Hanyang Med Rev.  2013 Nov;33(4):210-215. 10.7599/hmr.2013.33.4.210.

Cognitive Behavioral Therapy of Insomnia

• Jang CH
• Kim SH
• Oh DH

• KMID: 2284436
• DOI: http://doi.org/10.7599/hmr.2013.33.4.210

Abstract

Cognitive behavioral therapy for insomnia (CBT-I) is a group of strategies which includes sleep restriction, stimulus control therapy, relaxation training, cognitive therapy, and various combinations of those methods. Growing evidence from controlled clinical trials indicates that the majority of patients (70 to 80%) with persistent insomnia respond to CBT, and approximately half of them achieve clinical remission. CBT-I produces significant improvements of sleep-onset latency, wake after sleep onset, sleep efficiency, and sleep quality. These benefits are paralleled by reductions of daytime fatigue, improvement in psychological symptoms, and decreased usage of hypnotics. Changes in sleep patterns are well maintained after completing therapy. Treatment outcomes have been documented primarily with prospective sleep diaries; studies using polysomnography and actigraphy have also supported these results. Considering the results of current peer-reviewed research, CBT-I should be the first-line therapy for persistent insomnia. Despite strong evidence supporting its efficacy and effectiveness, CBT-I remains under utilized by health care practitioners. Increased application of evidence-based CBT-I therapies and their extension into primary medical practices should be highly effective and should be recommended in the future for better clinical management of insomnia-related disorders.

Keyword

Sleep Initiation and Maintenance Disorders; Cognitive Therapy; Sleep Disorders

MeSH Terms

Actigraphy
Cognitive Therapy*
Delivery of Health Care
Fatigue
Humans
Hypnotics and Sedatives
Methods
Polysomnography
Relaxation Therapy
Sleep Initiation and Maintenance Disorders*
Sleep Wake Disorders
Hypnotics and Sedatives

Reference

1. Ohayon MM, Hong SC. Prevalence of insomnia and associated factors in South Korea. J Psychosom Res. 2002; 53:593–600.

2. Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006; 7:123–130.

3. Espie CA. Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annu Rev Psychol. 2002; 53:215–243.

4. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. 1987; 10:541–553.

5. Perlis ML, Jungquist C, Smith MT, Posner D. Cognitive Behavioral Treatment of Insomnia: a Session-by-Session Guide. 1st ed. New York: Springer;2008. p. 7–11.

6. National Institutes of Health. National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13-15, 2005. Sleep. 2005; 28:1049–1057.

7. Vitiello MV, McCurry SM, Rybarczyk BD. The Future of Cognitive Behavioral Therapy for Insomnia: What Important Research Remains to Be Done? J Clin Psychol. 2013.

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

9. Jansson M, Linton SJ. Psychological mechanisms in the maintenance of insomnia: arousal, distress, and sleep-related beliefs. Behav Res Ther. 2007; 45:511–521.

10. Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987; 10:45–56.

11. Backhaus J, Hohagen F, Voderholzer U, Riemann D. Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia. Eur Arch Psychiatry Clin Neurosci. 2001; 251:35–41.

12. Ong JC, Shapiro SL, Manber R. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study. Behav Ther. 2008; 39:171–182.

13. Belanger L, Savard J, Morin CM. Clinical management of insomnia using cognitive therapy. Behav Sleep Med. 2006; 4:179–198.

14. Harvey AG, Sharpley AL, Ree MJ, Stinson K, Clark DM. An open trial of cognitive therapy for chronic insomnia. Behav Res Ther. 2007; 45:2491–2501.

15. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). Sleep. 2006; 29:1398–1414.

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

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

18. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002; 159:5–11.

19. Espie CA, Inglis SJ, Tessier S, Harvey L. The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice. Behav Res Ther. 2001; 39:45–60.

20. Espie CA, MacMahon KM, Kelly HL, Broomfield NM, Douglas NJ, Engleman HM, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007; 30:574–584.

21. Edinger JD, Wohlgemuth WK, Radtke RA, Coffman CJ, Carney CE. Dose-response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial. Sleep. 2007; 30:203–212.

22. Babson KA, Feldner MT, Badour CL. Cognitive behavioral therapy for sleep disorders. Psychiatr Clin North Am. 2010; 33:629–640.