ABSTRACT
The evidence for CBT-I is strong (Morin et al., 1999, 2006). Cognitive behavioral therapies are empirically driven therapies so they are developed and refined using data derived from research. The sleep index improvements with CBT-I are associated with large effect sizes in sleep continuity similar to the effect sizes for treatment with hypnotic medication in the short term (Morin, Culbert, & Schwartz, 1994a; Murtagh & Greenwood, 1995; Smith et al., 2002). Unlike hypnotic treatment, with CBT-I once therapy is discontinued, treatment gains are maintained into follow up periods for as long as two years post-therapy (Edinger et al., 1992, 1996, 2001; Edinger & Sampson, 2003; Morin et al., 1999a). Although CBT-I is a multicomponent therapy that can vary with regard to the components used, there are some common core elements (i.e., Stimulus Control and Sleep Restriction) that tend to be incorporated across all the treatment versions. These behavioral strategies form the backbone of the treatment. There is even evidence (see Morin et al., 1999b, 2006) for Stimulus Control and Sleep Restriction to be used successfully as monotherapies but in clinical practice, and in clinical trials, it is most common to combine these highly effective approaches into a multicomponent treatment package. Therefore the clinician has a menu of techniques from which to choose and can decide the appropriate sequence, emphasis, and combination of elements to use depending on the conceptualization of the relevant factors impacting the client's sleep. The most frequently utilized components of CBT-I (Edinger & Carney, 2014) include:
Stimulus Control (Bootzin, 1972): a set of sleep rules to address conditioned arousal.
Sleep Restriction (Spielman et al., 1987b): a technique to increase sleep drive by matching the time spent in bed with current sleep production time.
Cognitive Therapy: a set of techniques to modify catastrophizing beliefs about sleep and fatigue that cause or exacerbate insomnia (discussed in Chapter 7).
Counter arousal strategies: a set of techniques to address hyper arousal, including establishing a wind-down period before bed, pre-sleep structured information processing, and relaxation therapy.
Sleep Hygiene: a set of rules designed to address sleep-interfering habits, substances, or environmental factors.
