 |
|
Cognitive Behavior Therapy and Pharmacotherapy for Insomnia
A Randomized Controlled Trial and Direct Comparison
Gregg D. Jacobs, PhD;
Edward F. Pace-Schott, MA;
Robert Stickgold, PhD;
Michael W. Otto, PhD
Arch Intern Med. 2004;164:1888-1896.
Background Chronic sleep-onset insomnia is a prevalent health complaint in adults. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy, singly and in combination, for chronic sleep-onset insomnia.
Methods This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. The main outcome measures were sleep-onset latency as measured by sleep diaries; secondary measures included sleep diary measures of sleep efficiency and total sleep time, objective measures of sleep variables (Nightcap sleep monitor recorder), and measures of daytime functioning.
Results In most measures, CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation.
Conclusions These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia.
From the Sleep Disorders Center, Beth Israel Deaconess Medical Center (Dr Jacobs), Laboratory of Neurophysiology, Harvard Medical School (Drs Jacobs and Stickgold and Mr Pace-Schott), and Massachusetts General Hospital and Harvard Medical School (Dr Otto), Boston, Mass; and Mind/Body Medical Institute, Chestnut Hill, Mass (Dr Jacobs). Dr Otto has served as a consultant for Pfizer Inc, Janssen Pharmaceutica Products, and Wyeth, and receives research support from GlaxoSmithKline, Pfizer, and Eli Lilly and Company.
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
There and Back Again: A Current History of Sleep Medicine
Kirsch
Chest 2011;139:939-946.
ABSTRACT
| FULL TEXT
Barriers to nonpharmacologic treatments for stress, anxiety, and insomnia: Family physicians' attitudes toward benzodiazepine prescribing
Anthierens et al.
cfp 2010;56:e398-e406.
ABSTRACT
| FULL TEXT
Insomnia and Sleep-Related Breathing Disorders
Wickwire and Collop
Chest 2010;137:1449-1463.
ABSTRACT
| FULL TEXT
One-Year Outcomes of a Behavioral Therapy Intervention Trial on Sleep Quality and Cancer-Related Fatigue
Berger et al.
JCO 2009;27:6033-6040.
ABSTRACT
| FULL TEXT
Cognitive Behavioral Therapy Alone and With Medication for Persistent Insomnia--Reply
Morin
JAMA 2009;302:1054-1054.
FULL TEXT
Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial
Morin et al.
JAMA 2009;301:2005-2015.
ABSTRACT
| FULL TEXT
Cognitive-Behavioral Treatment for Chronic Insomnia
Perlis and Gehrman
ACCP Sleep Med Brd Rev 2009;4:223-232.
FULL TEXT
Diagnosis and treatment of insomnia
Passarella and Duong
Am J Health Syst Pharm 2008;65:927-934.
ABSTRACT
| FULL TEXT
Management of insomnia: treatments and mechanisms
Wilson and Nutt
Br. J. Psychiatry 2007;191:195-197.
ABSTRACT
| FULL TEXT
State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia
Lynch et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2007;1:274-282.
ABSTRACT
The Neuropharmacology of Sleep Disorders: Better Sleeping Through Chemistry?
Suhl
Journal of Pharmacy Practice 2007;20:181-191.
ABSTRACT
Acceptance and Change: The Integration of Mindfulness-Based Cognitive Therapy Into Ongoing Dialectical Behavior Therapy in a Case of Borderline Personality Disorder With Depression
Huss and Baer
Clinical Case Studies 2007;6:17-33.
ABSTRACT
Recent Developments in the Classification, Evaluation, and Treatment of Insomnia
Summers et al.
Chest 2006;130:276-286.
ABSTRACT
| FULL TEXT
Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial.
Sivertsen et al.
JAMA 2006;295:2851-2858.
ABSTRACT
| FULL TEXT
|
