Cognitive-Behavioral Approaches to the Treatment of Insomnia
J Clin Psychiatry 2004;65(suppl 16):33-40
© Copyright 2014 Physicians Postgraduate Press, Inc.
Insomnia is a pervasive condition with various causes, manifestations, and health consequences.
Regardless of the initial cause or event that precipitates insomnia, it is perpetuated into a chronic condition
through learned behaviors and cognitions that foster sleeplessness. This article reviews the rationale
and objectives of cognitive-behavioral therapy (CBT), a safe and effective treatment for insomnia
that may be used to augment hypnotic drugs or as a monotherapy. Cognitive-behavioral
management of insomnia includes 3 components—behavioral, cognitive, and educational modules—and is
usually presented in a group or individual therapy setting. Each treatment procedure is detailed
herein, and recommendations for implementation are given. The evidence supporting this behavioral
approach shows that CBT is effective for 70% to 80% of patients and that it can significantly reduce
several measures of insomnia, including sleep-onset latency and wake-after-sleep onset. Aside from
the clinically measurable changes, this therapy system enables many patients to regain a feeling of
control over their sleep, thereby reducing the emotional distress that sleep disturbances cause. Some
clinical and practical issues that often arise when implementing this therapeutic approach for insomnia
are also discussed.