Cognitive-Behavioral Approaches to the Treatment of Insomnia

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 conditionthrough learned behaviors and cognitions that foster sleeplessness. This article reviews the rationaleand objectives of cognitive-behavioral therapy (CBT), a safe and effective treatment for insomniathat may be used to augment hypnotic drugs or as a monotherapy. Cognitive-behavioralmanagement 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 detailedherein, and recommendations for implementation are given. The evidence supporting this behavioralapproach shows that CBT is effective for 70% to 80% of patients and that it can significantly reduceseveral measures of insomnia, including sleep-onset latency and wake-after-sleep onset. Aside fromthe clinically measurable changes, this therapy system enables many patients to regain a feeling ofcontrol over their sleep, thereby reducing the emotional distress that sleep disturbances cause. Someclinical and practical issues that often arise when implementing this therapeutic approach for insomniaare also discussed.