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Cognitive · 1970

Cognitive behavioural therapy for insomnia (CBT-I)

Do not chase sleep: create the conditions and let it happen.

CBT-I is the first-line psychological treatment for chronic insomnia because it addresses directly the mechanisms that maintain it: the conditioned bed–wakefulness association, the loss of sleep pressure through "compensations" (naps, going to bed too early, staying in bed awake) and the cognitive/affective arousal tied to sleep effort. Its operational centre is behavioural (sleep scheduling, restriction/compression and stimulus control), and it is strengthened by specific cognitive components (beliefs, catastrophising, sleep monitoring, performance anxiety) and by supporting measures (sleep hygiene, relaxation, management of substances and environment). The clinical framing matters: CBT-I does not aim to "sort out one's life" or replace a psychotherapy addressing conflict, trauma or life dilemmas; its function is to reorganise the sleep–wake system so as to reduce physiological noise, improve daytime energy and stability, and make subsequent psychotherapeutic work more feasible where there is comorbidity or dominant psychological content (Morin & Espie, 2004, ch. 5 "Sleep Scheduling", ch. 6 "Cognitive Therapy", ch. 8 "Clinical and Treatment Implementation Issues").

Influences

  • Sleep medicine (homeostatic and circadian regulation)
  • The 3P model of insomnia (predisposing–precipitating–perpetuating)
  • Behaviourism applied to sleep (stimulus control and associative learning)
  • Sleep restriction/compression and principles of consolidation
  • Cognitive models of insomnia (hypervigilance, beliefs, sleep effort)
  • Psychoeducation, self-monitoring and data-guided decision making

Key references

  • Morin, C. M., & Espie, C. A. (2004). Insomnia: A Clinical Guide to Assessment and Treatment. Springer.
  • Bootzin, R. R. (1972). Stimulus control treatment for insomnia. (Trabajo seminal; múltiples reediciones/capítulos posteriores).
  • Spielman, A. J., Caruso, L. S., & Glovinsky, P. B. (1987). A behavioral perspective on insomnia treatment. (Modelo 3P y mantenimiento conductual).
  • Edinger, J. D., & Means, M. K. (2005). Cognitive–behavioral therapy for primary insomnia. Clinical Psychology Review, 25, 539–558.
  • Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep, 29(11), 1398–1414.
  • Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869–893.
  • Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2005). Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide. Springer.