The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.
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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“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]
In the citing paper
“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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Night-to-night sleep variability in older adults with and without chronic insomnia
Buysse, D. J., Cheng, Y., Germain, A., Moul, D. E., Franzen, P. L., Fletcher, M., & Monk, T. H. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2009.02.010 · Cited by 252
Computerised Cognitive Behavioural Therapy for Insomnia: A Systematic Review and Meta-Analysis
Cheng, S. K., & Dizon, J. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000335379 · Cited by 241
Diagnosis and Treatment of Chronic Insomnia: A Review
Benca, R. M. (2005) · Psychiatric Services · doi:10.1176/appi.ps.56.3.332 · Cited by 248
Cognitive–behavioral treatment of insomnia secondary to chronic pain.
Currie, S. R., Wilson, K. G., Pontefract, A. J., & deLaplante, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.3.407 · Cited by 301
Bastien, C. H., Morin, C. M., Ouellet, M.-C., Blais, F. C., & Bouchard, S. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.4.653 · Cited by 243
“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
Weitzel, K. W., Wickman, J. M., Augustin, S., & Strom, J. G. (2000) · Clinical Therapeutics · doi:10.1016/s0149-2918(00)83024-6 · Cited by 245
REM Sleep Instability – A New Pathway for Insomnia?
Riemann, D. W., Spiegelhalder, K., Nissen, C., Hirscher, V., Baglioni, C., & Feige, B. (2012) · Pharmacopsychiatry · doi:10.1055/s-0031-1299721 · Cited by 254
Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions
Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-017-0234-5 · Cited by 242
“…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
Laidlaw, K., Thompson, L. W., Dick‐Siskin, L., & Gallagher‐Thompson, D. (2003) · doi:10.1002/9780470713402 · Cited by 238
Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.1.189 · Cited by 237
Self-citationParadoxical insomnia and subjective-objective sleep discrepancy: a review
Rezaie, L., Fobian, A. D., McCall, W. V., & Khazaie, H. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.01.002 · Cited by 236
Sleep Disturbance and Nonmalignant Chronic Pain: A Comprehensive Review of the Literature
Menefee, L. A., Cohen, M. J. M., Anderson, W. R., Doghramji, K., Frank, E. D., & Lee, H. B. (2000) · Pain Medicine · doi:10.1046/j.1526-4637.2000.00022.x · Cited by 234
Cognitive behavioural interventions for sleep problems in adults aged 60+
Montgomery, P., & Dennis, J. A. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003161 · Cited by 234
Assessment of preferences for treatment: Validation of a measure
Sidani, S., Epstein, D. R., Bootzin, R. R., Moritz, P., & Miranda, J. (2009) · Research in Nursing & Health · doi:10.1002/nur.20329 · Cited by 243
“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).”
BackgroundMethodGermain, A., Richardson, R., Moul, D. E., Mammen, O. K., Haas, G. L., Forman, S. D., Rode, N., Begley, A. E., & Nofzinger, E. A. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.11.010 · Cited by 238
Dose-Response Effects of Cognitive-Behavioral Insomnia Therapy: A Randomized Clinical Trial
Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Coffman, C. J., & Carney, C. E. (2007) · SLEEP · doi:10.1093/sleep/30.2.203 · Cited by 228
Baglioni, C., Altena, E., Bjorvatn, B., Blom, K., Bothelius, K., Devoto, A., Espie, C. A., Frase, L., Gavriloff, D., Tuuliki, H., et al. (2020) · Journal of Sleep Research · doi:10.1111/jsr.12967 · Cited by 259
Cheuk, D. K., Yeung, W., Chung, K., & Wong, V. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005472.pub2 · Cited by 228
Treatment of sleep disturbances in posttraumatic stress disorder: A review
Schoenfeld, F. B., DeViva, J. C., & Manber, R. (2012) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2011.09.0164 · Cited by 228
Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep?Wake Diaries
Khalsa, S. B. S. (2004) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-004-0387-0 · Cited by 224
Metadata
- 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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