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Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004)
Open accessAbstract
BACKGROUND: Recognition that psychological and behavioral factors play an important role in insomnia has led to increased interest in therapies targeting these factors. A review paper published in 1999 summarized the evidence regarding the efficacy of psychological and behavioral treatments for persistent insomnia. The present review provides an update of the evidence published since the original paper. As with the original paper, this review was conducted by a task force commissioned by the American Academy of Sleep Medicine in order to update its practice parameters on psychological and behavioral therapies for insomnia. METHODS: A systematic review was conducted on 37 treatment studies (N = 2246 subjects/patients) published between 1998 and 2004 inclusively and identified through Psyclnfo and Medline searches. Each study was systematically reviewed with a standard coding sheet and the following information was extracted: Study design, sample (number of participants, age, gender), diagnosis, type of treatments and controls, primary and secondary outcome measures, and main findings. Criteria for inclusion of a study were as follows: (a) the main sleep diagnosis was insomnia (primary or comorbid), (b) at least 1 treatment condition was psychological or behavioral in content, (c) the study design was a randomized controlled trial, a nonrandomized group design, a clinical case series or a single subject experimental design with a minimum of 10 subjects, and (d) the study included at least 1 of the following as dependent variables: sleep onset latency, number and/or duration of awakenings, total sleep time, sleep efficiency, or sleep quality. RESULTS: Psychological and behavioral therapies produced reliable changes in several sleep parameters of individuals with either primary insomnia or insomnia associated with medical and psychiatric disorders. Nine studies documented the benefits of insomnia treatment in older adults or for facilitating discontinuation of medication among chronic hypnotic users. Sleep improvements achieved with treatment were well sustained over time; however, with the exception of reduced psychological symptoms/ distress, there was limited evidence that improved sleep led to clinically meaningful changes in other indices of morbidity (e.g., daytime fatigue). Five treatments met criteria for empirically-supported psychological treatments for insomnia: Stimulus control therapy, relaxation, paradoxical intention, sleep restriction, and cognitive-behavior therapy. DISCUSSION: These updated findings provide additional evidence in support of the original review's conclusions as to the efficacy and generalizability of psychological and behavioral therapies for persistent insomnia. Nonetheless, further research is needed to develop therapies that would optimize outcomes and reduce morbidity, as would studies of treatment mechanisms, mediators, and moderators of outcomes. Effectiveness studies are also needed to validate those therapies when implemented in clinical settings (primary care), by non-sleep specialists. There is also a need to disseminate more effectively the available evidence in support of psychological and behavioral interventions to health-care practitioners working on the front line.
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In the citing paper
“there is a rationale for using CBT with both PI and IdI patients.”
From Comparative investigation of the psychophysiologic and idiopathic insomnia disorder phenotypes: Psychologic characteristics, patients' perspectives, and implications for clinical management (2012) · cites this paper as [44]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“CBT-I is recognised as being the treatment of choice for insomnia [93], both in isolated form or as a comorbidity [94], in psychiatric populations [95], among the elderly [96,97], and delivered remotely [98].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [93]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“There is a large body of evidence on the efficacy of cognitive behavioral therapy for insomnia (CBT-I).1-3”
From Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial (2021) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“considering that the efficacy of behavioral therapy components is well established.1-3”
From Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial (2021) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“It is important to mention that behavioral components, such as stimulus control and sleep restriction, were used in both groups, which may have contributed to similar results in both groups, considering that the efficacy of behavioral therapy components is well established.1-3”
From Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial (2021) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“cognitive behavioral treatments produce significant improvement of chronic insomnia in the short-term”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [67]
The cited source says what the claim attributes to it.
In the citing paper
“and these improvements appear sustained at follow-up for up to two years. 67”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [67]
In the citing paper
“CBT-I has a robust efficacy profile in the treatment of insomnia (Irwin et al, 2006;Morin et al, 2006).”
From Sleep health: Reciprocal regulation of sleep and innate immunity (2017) · cites this paper as Morin et al, 2006
In the citing paper
“A range of non-pharmacological treatments can reduce sleep problems”
From The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials (2019) · cites this paper as [31]
In the citing paper
“Evidence suggests that CBT-I is effective when compared with placebos [19,20].”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [19]
In the citing paper
“In 2006, the task force completed another systematic review of 37 treatment studies subsequent to the previous review (1998)(1999)(2000)(2001)(2002)(2003)(2004) [32].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [32]
In the citing paper
“In addition to revealing sleep improvements sustained in time in primary insomnia and in the presence of medical/psychiatric comorbidities, 9 treatment studies in older adults also indicated facilitation of discontinuation of hypnotic medication after chronic use [32].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [32]
In the citing paper
“Cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia (Morin et al., 2006), requires frequent monitoring and has a high cost (Passos et al., 2012).”
From Exercise can improve sleep quality: A systematic review and meta-analysis (2018) · cites this paper as Morin et al., 2006
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Psychological Models of Insomnia
Talbot, L. S., & Harvey, A. G. (2010) · Medical psychiatry · doi:10.3109/9781420080803.005 · Cited by 4
Nature and Treatment of Insomnia
Morin, C. M., & Benca, R. M. (2009) · Elsevier eBooks · doi:10.1016/b978-0-7506-7584-0.00026-4 · Cited by 3
Self-citationLenze, E. J., Wetherell, J. L., & Andreescu, C. (2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615370016.mt07 · Cited by 4
Die Prävention körperlicher Erkrankungen durch eine Behandlung von Insomnien
Spiegelhalder, K., Johann, A. F., Hertenstein, E., Baglioni, C., & Riemann, D. W. (2015) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-015-0003-y · Cited by 3
“Psychoedukation alleine hat in der Behandlung von Insomnien allenfalls eine geringfügige Wirksamkeit und wird dementsprechend sehr häufig als Kontrollgruppe in klinischen Studien eingesetzt [17].”
BackgroundCognitive Behavioural Therapy for Insomnia : How, for Whom and What about Acceptance?
Bothelius, K. (2015) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 2
Rissling, M. B. (2012) · eScholarship (California Digital Library) · Cited by 3
Anxiety and Sleep: The Bidirectional Relationship and Strategies for Improved Sleep.Preprint
Webb, A. (2023) · doi:10.22541/au.169531401.15330883/v1 · Cited by 4
A scoping review of insomnia treatments for people living with HIV
Miranda, J., Sidani, S., Côté, J., & Fredericks, S. (2021) · International Health Trends and Perspectives · doi:10.32920/ihtp.v1i1.1422 · Cited by 2
Obuća, F., & Aydın, O. (2025) · Sleep and Vigilance · doi:10.1007/s41782-025-00305-x · Cited by 3
“Current treatments for sleep problems range from cognitive–behavioral therapy to medication and relaxation techniques, but these approaches may be limited by accessibility, potential side effects, or variable patient responses [17].”
Alaya, W. B., Dhahbi, W., Souissi, M. A., Jebabli, N., Ceylan, H. İ., Ceylan, N. B., Muntean, R. I., & Souissi, N. (2026) · Life · doi:10.3390/life16020212 · Cited by 2
“Psychoeduca-tional strategies grounded in cognitive–behavioral principles address maladaptive beliefs regarding smartphone unavailability and promote adaptive coping responses [12].”
InfluentialJiayi, H., Zhenghai, S., Suzhen, G., & Zhibo, G. (2026) · Current Psychology · doi:10.1007/s12144-026-09078-6 · Cited by 2
Digital insomnia therapeutic as a workplace performance solution for improving productivity
Russell, J. P., Teotia, A., Kalmbach, D. A., Drake, C., & Cheng, P. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108896 · Cited by 2
Tan, Y., 罗永猛, & Mao, H. (2026) · Nursing Research and Practice · doi:10.1155/nrp/9570388 · Cited by 2
Redefining menopausal care: a randomized trial of group CBT for vasomotor symptoms in Korean women
Jung, D., Park, J. Y., Chung, K., & Kim, M.-R. (2026) · Climacteric · doi:10.1080/13697137.2026.2661353 · Cited by 2
Arnago, S. P. G., Barrientos, K. M., Bertel, F. D. C., Marriaga, A. D., & Cardona, J. (2014) · Archivos de Medicina (Manizales) · doi:10.30554/archmed.14.1.235.2014 · Cited by 7
Trastornos del sueño en la infancia. Clasificación, diagnóstico y tratamiento
Valderrama, E. B., & Herrero, C. M. (2014) · Anales de Pediatría Continuada · doi:10.1016/s1696-2818(14)70188-x · Cited by 2
Insomnia in Patients with Comorbid Medical Problems
Paul, R., & Anafi, R. C. (2016) · Springer eBooks · doi:10.1007/978-3-319-41400-3_11 · Cited by 3
Lim, J., Chung, S., Noh, K. J., Kim, G. G., & Jeong, H. T. (2019) · International Conference on Information and Communication Technology Convergence (ICTC) · doi:10.1109/ictc46691.2019.8939976 · Cited by 2
“sleep efficiency, total sleep time and the number of wake during sleep calculating that calculated from Fitbit sleep stage data [19].”
MethodDevelopment of Conversational AI for Sleep Coaching Programme
Shim, H. (2021) · Conference of the European Chapter of the Association for Computational Linguistics: Student Research Workshop (EACL SRW) · doi:10.18653/v1/2021.eacl-srw.17 · Cited by 2
“Since its goal is to change the potential causes, both behavioural and cognitive factors, it produces long-lasting improvement in the condition of insomnia, compared to the medication treatment (Morin et al., 2006).”
BackgroundGumport, N. B., & Harvey, A. G. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104029 · Cited by 3
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Cognitive-Behavioral Therapy for Insomnia and Nightmares in PTSD
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Lohse, M. J., & Müller-Oerlinghausen, B. (2016) · Springer eBooks · doi:10.1007/978-3-662-50351-5_29 · Cited by 2
Insomnia: Recent Advances in Genetic Aspects and Therapies
Riasat, M., Afzal, A., Khawar, M. B., Hamid, S. E., Habiba, U., Shahzaman, S., Shahid, N., & Naseem, R. (2023) · Biomedical Research and Therapy · doi:10.15419/bmrat.v10i4.804 · Cited by 2
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Shi, Y., Ren, R., Zhang, Y., Vitiello, M. V., & Tang, X. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14077 · Cited by 2
“…(psychoeducation and sleep hygiene), behavioural (sleep restriction, stimulus control, and relaxation), and cognitive restructuring techniques (challenging dysfunctional sleep-related beliefs, preventing or reducing excessive worrying about insomnia and daytime consequences) (Morin et al., 2006).”
Sankar, K., Shanmugasundram, N., Baskaran, B., Anabalagan, D., Sivaraman, V., Santhiyagu, X., & Rajanandh, M. G. (2023) · Clinical Therapeutics · doi:10.1016/j.clinthera.2023.10.010 · Cited by 2
Cognitive Behavioral Therapy for Insomnia (CBT-I): A Comprehensive Review
Basiouny, D. E., & Habib, H. I. (2023) · Indian Journal of Sleep Medicine · doi:10.5005/jp-journals-10069-0123 · Cited by 4
Hotchi, A., Yamadera, W., Iwashita, M., Utsumi, T., Amagai, M., Nakamura, S., Suzuki, T., & Shigeta, M. (2024) · BioPsychoSocial Medicine · doi:10.1186/s13030-024-00308-6 · Cited by 2
Adolescent Sleep Quality as Critical Component of Healthy Lifestyle
Adamčák, Š., Marko, M., & Bartík, P. (2024) · Health Technologies · doi:10.58962/ht.2024.2.3.8-19 · Cited by 2
Predictors and moderators of cognitive therapy and behavior therapy for insomnia disorder
Sunnhed, R., Hesser, H., Carlbring, P., Harvey, A. G., & Jansson‐Fröjmark, M. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106611 · Cited by 2
Management of Late-Life Insomnia
(2011) · Clinical Medicine Insights Geriatrics · doi:10.4137/cmger.s5974 · Cited by 2
Sleep Disturbances and Personality Type Test
Park, H. S. (2015) · Journal of Oral Medicine and Pain · doi:10.14476/jomp.2015.40.3.102 · Cited by 2
Metadata
- Authors
- Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L.
- Affiliations
- Université Laval (CA)
- University of Arizona (US)
- University of Pittsburgh (US)
- Duke University (US)
- University of Glasgow (GB)
- University of Alabama (US)
- Corresponding author
- Morin, Charles M.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-11
- Volume
- 29
- Issue
- 11
- Pages
- 1398-1414
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W1684861691
- Cited by
- 1,345
- References
- 92
- Citations by year
- 2026: 33 · 2025: 39 · 2024: 37 · 2023: 52 · 2022: 67 · 2021: 72 · 2020: 78 · 2019: 72 · 2018: 65 · 2017: 79 · 2016: 72 · 2015: 113 · 2014: 100 · 2013: 96 · 2012: 86
- FWCI
- 5.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- University of Regensburg Publication Server (University of Regensburg) (acceptedVersion)
- University of Regensburg Publication Server (University of Regensburg)
- Funders
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- Servier
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- insomnia, psychological intervention, behavior therapy, cognitive behavioral therapy, stimulus control therapy, relaxation training, paradoxical intention, sleep restriction, older adults, comorbid insomnia, sleep quality, daytime fatigue, treatment efficacy, treatment sustainability, empirically supported treatments, sleep efficiency, sleep latency, awakening, total sleep time, psychiatric comorbidity
- MeSH terms
- Adult, Aged, Behavior Therapy, Combined Modality Therapy, Cross-Sectional Studies, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Education as Topic, Comorbidity, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Evidence-Based Medicine
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