Comparison of Sleep Condition and Sleep-Related Psychological Activity after Cognitive-Behavior and Pharmacological Therapy for Chronic Insomnia
Abstract
Background: Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia. Methods: Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment. Results: The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups. Conclusion: Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning.
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Pharmacotherapy produced only moderate improvements that were limited to the duration of drug administration.
“Notably, pharmacotherapy produced only moderate improvements that were limited to the duration of drug administration.”
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 [101]
Three RCTs comparing CBT-I, benzodiazepine and placebo for chronic insomnia all show that CBT-I was the most effective sleep intervention.
“Three RCTs [99,100,101] which compared CBT-I, BZD and placebo for chronic insomnia all show that CBT-I was the most effective sleep intervention.”
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 [101]
The trials compared CBT-I to zopiclone, zolpidem, temazepam, and triazolam.
“The trials compared CBT-I to zopiclone [29], zolpidem [30], temazepam [31,32], and triazolam [33].”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [32]
In Wu et al., after 8 months the Pittsburgh Sleep Quality Index improved by 1.2 points with CBT-I and worsened by 0.8 points with temazepam (p < 0.01).
“Wu et al [32] surveyed patients using the Pittsburgh Sleep Quality Index: after 8 months this measure improved an average of 1.2 points in patients treated with CBT-I, while it worsened 0.8 points in patients given tamezepam (p < 0.01).”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [32]
Three included studies had a treatment arm combining CBT-I and medication.
“Of note, three of the studies [29,31,32] included a treatment arm that was a combination of CBT-I and medication.”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [32]
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- Authors
- Wu, R., Bao, J., Zhang, C., Deng, J., & Long, C.
- Affiliations
- Peking University (CN)
- ORCID
- Deng, Jun
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2006
- Volume
- 75
- Issue
- 4
- Pages
- 220-228
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W2006489842
- Cited by
- 120
- References
- 33
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 10 · 2022: 10 · 2021: 6 · 2020: 10 · 2019: 9 · 2018: 6 · 2017: 6 · 2016: 7 · 2015: 6 · 2014: 9 · 2013: 1 · 2012: 8
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- 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
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- chronic insomnia, cognitive behavioral therapy, pharmacotherapy, combination therapy, daytime functioning, sleep latency, total sleep time, pre-sleep arousal, dysfunctional beliefs about sleep, long-term treatment outcomes
- MeSH terms
- Adult, Chronic Disease, Combined Modality Therapy, Culture, Double-Blind Method, Female, Follow-Up Studies, Health Status, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Psychology, Surveys and Questionnaires, Social Behavior, Cognitive Behavioral Therapy, Treatment Outcome, Polysomnography
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