title: Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial.
abstract: OBJECTIVE
  To examine the unique contribution of behavior therapy (BT) and cognitive therapy (CT) relative to the full cognitive behavior therapy (CBT) for persistent insomnia.
  
  
  METHODS
  Participants were 188 adults (117 women; M age = 47.4 years, SD = 12.6) with persistent insomnia (average of 14.5 years duration). They were randomized to 8 weekly, individual sessions consisting of BT (n = 63), CT (n = 65), or CBT (n = 60).
  
  
  RESULTS
  Full CBT was associated with greatest improvements, the improvements associated with BT were faster but not as sustained and the improvements associated with CT were slower and sustained. The proportion of treatment responders was significantly higher in the CBT (67.3%) and BT (67.4%) relative to CT (42.4%) groups at post treatment, while 6 months later CT made significant further gains (62.3%), BT had significant loss (44.4%), and CBT retained its initial response (67.6%). Remission rates followed a similar trajectory, with higher remission rates at post treatment in CBT (57.3%) relative to CT (30.8%), with BT falling in between (39.4%); CT made further gains from post treatment to follow up (30.9% to 51.6%). All 3 therapies produced improvements of daytime functioning at both post treatment and follow up, with few differential changes across groups.
  
  
  CONCLUSIONS
  Full CBT is the treatment of choice. Both BT and CT are effective, with a more rapid effect for BT and a delayed action for CT. These different trajectories of changes provide unique insights into the process of behavior change via behavioral versus cognitive routes.
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Harvey
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Lynda
authors.initials: L
authors.lastname: Bélanger
authors.affiliation: Department of Psychiatry, University of California, San Francisco.
authors.forename: Lisa
authors.initials: L
authors.lastname: Talbot
authors.affiliation: Cognitive Behavior Therapy and Science Center.
authors.forename: Polina
authors.initials: P
authors.lastname: Eidelman
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Simon
authors.initials: S
authors.lastname: Beaulieu-Bonneau
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Émilie
authors.initials: É
authors.lastname: Fortier-Brochu
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Hans
authors.initials: H
authors.lastname: Ivers
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Manon
authors.initials: M
authors.lastname: Lamy
authors.affiliation: Department of Psychology, University of California, Berkeley.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Hein
authors.affiliation: Department of Psychiatry, University of Pittsburgh Medical Center.
authors.forename: Adriane M
authors.initials: AM
authors.lastname: Soehner
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Chantal
authors.initials: C
authors.lastname: Mérette
authors.affiliation: Department of Psychology, Université Laval.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Morin
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome