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Cognitive-Behavioral Therapy for Insomnia

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Clinical Handbook of Insomnia

Abstract

The most common cognitive-behavioral therapies for primary insomnia are: sleep hygiene education, stimulus control, sleep restriction, relaxation training, and cognitive therapy out of which stimulus control therapy is the most well validated and is considered “the gold standard” for the behavioral treatment of insomnia. In practice, most behavioral sleep medicine clinicians adopt a multicomponent approach which usually contains stimulus control, sleep restriction, and sleep hygiene therapy. Adjunctive interventions include phototherapy, relaxation therapy, and cognitive restructuring. CBT can be combined with pharmacological methods, but it has been shown more effective than medication on the long term.

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References

  1. Spielman A, Caruso L, Glovinsky P (1987) A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 10:541–553

    CAS  PubMed  Google Scholar 

  2. Stepanski EJ (2000) Behavioral therapy for insomnia. In: Kryger MH, Roth TG, Dement WC (eds) Principles and practice of sleep medicine. W. B. Saunders Company, Philadelphia, pp 647–656

    Google Scholar 

  3. Perlis ML, Giles DE, Mendelson WB, Bootzin RR, Wyatt JK (1997) Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res 6:179–188

    Article  CAS  PubMed  Google Scholar 

  4. Bastien CH, Morin CM (2000) Familial incidence of insomnia. J Sleep Res 9:49–54

    Article  CAS  PubMed  Google Scholar 

  5. Hall M, Buysse DJ, Reynolds CF, Kupfer DJ, Baum A (1996) Stress-related intrusive thoughts disrupt sleep onset and contiguity. Sleep Res 25:163 (Abstract)

    Google Scholar 

  6. Morin CM (1993) Insomnia: psychological assessment and management. New York, NY, Guilford Press

    Google Scholar 

  7. Espie CA (1991) The psycological treatment of insomnia. New York, John Wiley and Sons

    Google Scholar 

  8. Harvey AG (2002) A cognitive model of insomnia. Behav Res Ther 40: 869–893

    Article  CAS  PubMed  Google Scholar 

  9. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE (2001) Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA 285:1856–1864

    Article  CAS  PubMed  Google Scholar 

  10. Morin CM, Blais F, Savard J (2002) Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behav Res Ther 40:741–752

    Article  CAS  PubMed  Google Scholar 

  11. Lichstein K, Rosentha T (1980) Insomniacs’ perceptions of cognitive versus somatic determinants of sleep disturbance. J Abnorm Psychol 89:105–107

    Article  CAS  PubMed  Google Scholar 

  12. Nicassio PM, Mendlowitz DR, Fussell JJ, Petras L (1985) The phenomenology of the pre-sleep state: the development of the pre- sleep arousal scale. Behav Res Ther 23:263–271

    Article  CAS  PubMed  Google Scholar 

  13. Van Egeren L, Haynes SN, Franzen M, Hamilton J (1983) Presleep cognitions and attributions in sleep-onset insomnia. J Behav Med 6:217–232

    Article  PubMed  Google Scholar 

  14. Kuisk LA, Bertelson AD, Walsh JK (1989) Presleep cognitive hyperarousal and affect as factors in objective and subjective insomnia. Percept Mot Skills 69:1219–1225

    Article  CAS  PubMed  Google Scholar 

  15. Watts FN, Coyle K, East MP (1994) The contribution of worry to insomnia. Br J Clin Psychol 33:211–220

    Article  PubMed  Google Scholar 

  16. Perlis ML, Smith MT, Orff HJ, Andrews PJ, Giles DE (2001) Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep 24:110–117

    CAS  PubMed  Google Scholar 

  17. Perlis ML, Merica H, Smith MT, Giles DE (2001) Beta EEG in insomnia. Sleep Med Rev 5: 364–375

    Google Scholar 

  18. Merica H, Blois R, Gaillard JM (1998) Spectral characteristics of sleep EEG in chronic insomnia. Eur J Neurosci 10:1826–1834

    Article  CAS  PubMed  Google Scholar 

  19. Merica H, Gaillard JM (1992) The EEG of the sleep onset period in insomnia: a discriminant analysis. Physiol Behav 52:199–204

    Article  CAS  PubMed  Google Scholar 

  20. Freedman R (1986) EEG power in sleep onset insomnia. Electroencephalogr Clin Neurophysiol 63:408–413

    Article  CAS  PubMed  Google Scholar 

  21. Lamarche CH, Ogilvie RD (1997) Electrophysiological changes during the sleep onset period of psychophysiological insomniacs, psychiatric insomniacs, and normal sleepers. Sleep 20:724–733

    CAS  PubMed  Google Scholar 

  22. Hall M, Buysse DJ, Nowell PD, Nofzinger EA, Houck P, Reynolds CF III, Kupfer DJ (2000) Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosom Med 62:227–230

    Article  CAS  PubMed  Google Scholar 

  23. Krystal AD, Edinger JD, Wohlgemuth WK, Michaels C (2002) A within-subject study of the relationship of non-REM EEG spectral amplitude and the agreement between subjective and objective assessments of sleep time. Sleep 25(Abstract Suppl):A33–A34 (Abstract)

    Google Scholar 

  24. Krystal AD, Edinger JD, Wohlgemuth WK, Marsh GR (2001) A pilot study of the sleep EEG power spectral effects of behavioral therapy in primary insomniacs. Sleep 24(Abstract Suppl):A62 (Abstract)

    Google Scholar 

  25. Perlis ML, Smith MT, Orff HJ, Andrews PJ, Giles DE (2001) The mesograde amnesia of sleep may be attenuated in subjects with primary insomnia. Physiol Behav 74(1–2):71–76

    Article  CAS  PubMed  Google Scholar 

  26. Monk TH, Reynolds CF, Kupfer DJ (1994) The Pittsburgh Sleep Diary (PghSD). J Sleep Res 3:111–120

    Article  CAS  Google Scholar 

  27. Carskadon M, Dement W, Mitler M, Guilleminault C, Zarcone VP, Spiegel R (1976) Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am J Psychiatry 133:1382–1388

    Article  CAS  PubMed  Google Scholar 

  28. Frankel BL, Coursey R, Buchbinder R, Snyder F (1976) Recorded and reported sleep in primary chronic insomnia. Arch Gen Psuchiatry 33:615–623

    Article  CAS  Google Scholar 

  29. Coates TJ, Killen J, George J, Marchini E, Hamilton S, Thoresen C (1982) Estimating sleep parameters: a multitrait-multimethod analysis. J Consult Clin Psychol 50:345–352

    Article  CAS  PubMed  Google Scholar 

  30. Kales A, Caldwell A, Preston T (1976) Personality patterns in insomnia. Arch Gen Psychiatry 33:1128–1134

    Article  CAS  PubMed  Google Scholar 

  31. Kales A, Bixler E, Vela-Bueno A, Cadieux R, Soldatos C, Kales J (1984) Biopsychobehavioral correlates of insomnia: III. Polygraphic findings of sleep difficulty and their relationship to psychopathology. Int J Neurosci 23:43–56

    Article  CAS  PubMed  Google Scholar 

  32. Bonnet MH, Arand DL (1997) Physiological activation in patients with sleep state misperception. Psychosom Med 59:533–540

    Article  CAS  PubMed  Google Scholar 

  33. Chesson AL Jr, Anderson WM, Littner M, Davila D, Hartse K, Johnson S, Wise M, Rafecas J (1999) Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine [In Process Citation]. Sleep 22:1128–1133

    PubMed  Google Scholar 

  34. Shoham-Salomon V, Rosenthal R (1987) Paradoxical interventions: a meta-analysis. J Consult Clin Psychol 55:22–28

    Article  CAS  PubMed  Google Scholar 

  35. Harvey AG, Payne S (2002) The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction. Behav Res Ther 40:267–277

    Article  PubMed  Google Scholar 

  36. Buysse DJ, Perlis ML (1996) The evaluation and treatment of insomnia. J Prac Psych Behav Health March:80–93

    Google Scholar 

  37. Barlow DH, Craske MG, Cerny JA, Klosko JS (1989) Behavioral treatment of panic disorder. Behav Ther 20(2): 261–282

    Article  Google Scholar 

  38. Barlow DH (1992) Cognitive-behavioral approaches to panic disorder and social phobia. Bull Menninger Clin 56(2 Suppl A):A14–A28

    CAS  PubMed  Google Scholar 

  39. Barlow DH (1997) Cognitive-behavioral therapy for panic disorder: current status. J Clin Psychiatry 58(Suppl 2):32–36

    PubMed  Google Scholar 

  40. Lichstein KL, Riedel BW, Wilson NM, Lester KW, Aguillard RN (2001) Relaxation and sleep compression for late-life insomnia: a placebo- controlled trial. J Consult Clin Psychol 69:227–239

    Article  CAS  PubMed  Google Scholar 

  41. Haynes SN, Woodward S, Moran R, Alexander D (1974) Relaxation treatment of insomnia. Behav Ther 5:555–558

    Article  Google Scholar 

  42. Freedman R, Papsdorf JD (1976) Biofeedback and progressive relaxation treatment of sleep-onset insomnia: a controlled, all-night investigation. Biofeedback Self Regul 1:253–271

    Article  CAS  PubMed  Google Scholar 

  43. Bootzin RR (1984) Evaluation of stimulus control instructions, progressive relaxation, and sleep hygiene as treatments for insomnia. In: Koella WP, Ruther E, Schulz H (eds) Sleep. Gustav Fischer Verlag, Stuttgart, Germany, pp 142–144

    Google Scholar 

  44. Borkovec TD, Fowles DC (1973) Controlled investigation of the effects of progressive and hypnotic relaxation on insomnia. J Abnorm Psychol 82:153–158

    Article  CAS  PubMed  Google Scholar 

  45. Hauri PJ (1997) Can we mix behavioral therapy with hypnotics when treating insomniacs? Sleep 20:1111–1118

    CAS  PubMed  Google Scholar 

  46. Milby JB, Williams V, Hall JN, Khuder S, McGill T, Wooten V (1993) Effectiveness of combined triazolam-behavioral therapy for primary insomnia. Am J Psychiatry 150:1259–1260

    Article  CAS  PubMed  Google Scholar 

  47. Morin CM, Colecchi C, Stone J, Sood R, Brink D (1999) Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial [see comments]. JAMA 281:991–999

    Article  CAS  PubMed  Google Scholar 

  48. Morin CM, Colecchi CA, Ling WD, Sood RK, Williams H (1994) Cognitive-behavioral therapy for benzodiazepine-dependent insomniacs. Sleep Res 23:295 (Abstract)

    Google Scholar 

  49. Vallieres A, LeBlanc M, Guay B, Morin CM (2002) Sequntial use of medication and behavioural therapies for chronic insomnia. Sleep 25(Abstract Suppl):A69–A70 (Abstract)

    Google Scholar 

  50. Morin CM, Culbert JP, Schwartz SM (1994) Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 151:1172–1180

    Article  CAS  PubMed  Google Scholar 

  51. Murtagh DR, Greenwood KM (1995) Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol 63:79–89

    Article  CAS  PubMed  Google Scholar 

  52. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, Buysse DJ (2002) Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 159:5–11

    Article  PubMed  Google Scholar 

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Perlis, M.L., Smith, M.T., Jungquist, C., Nowakowski, S., Orff, H., Soeffing, J. (2010). Cognitive-Behavioral Therapy for Insomnia. In: Attarian, H., Schuman, C. (eds) Clinical Handbook of Insomnia. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-042-7_22

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  • DOI: https://doi.org/10.1007/978-1-60327-042-7_22

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  • Publisher Name: Humana Press, Totowa, NJ

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