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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“Sleep education and hygiene is a credible treatment with minimal efficacy in reducing insomnia (Morin et al. 1994) and thus it was the non-active intervention component as opposed to the active treatment components (SRT and SCI) which the CBT-I group received.”
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Dissemination of CBTI to the Non-Sleep Specialist: Protocol Development and Training Issues
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“) Subsequently, we expanded the CBTI training program to meet the needs of all mental health providers (regardless of their background in CBTI) within the VHA if they meet the following prerequisites: (1) they are licensed, credentialed, and routinely provide psychotherapy; (2) they receive approval and release time f…”
Correcting distorted perception of sleep in insomnia: a novel behavioural experiment?
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“For example cognitive behavioral therapy for insomnia (CBT-I) effectively improves sleep (19–20) and behavior activation interventions increase recreational activities (21).”
A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults.
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“…can be efficacious for the short-term treat-ment 6,7 of stimulus control 5 and sleep restriction 6 for the behavioral treat-ment of insomnia 7,8 in both younger older adults, 9,10 whereas sleep hygiene shown little efficacy when used Typically, behavioral insomnia treatments are delivered…”
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“Interestingly, the procedure closely resembles a combination of two behavioral interventions, sleep restriction and stimulus control instructions, which have the strongest treatment efficacy for chronic adult insomnia [55].”
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“Second, the treatment components were selected based on two meta-analyses suggesting the effectiveness of BT for chronic insomnia [15,57].”
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“stimulus control, which involves restricting the bed/bedroom to sleep; and (3) cognitive restructuring, which addresses maladaptive thoughts and beliefs about sleep.”
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“The goal of using the component control was to include a credible treatment with minimal efficacy (i.e., sleep education and hygiene) (Morin et al., 1994) and nonspecific treatment factors (i.e., elements common to psychotherapy such as therapist contact, treatment frequency, and treatment duration).”
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“A meta-analysis of adults undergoing cognitive behavioural therapy for insomnia 39 and a randomised controlled trial of women using a pharmacological approach to insomnia 40 To account for 10% loss of data and loss of participants to follow-up, we planned to recruit 234 women.”
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Self-citationEEG Spectral Analysis of Relaxation Techniques
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“Long-term follow-up data from both meta-analyses on the behavioral treatment of insomnia are consistent with this perspective (Morin et al., 1994; Murtagh and Greenwood, 1995).”
BackgroundMethodResultInfluentialSleep Maintenance Insomnia: Strengths and Weaknesses of Current Pharmacologic Therapies
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Nonpharmacological treatment of late-life insomnia
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“The clinical efficacy of these treatment modalities has been well established for insomnia among younger and middle-aged individuals [25, 26].”
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“As behavioral intentions have been shown to relate to changes in clinician behavior (e.g., Perkins et al. 41 ), 2 additional items focused on participants’ intention to use the app (i.e., future use intention) if it were available.”
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“CBT-I has been shown to be as effective as pharmacotherapy (Edinger et al., 2001a; Espie et al., 2001; Morin et al., 1994, 1999; Murtagh and Greenwood, 19954 ; Smith et al., 2002; Verbeek et al., 1999).”
MethodIs exercise an alternative treatment for chronic insomnia?
Passos, G. S., Poyares, D. L. R., Santana, M. G., Tufik, S., & de Mello, M. T. (2012) · Clinics · doi:10.6061/clinics/2012(06)17 · Cited by 131
“Of these alternatives, cognitive behavioral therapy (CBT) has received the most attention in research (8,9).”
BackgroundMaladaptive Sleep Hygiene Practices in Good Sleepers and Patients with Insomnia
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“Previous studies have shown that sleep hygiene alone is not a sufficient treatment for insomnia (Lacks & Morin, 1992; Morin et al., 2006; Morin et al., 1994; Morin et al., 1999; Murtagh & Greenwood, 1995).”
BackgroundThe Relationship Between Lifestyle Regularity and Subjective Sleep Quality
Monk, T. H., Reynolds, C. F., Buysse, D. J., DeGrazia, J. M., & Kupfer, D. J. (2003) · Chronobiology International · doi:10.1081/cbi-120017812 · Cited by 132
“, robust and appropriately phased) circadian rhythms lead to better sleep, and many behavioral techniques to counter insomnia prescribe behaviors (such as regularity in bedtimes) that are likely to lead to high-amplitude, phase-stable, circadian rhythms (Manber and Bootzin, 1991; Morin et al., 1994).”
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GPs’ management strategies for patients with insomnia: A survey and qualitative interview study
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“Less commonly used techniques include autogenic training, guided imagery, self-hypnosis and meditation [21,22].”
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“Such psychological interventions have been shown to produce significant improvements in sleep that are superior to no-treatment control conditions for adults with insomnia (Morin et al., 1994; Murtagh and Greenwood, 1995).”
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“Also, there is recent research documenting that patients prefer nondrug approaches over pharmacotherapy (Morin et al., 1994).”
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Self-citation
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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