What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) for insomnia is a non-medical approach to the treatment of insomnia. It is one form of CBT that is related to, but differs substantially from, other Cognitive Behavioral Therapies; for example those used to treat other sleep disorders, chronic pain conditions, psychiatric illnesses (e.g., depression & anxiety), addiction disorders, and obesity.

CBT-I is based on the perspective that chronic insomnia occurs in association with predisposing, precipitating, and maintaining factors. Interestingly, patients often describe their insomnia in precisely these terms:

"I started having trouble sleeping a year ago when I had a job interview. I've always been high strung and a bit of a worrier, but the stress of that interview really did me in. What I don't understand is that I got the job and things have been great ever since, but I still can't sleep."

CBT-I focuses primarily upon the maintaining factors and does so using an evidence based approach to treatment. That is, the patient and the therapist carefully assess the insomnia complaint (usually with a clinical interview, questionnaires, sleep diaries, and sometimes with a form of monitoring called actigraphy) and these "data", in turn, set the foundation for treatment and guide how therapy is conducted.

The most common form of CBT-I (and best evaluated for effectiveness) includes a cognitive component and several behavioral interventions including sleep restriction, stimulus control, and sleep hygiene instructions. These procedures are often complimented with relaxation training.

Treatment is generally conducted in the context of 4 to 8 individual therapy sessions (but as few as 2 and as many as 12 for some individuals), occurring weekly or every other week. In some cases CBT may involve group treatment. Clinicians who are trained in the practice of CBT-I are usually clinical psychologists or psychiatrists working in an office setting or in a sleep center.

Finally, it is important to understand that CBT-I is considered "active therapy." That is, both you and your clinician will take an active part in your treatment….so much so that you may come to view your therapist as less a "clinician" and more like a personal trainer. The other aspect of CBT-I that makes it an "active therapy" is that by the end of treatment patients have learned many of the tools they need to maintain improvements in sleep, particularly when they experience events which previously contributed to insomnia. Experts believe that this learning process is the reason that many patients continue to sleep well, and may improve further, even months after they have completed the CBT-I appointments with their clinician.