ABSTRACT

Cognitive Behavior Therapy for Insomnia is an empirically based treatment focused on addressing research-identified maintaining factors for insomnia. It is a multicomponent treatment made up of techniques that have been empirically validated. One advantage of the CBT model is that it is applicable across a wide array of diagnostic categories. This is because the model is based on the concept, that despite the variety of precipitating events that might have initially caused the insomnia, the factors that tend to maintain the chronicity of the disorder are similar from case to case and are responsive to behavioral and cognitive change strategies. The idea is that in any case, if the maladaptive perpetuating factors are present, then alterations of these factors will lead to reductions in symptoms. Therefore, the debate about biological versus psycho - logical etiologies determining treatment modality is somewhat of a moot point since we know that there are many pathways to disorder and recovery. Even for biological sleep regulatory systems such as the circadian and homeostatic systems, we know that behavioral and environmental input can have profound corrective or disruptive influence. The evidence for CBT-I is strong and the effect sizes are similarly large when compared with pharmacotherapy. CBT-I is the frontline recommended treatment in those with chronic insomnia (Howell et al., 2012; National Institutes of Health, 2005; Wilson et al., 2010) because of the impressive short-term effects and because it is so brief, durable, without polypharmacy risks, patient-preferred (Morin et al., 1992; Vincent & Lionberg, 2001), and an excellent economical choice. Despite criticisms that it is not widely available, there have been excellent gains made in the past few years with respect to training (e.g., Manber et al., 2012), owing in part to an increase in workshop and training opportunities, and a CBT-I training program in the Veteran’s Affairs Administration. Moreover, there are online and telehealth treatment programs with support (Espie et al., 2012; Ritterband et al., 2009; Vincent & Walsh, 2013). Lastly, we have a large number of effectiveness trials demonstrating that non-sleep specialists can effectively deliver this treatment (Buysse et al., 2011; Espie et al., 2007; Jungquist et al., 2010). There has been discussion of utilizing stepped care modes of delivery for CBT-I in which large numbers of patients could be introduced into early steps such as self-help strategies and online programs, and, as needed, funnel through to steps that might include groups run by paraprofessionals, and eventually treatment by a therapist certified in behavioral sleep medicine for the more complex cases (Espie, 2009).