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Psychological and Behavioral Treatments for Insomnia
Brenda Byrne, Ph.D.
FOCUS 2014;12:31-37. doi:10.1176/appi.focus.12.1.31
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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


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.

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


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References Container

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
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
The risk of insomnia is greatest in which of the following populations:

See Doghramji: Prevalence, p 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
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