Cognitive-Behavioral Therapy Approaches for Insomnia

  • Edward J. Stepanski
Part of the Current Clinical Practice book series (CCP)

Abstract

There are many specific treatment approaches for insomnia that fall under the general category of cognitive-behavioral therapy (CBT). Therapies in this area have common elements: patients gain more control on sleep by modifying their sleep-wake schedules, learning relaxation skills, changing sleep-related habits, and/or learning to decrease worry about sleep. These skills can be taught in different ways. The specific CBT approach most likely to be effective in a particular patient presumably depends on the etiology of their insomnia. However, attempts to match patients to particular behavioral therapies have met with limited success. One study did show that patients with increased muscle tension benefited more from electromyograph (EMG) biofeedback, and patients without this tension did better with electroencephalograph (EEG)-based biofeedback (1). However, another study that attempted to match patients to treatment modalities, based on aspects of clinical history, actually found that patients did worse when receiving the predicted “correct” treatment than those receiving the “incorrect” treatment (2). The recent trend has been to provide a CBT program that combines different behavioral treatments and cognitive therapy. As all patients are receiving several different treatments, this approach does not require any matching of treatment types to patient’s characteristics.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hauri P, Percy L, Hellekson C, et al. (1982) The treatment of psychophysiologic insomnia with biofeedback: a replication study. Biofeedback Self Regul 7:223–234.PubMedCrossRefGoogle Scholar
  2. 2.
    Espie C, Brooks D, Lindsay W (1989) An evaluation of tailored psychological treatment of insomnia. J Behav Ther Exp Psychiatry 20:143–153.PubMedCrossRefGoogle Scholar
  3. 3.
    Buysse D, Reynolds C, Kupfer D, et al. (1997) Effects of diagnosis on treatment recommendations in chronic insomnia: a report from the APA/NIMH DSM-IV field trial. Sleep 20:542–552.PubMedGoogle Scholar
  4. 4.
    Stepanski E Behavioral therapy for insomnia, in: Principles and Practice of Sleep Medicine. 3rd ed. (Kryger M, Roth T, Dement W, eds.) WB Saunders, Philadelphia, PA, 2000 pp. 647–656.Google Scholar
  5. 5.
    Zayfert C, De Viva J (2004) Residual insomnia following cognitive behavioral treatment therapy for PTSD. J Trauma Stress 17:69–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Spielman AJ, Caruso L, Glovinsky P (1987) A behavioral perspective on insomnia. Psychiatric Clin North America 10:541–553.Google Scholar
  7. 7.
    Rybarczyk B, Lopez M, Benson R, et al. (2003) The efficacy of two behavioral treatment programs for comorbid geriatric insomnia. Psychol Aging 48:23–36.Google Scholar
  8. 8.
    Lichstein KL, Wilson NM, Johnson CT (2000) Psychological treatment of secondary insomnia. Psychol Aging 15:232–240.PubMedCrossRefGoogle Scholar
  9. 9.
    Hauri P Current Concepts: The Sleep Disorders. The Upjohn Company, Kalamazoo, MI, 1977.Google Scholar
  10. 10.
    Stepanski E, Wyatt J (2003) The efficacy of sleep hygiene in the treatment of insomnia. Sleep Med Rev 7:215–225.PubMedCrossRefGoogle Scholar
  11. 11.
    Chesson AL, Anderson WM, Littner M, et al. (1999) Practice parameters for the nonpharmacologic treatment of chronic insomnia. Sleep 22:1128–1133.PubMedGoogle Scholar
  12. 12.
    Jacobson E You Can Sleep Well. McGraw-Hill Book Company, New York, NY, 1938.Google Scholar
  13. 13.
    Bernstein D, Borkovec T Progressive Relaxation Training. Research Press, Champaign, IL, 1973.Google Scholar
  14. 14.
    Morin CM, Culvert JP, Schwartz SM (1994) Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 151:1172–1180.PubMedGoogle Scholar
  15. 15.
    Murtagh DR, Greenwood KM (1995) Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol 63:79–89.PubMedCrossRefGoogle Scholar
  16. 16.
    Hauri P (1981) Treating psychophysiologic insomnia with biofeedback. Arch Gen Psychiatry 38:752–758.PubMedGoogle Scholar
  17. 17.
    Bootzin RR (1972) Stimulus control treatment for insomnia. Proceedings, 80th Annual Convention, APA vol. 395 pp. 395–396.Google Scholar
  18. 18.
    Spielman AJ, Saskin P, Thorpy MJ (1987) Treatment of chronic insomnia by restriction of time in bed. Sleep 10:45–56.PubMedGoogle Scholar
  19. 19.
    Edinger JD, Wohlgemuth WK, Radtke RA, et al. (2001) Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA 285:1856–1864.PubMedCrossRefGoogle Scholar
  20. 20.
    Morin CM, Colecchi C, Stone J, et al. (1999) Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial [see comments]. JAMA 281:991–999.PubMedCrossRefGoogle Scholar
  21. 21.
    Jacobs GD, Pace-Schott EF, Stickgold R, et al. (2004) Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 164:1888–1896.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

Authors and Affiliations

  • Edward J. Stepanski
    • 1
  1. 1.Supportive Oncology ServicesInc. Accelerated Community Oncology Research NetworkMemphis

Personalised recommendations