Cited by 1,053Sleep and related disordersObstructive Sleep Apnea ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis

Trauer, James M., Qian, Mary Y., Doyle, Joseph S., Rajaratnam, Shantha M.W., Cunnington, David·2015·Annals of Internal Medicine

DOI 10.7326/m14-2841

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Abstract

BACKGROUND: Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia. PURPOSE: To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia. DATA SOURCES: Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening. STUDY SELECTION: Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia. Studies of insomnia comorbid with medical, sleep, or psychiatric disorders were excluded. DATA EXTRACTION: Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%). DATA SYNTHESIS: Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64% female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95% CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE% improved by 9.91% (CI, 8.09% to 11.73%). Changes seemed to be sustained at later time points. No adverse outcomes were reported. LIMITATION: Narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and accuracy of estimates at later time points was less clear. CONCLUSION: CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes. PRIMARY FUNDING SOURCE: None. (PROSPERO registration number: CRD42012002863).

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Authors: Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D.
Affiliations: Burnet Institute (AU)
ORCID: Trauer, James M.
Qian, Mary Y.
Doyle, Joseph S.
Rajaratnam, Shantha M.W.
Cunnington, David
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2015-08-04
Volume: 163
Issue: 3
Pages: 191-204
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/m14-2841
OpenAlex: W1937224863
Cited by: 1,053
References: 100
Citations by year: 2026: 119 · 2025: 120 · 2024: 102 · 2023: 99 · 2022: 122 · 2021: 93 · 2020: 101 · 2019: 96 · 2018: 76 · 2017: 75 · 2016: 45 · 2015: 3
FWCI: 8.64
Type: journal article
Language: en
Open access: closed
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: cognitive behavioral therapy for insomnia, chronic insomnia, sleep latency, wake after sleep onset, total sleep time, sleep efficiency, sleep restriction, stimulus control, sleep hygiene, relaxation training
MeSH terms: Chronic Disease, Humans, Sleep Initiation and Maintenance Disorders, Relaxation Therapy, Time Factors, Cognitive Behavioral Therapy

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Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis

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