National Sleep Foundation

Chapter 2: Insomnia

Insomnia Treatment: Cognitive Behavioral Therapy – Cognitive Therapy

Cognitive Therapy

Cognitive behavioral therapy for insomnia (CBT-I) seeks to change a person’s dysfunctional beliefs and attitudes about sleep.1

Cognitive behavioral therapy for insomnia (CBT-I) seeks to change a person’s dysfunctional beliefs and attitudes about sleep. 

CBT-I helps understand how dysfunctional thoughts drive one’s beliefs. It is often critical before other behavioral treatments can be successfully implemented. For example, if an individual has the erroneous belief that his insomnia is caused solely by a biochemical imbalance, he is unlikely to accept a course in relaxation therapy that involves guided imagery. However, CBT for insomnia often goes beyond identification of dysfunctional beliefs about sleep to identify non-sleep related intrusive and dysfunctional thoughts and beliefs which may interfere with one’s ability to wind down and sleep at night, often these include anxious thoughts related to expectations or disappointments.

Optimally, CBT-I includes a multimodal approach to care which incorporates many of the below strategies into a treatment plan.   Cognitive therapy seeks to empower the patient to see him/herself as an effective agent in change and the mind as able to manage arousal and to achieve relaxation and sleep, despite life stressors and health problems.


When practicing cognitive therapy, therapists endeavor to guide patients to draw their own conclusions, since durable change is best achieved when patients identify erroneous thinking and solve challenges themselves. Table 2.3 provides examples of cognitive treatment targets for this form of CBT.

Table 2.3: Examples of treatment targets for cognitive therapy.2

Treatment Target

Example of Dysfunctional Belief or Attitude

Unrealistic Sleep Expectation Dysfunctional belief: “I must get 8 hours of sleep every night.”
Misconceptions about the causes of insomnia Dysfunctional belief: “My insomnia is entirely due to a chemical imbalance.”
Amplifications of insomnia’s consequences Dysfunctional belief: “I can’t accomplish anything after having a poor night’s sleep.
Anxiety resulting from counter-productive attempts to control the sleep process Dysfunctional belief: “I have to distract myself at night and often feel I have no control over my racing mind.”

 

References

  1. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. Sleep. 1999;22:1134-1156.
  2. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. Sleep. 1999;22:1134-1156.