Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy
Abstract
OBJECTIVE: Because of the role of psychological factors in insomnia, the shortcomings of hypnotic medications, and patients' greater acceptance of nonpharmacological treatments for insomnia, the authors conducted a meta-analysis to examine the efficacy and durability of psychological treatments for the clinical management of chronic insomnia. METHOD: A total of 59 treatment outcome studies, involving 2,102 patients, were selected for review on the basis of the following criteria: 1) the primary target problem was sleep-onset, maintenance, or mixed insomnia, 2) the treatment was nonpharmacological, 3) the study used a group design, and 4) the outcome measures included sleep-onset latency, time awake after sleep onset, number of nighttime awakenings, or total sleep time. RESULTS: Psychological interventions, averaging 5.0 hours of therapy time, produced reliable changes in two of the four sleep measures examined. The average effect sizes (i.e., z scores) were 0.88 for sleep latency and 0.65 for time awake after sleep onset. These results indicate that patients with insomnia were better off after treatment than 81% and 74% of untreated control subjects in terms of sleep induction and sleep maintenance, respectively. Stimulus control and sleep restriction were the most effective single therapy procedures, whereas sleep hygiene education was not effective when used alone. Clinical improvements seen at treatment completion were well maintained at follow-ups averaging 6 months in duration. CONCLUSIONS: The findings indicate that nonpharmacological interventions produce reliable and durable changes in the sleep patterns of patients with chronic insomnia.
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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 [247]
Relaxation is especially effective in helping with sleep initiation.
“Research suggests that relaxation is especially effective in helping with sleep initiation [29].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [29]
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BackgroundInsomnia and daytime functioning
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Sleep disturbances are correlated with decreased morning awakening salivary cortisol
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“Although enzodiazepines are known to be effective for insomnia, the linical benefit is small ( 1 hour of increased sleep) and imilar to that found with exercise therapy alone.(6) Morever, chronic benzodiazepine therapy for sleep is associated ith several negative side effects, including cognitive imairment and an incr…”
BackgroundDeng, G. E., Frenkel, M. A., Cohen, L. G., Cassileth, B. R., Abrams, D. I., Capodice, J. L., Courneya, K. S., Dryden, T., Hanser, S. B., Kumar, N. B., et al. (2009) · PubMed · Cited by 266 · see citing works
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“All treatment gains reported in this review are modest when compared with those reported by others.(41,74) This can be explained partly by the rigorous inclusion criteria applied within this review.”
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Night-to-night sleep variability in older adults with and without chronic insomnia
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Cognitive–behavioral treatment of insomnia secondary to chronic pain.
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“A slight advantage of the individual over the group modality has been proposed (Lacks, 1991; Morin et al., 1994), but these results are insufficient to declare the superiority of individual therapy.”
BackgroundResultZaleplon: a pyrazolopyrimidine sedative-hypnotic agent for the treatment of insomnia
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REM Sleep Instability – A New Pathway for Insomnia?
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Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions
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“…of psychological interventions for sleep problems have suggested that individual and group treatments are equally effective (Murtagh and Greenwood 1995; Trauer et al. 2015; van Straten et al. 2017), while another indicated that individual treatment is most effective (Morin et al. 1994).”
BackgroundCognitive Behaviour Therapy with Older People
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Self-citationParadoxical insomnia and subjective-objective sleep discrepancy: a review
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Sleep Disturbance and Nonmalignant Chronic Pain: A Comprehensive Review of the Literature
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Assessment of preferences for treatment: Validation of a measure
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“This difference can be explained by the fact that these two treatment options were described as effective and were equally attractive to participants (Morin et al., 1994).”
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Dose-Response Effects of Cognitive-Behavioral Insomnia Therapy: A Randomized Clinical Trial
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Treatment of sleep disturbances in posttraumatic stress disorder: A review
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Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep?Wake Diaries
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- Authors
- Morin, C. M., Culbert, J. P., & Schwartz, S. M.
- Affiliations
- Virginia Commonwealth University (US)
- ORCID
- Charles M. Morin
- Venue
- American Journal of Psychiatry
- Published
- 1994-08-01
- Volume
- 151
- Issue
- 8
- Pages
- 1172-1180
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W1926957827
- Cited by
- 1,098
- References
- 32
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 20 · 2023: 20 · 2022: 19 · 2021: 31 · 2020: 40 · 2019: 28 · 2018: 28 · 2017: 31 · 2016: 40 · 2015: 51 · 2014: 52 · 2013: 48 · 2012: 49
- FWCI
- 6.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r29mh047020-05)
- National Institute of Mental Health (NIMH MH-47020)
- 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, non-pharmacological treatment, psychological intervention, sleep onset insomnia, sleep maintenance insomnia, stimulus control, sleep restriction, sleep hygiene education, sleep latency, treatment efficacy, treatment durability
- MeSH terms
- Adult, Behavior Therapy, Biofeedback, Psychology, Chronic Disease, Circadian Rhythm, Female, Follow-Up Studies, Health Education, Humans, Sleep Initiation and Maintenance Disorders, Male, Medical Records, Psychotherapy, Relaxation Therapy, Sleep, Wakefulness, Cognitive Behavioral Therapy, Treatment Outcome
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