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.
Abstract Teaser