia report significant improvements in SE, SOL and WASO, but non-significant increases in TST (e.g. Improvement was also seen in anxiety and depression,…”
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Cognitive-behavioral therapy for primary insomnia: a systematic review
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Authors: Harvey, A. G., & Tang, N. K. Y.
Affiliations: University of Oxford (GB)
ORCID: Harvey, Allison G
Tang, Nicole K.Y
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2003-06
Volume: 7
Issue: 3
Pages: 237-262
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1053/smrv.2002.0266
OpenAlex: W2171860213
Cited by: 158
References: 80
Citations by year: 2026: 2 · 2025: 8 · 2024: 8 · 2023: 12 · 2022: 8 · 2021: 10 · 2020: 10 · 2019: 7 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 11 · 2013: 5 · 2012: 6
FWCI: 1.27
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Funders: Wellcome Trust
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 › Psychotherapy Techniques and Applications
Keywords: cognitive behavioral therapy, primary insomnia, chronic insomnia, treatment effectiveness, effect size
MeSH terms: Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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Cognitive behaviour therapy for primary insomnia: Can we rest yet?

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