Cited by 1,098Sleep and related disordersPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy

Charles M. Morin, J P Culbert, S M Schwartz·1994·American Journal of Psychiatry

DOI 10.1176/ajp.151.8.1172

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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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outcomemeasuresResponsestoasleepquestionnairecontainingthePittsburgh SleepQualityIndexandobtainingsleephygieneknowledgeand practice, aswellasknowledgeoncaffeinewereusedfordata collection. ResultsRegressionanalysiswithstepwiseselectionprocedurerevealed thatsleephygienepracticewassignificantlyassociatedwiththe PittsburghSleepQualityIndexscoreafteradjustingforage, gender,yearofstudy,andtypeofresidence(b=-0.08,P<0.001). ConclusionsOurstudy'sresultsindicatedthatsleephygienepracticewas …
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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
Publisher: American Psychiatric Association Publishing
Published: 1994-08-01
Volume: 151
Issue: 8
Pages: 1172-1180
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/ajp.151.8.1172
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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Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy

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