title: Psychological and Behavioral Interventions for Managing Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians.
abstract: BACKGROUND
  Psychological and behavioral interventions are frequently used for insomnia disorder.
  
  
  OBJECTIVE
  To assess benefits and harms of psychological and behavioral interventions for insomnia disorder in adults.
  
  
  METHODS
  Ovid MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and PsycINFO through September 2015, supplemented with hand-searching.
  
  
  METHODS
  Randomized, controlled trials of psychological or behavioral interventions that were published in English and enrolled adults with insomnia disorder lasting 4 or more weeks.
  
  
  METHODS
  Data extraction by single investigator confirmed by a second reviewer; dual investigator assessment of risk of bias; consensus determination of strength of evidence.
  
  
  RESULTS
  Sixty trials with low to moderate risk of bias compared psychological and behavioral interventions with inactive controls or other psychological and behavioral interventions. Cognitive behavioral therapy for insomnia (CBT-I) improved posttreatment global and most sleep outcomes, often compared with information or waitlist controls (moderate-strength evidence). Use of CBT-I improved several sleep outcomes in older adults (low- to moderate-strength evidence). Multicomponent behavioral therapy improved several sleep outcomes in older adults (low- to moderate-strength evidence). Stimulus control improved 1 or 2 sleep outcomes (low-strength evidence). Evidence for other comparisons and for harms was insufficient to permit conclusions.
  
  
  CONCLUSIONS
  A wide variety of comparisons limited the ability to pool data. Trials did not always report global outcomes and infrequently conducted remitter or responder analysis. Comparisons were often information or waitlist groups, and publication bias was possible.
  
  
  CONCLUSIONS
  Use of CBT-I improves most outcomes compared with inactive controls. Multicomponent behavioral therapy and stimulus control may improve some sleep outcomes. Evidence on other outcomes, comparisons, and long-term efficacy were limited.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality. (
  CRD42014009908).
authors.forename: Michelle
authors.initials: M
authors.lastname: Brasure
authors.forename: Erika
authors.initials: E
authors.lastname: Fuchs
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Nelson
authors.forename: Erin
authors.initials: E
authors.lastname: Koffel
authors.forename: Carin M
authors.initials: CM
authors.lastname: Olson
authors.forename: Imran S
authors.initials: IS
authors.lastname: Khawaja
authors.forename: Susan
authors.initials: S
authors.lastname: Diem
authors.forename: Maureen
authors.initials: M
authors.lastname: Carlyle
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: Jeannine
authors.initials: J
authors.lastname: Ouellette
authors.forename: Mary
authors.initials: M
authors.lastname: Butler
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
mesh_terms: D001521:Behavior Therapy; D015928:Cognitive Behavioral Therapy; D057186:Comparative Effectiveness Research; D019317:Evidence-Based Medicine; D006801:Humans; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology* / Q000628:therapy*