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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]
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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]
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“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]
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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]
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“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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Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic
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Psychological and Behavioral Treatments for Insomnia I
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MethodSleep Quality Among Teenagers and Young Adults With Cancer
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Self-citationCognitive Behavior Therapies for Insomnia I
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“Because CBT has been proven effective for insomnia and is currently widely used, the following question is: why we still need Tai Chi Chuan to treat people with poor sleep quality? First, CBT is an intensive form of intervention that requires proper administration and supervision by highly trained clinicians [88].”
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“91 94 Standard psychological-based treatments for insomnia include cognitive and/or behavioral strategies, sleep hygiene education, stimulus control therapy, sleep restriction therapy, relaxation, and/or biofeedback.”
Time to Disseminate Cognitive Behavioral Treatment of Insomnia
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“1,2 it is 3-5 Despite a wealth of data showing efficacy, CBTI has not been available in most practice settings, including many specialized sleep centers whose focus is on the assessment and treatment of sleep apnea.”
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Self-citationAwake EEG Disregulation in Good Compared to Poor Sleepers
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“In contrast, a review of CBT-I outcomes by the Standards of Practice Committee of the American Academy of Sleep Medicine found that CBT-I is highly effective in achieving both short-term improvements in sleep and sustained gains over long-term follow-up (Morin et al., 2006).”
ResultTaylor, D. J., Gehrman, P., Dautovich, N. D., Lichstein, K. L., & McCrae, C. S. (2014) · doi:10.1007/978-1-907673-73-3 · Cited by 15
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Self-citationAn Algorithmic Approach to the management of Insomnia in Patients with Schizophrenia
Cole, K., Tabbane, K., Boivin, D. B., & Joober, R. (2017) · Annals of Clinical Psychiatry · doi:10.1177/104012371702900207 · Cited by 15
Is Brief Behavioral Treatment for Insomnia Effective?
Bootzin, R. R. (2006) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.26655 · Cited by 15
Self-citationTroxel, W., & Drerup, M. L. (2020) · Springer eBooks · doi:10.1007/978-1-4614-6439-6_845-2 · Cited by 16
Vargas, C., Paoletti, D., Stasio, S. D., & Berenguer, C. (2025) · Autism · doi:10.1177/13623613251319391 · Cited by 15
“By modifying maladaptive thoughts and behaviors, CBT reduces pre-sleep anxiety and promotes a state conducive to sleep, resulting in long-term improvements in sleep quality (Morin et al., 2006).”
Stevens, A. K., Gunn, R. L., Jackson, K. M., Borsari, B. E., & Metrik, J. (2020) · Psychology of Addictive Behaviors · doi:10.1037/adb0000682 · Cited by 15
“…sleep disturbance, such as cognitive–behavioral treatment for insomnia or EEG-biofeedback, may be effective treatment options for veterans who use cannabis and have ADHD symptoms (Diaz, Sloot, Mansvelder, & Linkenkaer-Hansen, 2012; Morin et al., 2006; Perlis, Jungquist, Smith, & Posner, 2006).”
BackgroundCognitive-Behavioral Therapy for Insomnia in Older Adults
Cassidy‐Eagle, E. L., Siebern, A. T., Chen, H., Kim, H., & Palesh, O. G. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.04.002 · Cited by 15
Forsell, E., Jernelöv, S., Blom, K., & Kaldo, V. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100554 · Cited by 14
“…outcome regardless of delivery format and type of disorders (G. Andersson et al., 2019; Lambert, 2015; Rozental et al., 2019; Slade et al., 2008), and this is also true for CBT for insomnia (Forsell et al., 2019b; Jernelov et al., 2012; Charles M. Morin et al., 2009; Ritterband et al., 2017).”
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“…standalone interventions (Bootzin & Epstein, 2011; Edinger et al., 2021; Harvey et al., 2002; Kaldo et al., 2015; Miller et al., 2014; Morin, 2011; Morin et al., 1994, 2006, 2015), and they are commonly included in brief therapies for insomnia (Edinger et al., 2021), and are thus strong…”
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“For example, although irregular sleep rhythm has been linked to health problems [15], extremely regular sleep rhythm is not recommended in clinical sleep treatments because of stress management [48, 49].”
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Ritterband, L. M., & Thorndike, F. P. (2012) · SLEEP · doi:10.5665/sleep.1850 · Cited by 14
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Pharmacological and non-pharmacological treatments for insomnia
Wang, C., Deng, C., Han, Q., Zhu, D.-L., Li, Z.-M., & Li, J. (2021) · Medicine · doi:10.1097/md.0000000000026678 · Cited by 9
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Greve, H., & Pedersen, P. U. (2015) · Journal of Nursing Education and Practice · doi:10.5430/jnep.v6n3p15 · Cited by 14
An Evidence-Based Review of Insomnia Treatment in Early Recovery
Kaplan, K. A., McQuaid, J. R., Primich, C., & Rosenlicht, N. Z. (2014) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000052 · Cited by 14
Cognitive Therapy for Dysfunctional Beliefs about Sleep and Insomnia
Morin, C. M., & Bélanger, L. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-381522-4.00011-0 · Cited by 14
Self-citationCognitive 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
Macronutrients and water – do they matter in the context of cognitive performance in athletes?
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Internet-Delivered Cognitive Behavioral Therapy for Insomnia
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Sleep Disorders and Aging in Women
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Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans
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“Cognitive behavioral therapy for insomnia (CBT-I) is an effective intervention to treat insomnia among older adults and typically includes cognitive therapy, stimulus control, sleep hygiene, and relaxation training [53, 54].”
BackgroundExploring the nexus between bedroom design and sleep quality in a warming climate
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Actitudes ante el insomnio de los médicos de AP de Mallorca
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Revisiting the relationship between wages and sleep duration: The role of insomnia
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The Effect of Reducing Insomnia Severity on Work- and Activity-Related Impairment
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“Cognitive Behavior Therapy for Insomnia (CBT-I) is the recommended first-line treatment for insomnia (Morin et al., 2006; Riemann et al., 2017; Wilson et al., 2019), which is associated with demonstrable improvements in daytime symptoms such as fatigue, mood, and mental functioning (Batterham et…”
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Insomnia Treatment Options for Women
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Recognizing that truth is unattainable and attending to the most informative research evidence
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“The only efficacious treatments for chronic insomnia are CBTs (Morin et al., 2006).”
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Hypnotic Discontinuation in Chronic Insomnia
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Self-citation
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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