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Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004)
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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]
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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]
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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]
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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“Cognitive-behavioral therapy for insomnia (CBT-I) is considered an effective non-pharmacological intervention; however, access to trained therapists and the time commitment required for treatment can be barriers to its widespread use (Morin et al. 2006; Rossman 2019; D. Xu et al. 2024a, b).”
The Contribution of Treatment Allocation Method to Outcomes in Intervention Research
Sidani, S., Epstein, D. R., Bootzin, R. R., Miranda, J., & Cousins, J. C. (2015) · Canadian Journal of Nursing Research · doi:10.1177/084456211504700205 · Cited by 8
“It has demonstrated effec tiveness in reducing the perceived insomnia severity and improving sleep parameters (Morin et al., 2006).”
BackgroundSelf-citationIntervención psicológica en trastornos del sueño: una revisión actualizada
García, H. B. Á., & Jiménez‐Correa, U. (2020) · Clínica Contemporánea · doi:10.5093/cc2020a9 · Cited by 11
Peng, L., Jing, J., Ma, J., He, S., Gao, X., & Wang, T. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.995664 · Cited by 9
“Insomnia is a modifiable risk factor, and studies have shown that some relaxation therapies, such as tai chi and yoga, can greatly improve symptoms of insomnia (32, 33).”
BackgroundHaggerty, D. K., Contreras, D. A., Carter, A., Drake, C. L., & Tucker, R. M. (2022) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2146693 · Cited by 8
“…outcomes among older adults (Bootzin & Epstein, 2011; Epstein et al., 2012; Joshi, 2008; Lacks & Powlishta, 1989; C. Morin & Azrin, 1988; C. M. Morin et al., 2006; Murawski et al., 2017, 2019; Soh et al., 2020; Van Straten et al., 2018), far fewer explore whether these benefits persist over…”
BackgroundEidani, M., Montazeri, S., Mousavi, P., Haghighizadeh, M. H., & Valiani, M. (2022) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_243_22 · Cited by 8
Paradoxic Intention as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia
Jansson‐Fröjmark, M., Sandlund, C., & Norell‐Clarke, A. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2022.10.001 · Cited by 8
Current Pharmacological and Nonpharmacological Options for the Management of Insomnia
Pigeon, W. R., Bishop, T. M., & Marcus, J. A. (2013) · Clinical Medicine Insights Therapeutics · doi:10.4137/cmt.s10239 · Cited by 8
Harman, K., Keating, E., Mayes, S., Walsh, J., & MacCallum, S. (2014) · Work · doi:10.3233/wor-131655 · Cited by 8
Rydzkowski, W., Canale, N., & Reynolds, L. (2015) · Educational Psychology in Practice · doi:10.1080/02667363.2015.1090403 · Cited by 8
Exploring a Behavioural Therapy for Insomnia in Shift Workers
Roy, A. V. M. (2015) · Journal of Sleep Disorders & Therapy · doi:10.4172/2167-0277.1000202 · Cited by 8
Top Ten Tips Palliative Care Clinicians Should Know About Mental Health and Serious Illness
Riordan, P. A., Briscoe, J. G., Kamal, A. H., Jones, C. A., & Webb, J. A. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0207 · Cited by 8
“80,81 Tip #10.”
Holzinger, B., Mayer, L., Levec, K., Munzinger, M.-M., & Klösch, G. (2019) · Archives of Industrial Hygiene and Toxicology · doi:10.2478/aiht-2019-70-3244 · Cited by 9
Granberg, R. E., Heyer, A., Gehrman, P., Günter, P., Hoff, N., Guth, A., Kayser, M. S., Kuna, S. T., & Frasso, R. (2022) · Cogent Psychology · doi:10.1080/23311908.2022.2038936 · Cited by 9
“Several meta-analyses and systematic reviews have demonstrated the efficacy of cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia in adults (Irwin et al., 2006; Mitchell et al., 2012; Montgomery & Dennis, 2003; Morin et al., 2006).”
BackgroundKwon, M., Dickerson, S. S., Wilding, G. E., Aquilina, A. T., Reid, M. E., & Dean, G. E. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106939 · Cited by 10
The Nocturnal Return of Neglected Regrets: Deficits in Regret Anticipation Predict Insomnia Symptoms
Schmidt, R. E. (2011) · The Open Sleep Journal · doi:10.2174/1874620901104010020 · Cited by 8
Primary Insomnia: An Overview of Practical Management Using Cognitive Behavioral Techniques
Espie, C. A., & Kyle, S. D. (2009) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2009.07.009 · Cited by 8
Self-citationPersonalized Pharmacotherapy for Treatment Approaches Focused at Primary Insomnia
Smith, H. S., Barkin, R. L., & Barkin, S. J. (2011) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e3182012fb4 · Cited by 8
Vézina‐Im, L., Moreno, J. P., Nicklas, T. A., & Baranowski, T. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0490-y · Cited by 8
Pruiksma, K. E., Fina, B. A., Dietch, J. R., Dondanville, K. A., Williams, J. M., Wright, E. C., Molino, A. T. C., Hall‐Clark, B. N., Nicholson, K. L., Peterson, A. L., et al. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.12.007 · Cited by 9
Johnson, K. A., Gordon, C., & Grunstein, R. (2019) · NeuroRehabilitation (Reading, MA) · doi:10.3233/nre-192868 · Cited by 7
“Sleep disturbance after traumatic brain injury is common, with a reported prevalence between 30% and 70% (Ouellet, Beaulieu-Bonneau, & Morin, 2006).”
Mulsant, B. H., & Pollock, B. G. (2013) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615370016.mt02 · Cited by 8
Dekker, K., Benjamins, J. S., van Straten, A., Hofman, W. F., & Someren, E. J. W. V. (2015) · Trials · doi:10.1186/s13063-015-0790-2 · Cited by 9
“CBT-I has been shown to be effective in numerous randomized clinical trials [24, 29 – 34].”
Basiri, N., Khayyer, Z., Hadianfard, H., & Ghaderi, A. (2017) · Global Journal of Health Science · doi:10.5539/gjhs.v9n7p35 · Cited by 7
Sleep and mild cognitive impairment
Cassidy‐Eagle, E. L., & Siebern, A. T. (2017) · Sleep Science and Practice · doi:10.1186/s41606-017-0016-5 · Cited by 8
“CBT-I treatment outcomes have not been shown to be age related and are comparable to younger and middle aged adults (Morin et al. 1994; Morin et al. 2006).”
ResultJun, L., Li, X., Wen, Y., & Yongxiang, W. (2024) · Frontiers in Sleep · doi:10.3389/frsle.2024.1323967 · Cited by 7
Bothelius, K., Jernelöv, S., Kaldo, V., Lu, C., Stråle, M.-M., & Jansson‐Fröjmark, M. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100781 · Cited by 8
“Cognitive behavioural therapy for insomnia, CBT-i (Morin et al., 2006), has been demonstrated to be effective in treating comorbid insomnia (Geiger-Brown et al., 2015; Wu et al., 2015; Zhou et al., 2020; Hertenstein et al., 2022; Blom et al., 2024).”
BackgroundMethodInfluentialKamara, D., Bernard, A., Clark, E., Duraccio, K., Ingram, D., Li, T.-J., Piper, C., Cooper, E. H., & Simon, S. L. (2025) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsae096 · Cited by 9
Das Kapitel Schlafstörungen im DSM-V – ein Zwischenbericht
Riemann, D. W., Charles, M., & Charles, F. (2011) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000082 · Cited by 7
Yeung, T., Martin, J. L., Fung, C. H., Fiorentino, L., Dzierzewski, J. M., Tapia, J. C. R., Song, Y., Josephson, K. R., Jouldjian, S., Mitchell, M. N., et al. (2018) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2018.00274 · Cited by 8
“Taken together, CBT-I commonly involves approaches such as: (1) decreasing excessive time in bed awake; (2) limiting naps, which can impair the sleep drive, and increasing daytime alertness via increased daytime activity and light exposure; (3) re-establishing the association between the bed and sleep; (4) decreasing…”
BackgroundSleep hygiene and the prevention of chronic insomnia
Ellis, J. G., & Allen, S. F. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815373-4.00011-3 · Cited by 9
Marks, E. M., Hallsworth, C. A., & McKenna, L. (2019) · Trials · doi:10.1186/s13063-019-3778-5 · Cited by 7
Blom, K., Isacsson, N. H., Forsell, E., Rosén, A., Kraepelien, M., Jernelöv, S., & Kaldo, V. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13376 · Cited by 7
“Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society. studied treatments show results with room for improvements (Morin et al., 2006).”
BackgroundBedrooms and the Vulnerability of Sleepers to Extreme Heat Events
Emmitt, S. (2023) · Atmosphere · doi:10.3390/atmos14121782 · Cited by 7
“Age, mental health, physical health, diet, alcohol consumption, and drug dependency influence sleep efficiency and sleep quality [18,19].”
Chung, S., An, H., Park, J., & Kim, H.-J. (2011) · Sleep Medicine Research · doi:10.17241/smr.2011.2.1.10 · Cited by 9
Preferences for behavioral therapies for chronic insomnia
Ibrahim, S., & Sidani, S. (2013) · Health · doi:10.4236/health.2013.511240 · Cited by 7
Cognitive behavioral therapy for the management of poor sleep in insomnia disorder
Kyle, S. D., Miller, C. B., & Espie, C. A. (2014) · ChronoPhysiology and Therapy · doi:10.2147/cpt.s54220 · Cited by 9
“23,24 Non-evidence-based treatments for insomnia, however, do have the potential to further disrupt sleep and may cause harm and/or dependence (eg, alcohol, marijuana).”
Self-citationBosch, P., van den Noort, M., Staudte, H., Lim, S., Yeo, S., Coenen, A. M. L., & van Luijtelaar, G. (2016) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2016.06.004 · Cited by 8
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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