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Cited by 152Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia

H Y McClusky, Jesse B. Milby, Paul Kent Switzer, V Williams, Virgil D. Wooten·1991·American Journal of Psychiatry
DOI 10.1176/ajp.148.1.121
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Abstract

OBJECTIVE: This study compared differential effects of behavioral therapy and triazolam in a clinical population with sleep-onset insomnia. Triazolam was hypothesized to decrease sleep latency and frequency and duration of awakening, with some effects during the first night's administration. But at follow-up, sleep measures were predicted to return to baseline levels. Behavioral treatment was hypothesized to effect sleep after 2 or more weeks of training which persisted at follow-up. METHOD: Thirty patients with average sleep latencies of 81.48 minutes, who reported chronic insomnia for an average of 2.6 years, were randomly assigned to one of two treatment groups: behavioral stimulus control/relaxation training and triazolam. RESULTS: Both treatments decreased sleep latency but differentially. Triazolam was effective immediately but maintained only some gains at follow-up. Behavioral treatment decreased sleep latency beginning the second week, when subjects expected no improvement, with gains maintained at follow-up. Comparisons showed that triazolam group latencies returned toward baseline, while behavioral group gains were maintained at follow-up. CONCLUSIONS: Triazolam treatment showed superior immediate treatment effects, while behavioral treatment showed superior treatment effects at follow-up, effects that accrued during the training period and differentially persisted at follow-up. One treatment strategy implied by these results would be to combine these two interventions concurrently. This would seem to use the immediate effects produced by the medication until the behavioral skills were learned, at which point medication would be terminated. This strategy could offer immediate relief and sustained effects at drug termination.

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  • Cognitive Behavioral Therapy for Insomnia does not carry the risks of prescription hypnotic medications and is therefore preferable for reasons beyond demonstrated efficacy, efficacy relative to medications, and effectiveness.

    “The recommended first-line treatment, Cognitive Behavioral Therapy for Insomnia (CBTI) does not carry these risks and is therefore preferable for reasons beyond demonstrated efficacy(244-248), efficacy relative to medications(249-253), and effectiveness(254).”

    From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [249]

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Authors
McClusky, H. Y., Milby, J. B., Switzer, P. K., Williams, V., & Wooten, V. D.
Affiliations
University of Alabama at Birmingham (US)
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
1991-01-01
Volume
148
Issue
1
Pages
121-126
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/ajp.148.1.121
OpenAlex
W1811457666
Cited by
152
References
34
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 5 · 2013: 1 · 2012: 6
FWCI
9.66
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (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
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
sleep onset insomnia, chronic insomnia, triazolam, behavior therapy, stimulus control, relaxation training, sleep latency, maintenance therapy, medication effects, combination therapy
MeSH terms
Adult, Behavior Therapy, Evaluation Studies as Topic, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Personality Inventory, Relaxation Therapy, Sleep, Triazolam

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