0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

CLINICAL SYNTHESIS   |    
Psychological and Behavioral Treatments for Insomnia
Brenda Byrne, Ph.D.
FOCUS 2014;12:31-37. doi:10.1176/appi.focus.12.1.31
View Author and Article Information

Author Information and CME Disclosure

Brenda Byrne, Ph.D., Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA

Dr. Byrne reports no competing interests.

Address correspondence to Brenda Byrne, Ph.D., 1015 Chestnut St, Suite 901, Philadelphia, PA 19107; e-mail: brenbyr@aol.com

Abstract

Insomnia, a costly public health problem, can be precipitated by multiple forms of stress. Sleep difficulties have many sources, some based in medical or mental health disorders and some based in other sleep disorders or in substance abuse. Primary insomnia, not accounted for by other health or sleep disorders, has been addressed by psychological and behavioral treatments, which offer remedies for the perpetuating factors that extend insomnia into chronic forms. Many people prefer not to rely on hypnotic medications as a permanent solution to insomnia. A report by the American Academy of Sleep Medicine (AASM) has identified several nonmedication-based interventions judged to be effective and recommended in the treatment of chronic primary insomnia. These include stimulus control, sleep restriction, relaxation training, cognitive behavior therapy, paradoxical intention, and biofeedback. Models of physiological, behavioral, cognitive, and metacognitive factors support these treatments and account for their effects.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1.Suggested Assessment Tools for Insomnia
Anchor for Jump
Table 2.Getting a Better Night’s Sleep
Anchor for Jump
Table 3.Examples of Various Beliefs about Sleep
Anchor for Jump
Table 4.Stimulus Control Strategy: Directions For Patients
Anchor for Jump
Table 5.Sleep Restriction Strategy: Directions for Sleep Specialist
Anchor for Jump
Table 6.Resources for Better Sleep
+

References

Mai  E;  Buysse  DJ:  Insomnia: prevalence, impact, pathogenesis, differential diagnosis, and evaluation.  Sleep Med Clin 2008; 3:167–174
[CrossRef] | [PubMed]
 
American Academy of Sleep Medicine: The international classification of sleep disorders, second edition: Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine; 2005
 
Taylor  DJ;  Lichstein  KL;  Durrence  HH:  Insomnia as a health risk factor.  Behav Sleep Med 2003; 1:227–247
[CrossRef] | [PubMed]
 
Morgenthaler  T;  Kramer  M;  Alessi  C;  Friedman  L;  Boehlecke  B;  Brown  T;  Coleman  J;  Kapur  V;  Lee-Chiong  T;  Owens  J;  Pancer  J;  Swick  T; American Academy of Sleep Medicine:  Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American academy of sleep medicine report.  Sleep 2006; 29:1415–1419
[PubMed]
 
Espie  CA;  Kyle  SD:  Cognitive behavioral and psychological therapies for chronic insomnia, in  Therapy in Sleep Medicine . Edited by Barkoukis  TJ;  Matheson  JK;  Ferber  R;  Doghramji  K.  Philadelphia, PA,  Elsevier Saunders, 2012, pp 161–171
 
Morawetz  D:  Insomnia and depression: which comes first? Sleep Res Online 2003; 5:77–81
 
Spielman  AJ;  Saskin  P;  Thorpy  MJ:  Treatment of chronic insomnia by restriction of time in bed.  Sleep 1987; 10:45–56
[PubMed]
 
Harvey  AG:  A cognitive model of insomnia.  Behav Res Ther 2002; 40:869–893
[CrossRef] | [PubMed]
 
Borbély  AA:  A two process model of sleep regulation.  Hum Neurobiol 1982; 1:195–204
[PubMed]
 
Riemann  D;  Spiegelhalder  K;  Feige  B;  Voderholzer  U;  Berger  M;  Perlis  M;  Nissen  C:  The hyperarousal model of insomnia: a review of the concept and its evidence.  Sleep Med Rev 2010; 14:19–31
[CrossRef] | [PubMed]
 
Ong  JC;  Ulmer  CS;  Manber  R:  Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia.  Behav Res Ther 2012; 50:651–660
[CrossRef] | [PubMed]
 
Hayes  SC:  Acceptance and commitment therapy and the new behavior therapies: mindfulness, acceptance, and relationship, in  Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition . Edited by Hayes  SC;  Follette  VM;  Linehan  MM.  New York,  The Guilford Press, 2004, pp 1–29
 
Rogojanski  J;  Carney  CE;  Monson  CM:  Interpersonal factors in insomnia: a model for integrating bed partners into cognitive behavioral therapy for insomnia.  Sleep Med Rev 2013; 17:55–64
[CrossRef] | [PubMed]
 
Bastien  CH;  Vallières  A;  Morin  CM:  Validation of the Insomnia Severity Index as an outcome measure for insomnia research.  Sleep Med 2001; 2:297–307
[CrossRef] | [PubMed]
 
Buysse  DJ;  Reynolds  CF  3rd;  Monk  TH;  Berman  SR;  Kupfer  DJ:  The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.  Psychiatry Res 1989; 28:193–213
[CrossRef] | [PubMed]
 
Krupps  LB:  Fatigue severity scale (FSS).  Red Bank, NJ,  HealthyWomen, 2013 (http://www.healthywomen.org/content/article/fatigue-severity-scale-fss)
 
Morin  CM;  Stone  J;  Trinkle  D;  Mercer  J;  Remsberg  S:  Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints.  Psychol Aging 1993; 8:463–467
[CrossRef] | [PubMed]
 
Morin  CM;  Vallières  A;  Ivers  H:  Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16).  Sleep 2007; 30:1547–1554
[PubMed]
 
Beck  AT;  Steer  RA:  Beck Depression Inventory .  Lutz FL,  Psychological Corp., 1996
 
Beck  AT;  Steer  RA:  Beck Anxiety Inventory .  Lutz FL,  Psychological Corp., 1990
 
Carney  CE;  Buysse  DJ;  Ancoli-Israel  S;  Edinger  JD;  Krystal  AD;  Lichstein  KL;  Morin  CM:  The consensus sleep diary: standardizing prospective sleep self-monitoring.  Sleep 2012; 35:287–302
[PubMed]
 
Hauri  P;  Linde  S:  No More Sleepless Nights .  New York,  John Wiley & Sons, 1996
 
Jacobs  GD:  Say Good Night to Insomnia .  New York,  St Martin’s Press, 2009
 
Bootzin  RR:  Stimulus control treatment for insomnia.  Proceedings of the American Psychological Association 1972; 7:395–396
 
Spielman  AJ;  Caruso  LS;  Glovinsky  PB:  A behavioral perspective on insomnia treatment.  Psychiatr Clin North Am 1987; 10:541–553
[PubMed]
 
Benson  H:  The Relaxation Response .  New York,  Avon Books, 2000
 
Espie  CA:  Overcoming insomnia and sleep problems: a self-help guide using cognitive behavioral techniques .  London,  Constable and Robinson Ltd, 2006
 
Bharati  SJ:  Yoga Nidra: Yogic Conscious Deep Sleep , 2013. http://www.swamij.com/yoga-nidra.htm
 
Naparstek  B:  Healthful sleep .  Health Journeys, 2013. http://www.healthjourneys.com
 
Ortiz  J:  Sound psychology.  Institute of Applied Psychomusicology, 2012. http://www.soundpsych.com
 
Headspace Inc.:  Headspace is meditation for modern living. http://www.headspace.com
 
Sterman  MB;  Howe  RC;  Macdonald  LR:  Facilitation of spindle-burst sleep by conditioning of electroencephalographic activity while awake.  Science 1970; 167:1146–1148
[CrossRef] | [PubMed]
 
Cheng  SK;  Dizon  J:  Computerised cognitive behavioural therapy for insomnia: A systematic review and meta-analysis.  Psychother Psychosom 2012; 81:206–216
[CrossRef] | [PubMed]
 
Ritterband  LM;  Thorndike  FP;  Gonder-Frederick  LA;  Magee  JC;  Bailey  ET;  Saylor  DK;  Morin  CM:  Efficacy of an Internet-based behavioral intervention for adults with insomnia.  Arch Gen Psychiatry 2009; 66:692–698
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Changes in the diagnostic formulation of insomnia in DSM-5 include which of the following:

See Doghramji: Table 1. DSM-5 Criteria for Insomnia Disorder p 6
2.
The risk of insomnia is greatest in which of the following populations:

See Doghramji: Prevalence, p 3
3.
A 75-year old woman requests a psychiatric consultation for frequently interrupted sleep; she falls asleep readily but awakens about six times per night, getting only about 6 hours of sleep between her bedtime of 11 p.m. and rising at 8 a.m. She is apparently in good health but is fatigued and very worried about getting inadequate sleep. A sleep laboratory study revealed no sleep disorder requiring medical management. Which of the following is the first best treatment choice?

See Byrne: Behavioral Strategies of CBT-I, Sleep Restriction Treatment p 35
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 56.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 56.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 29.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 60.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 22.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles