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To the Editor: We have some concerns about the design of the randomized controlled trial in which Dr Morin and colleagues¹ studied the effect of CBT, singly and combined with medication, for persistent insomnia. First, the placebo effect was not investigated. At the first stage, placebo medication was not administered in the group that received only CBT for the first 6 weeks, so the specific effects of zolpidem could not be assessed. Regarding the second stage, according to the expectancy theory of placebo effects,² patients who received CBT plus daily zolpidem for 6 weeks and extended CBT alone for 6 months may have anticipated that, if after the first 6 weeks' treatment their insomnia had been controlled well, they could maintain the outcomes without the pills. The group that received CBT plus daily zolpidem for 6 weeks and extended CBT plus zolpidem as needed for 6 months may have ascribed . . . [Full Text of this Article]

Yebing Yang, PhD; Danmin Miao, PhD; Yunfeng Sun, PhD
yunfsun@163.com
Fourth Military Medical University
Xi’an, China

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