Cognitive and behavioral psychotherapy in the treatment of insomnia: looking beyond models and techniques
DOI:
https://doi.org/10.25118/2236-918X-6-2-3Keywords:
Psychotherapy, behavioral and cognitive therapy, insomniaAbstract
Cognitive and behavioral therapy is recommended as first-line treatment for insomnia disorder. Even though several studies have shown the effectiveness of cognitive and behavioral therapy in the treatment of insomnia, there is a significant number of patients who do not benefit from this therapy. Factors related to non-response should be investigated. The present article analyzes some of the potential factors that may contribute to failure in insomnia treatment through the cognitive and behavioral approach. In the assessment of these factors, different aspects may be assessed for a better understanding of the mechanisms involved in treatment response. Among the components involved in the therapeutic process, some topics stand out, including information regarding what is being treated, who is being treated, how the response is being assessed, what type of treatment is being carried out, and who provides the therapy. Through the assessment of these components, we try to look beyond cognitive and behavioral therapy techniques; rather, we try to think of ways to broaden the benefits of the approach based on the results obtained and/or so far described.
Downloads
Metrics
References
Drake CL, Roehrs T, Roth T. Insomnia causes, consequences, and therapeutics: an overview. Depress Anxiety. 2003;18:163-76.
Margis R. Terapia cognitivo-comportamental na insônia. Rev Debates Psiquiatr. 2015;5:22-7.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4:487-504.
Associação Brasileira do Sono, Bacelar A, Pinto LR Jr. Insônia: do diagnóstico ao tratamento: III Consenso Brasileiro de Insônia. São Paulo: Omnifarma; 2013.
Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep. 1999;22:1134-56.
Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep. 2006;29:1398-414.
Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract. 2012;13:40.
Geiger-Brown JM, Rogers VE, Liu W, Ludeman EM, Downton KD, Diaz-Abad M. Cognitive behavioral therapy in persons with comorbid insomnia: a meta-analysis. Sleep Med Rev. 2014;23:54-67.
Wu JQ, Appleman ER, Salazar RD, Ong JC. Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Intern Med. 2015;175:1461-72.
van de Laar M, Pevernagie D, van Mierlo P, Overeem S. Psychiatric comorbidity and aspects of cognitive coping negatively predict outcome in cognitive behavioral treatment of psychophysiological insomnia. Behav Sleep Med. 2015;13:140-56.
Ong JC, Kuo TF, Manber R. Who is at risk for dropout from group cognitive-behavior therapy for insomnia? J Psychosom Res. 2008;64:419-25.
Edinger JD, Carney CE, Wohlgemuth WK. Pretherapy cognitive dispositions and treatment outcome in cognitive behavior therapy for insomnia. Behav Ther. 2008;39:406-16.
Espie CA, Inglis SJ, Harvey L. Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: analysis of outcome data at 12 months posttreatment. J Consult Clin Psychol. 2001;69:58-66.
Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? Sleep. 2001;24:591-9.
Van Houdenhove L, Buyse B, Gabriëls L, Van den Bergh O. Treating primary insomnia: clinical effectiveness and predictors of outcomes on sleep, daytime function and health-related quality of life. J Clin Psychol Med Settings. 2011;18:312-21.
van de Laar M, Verbeek I, Pevernagie D, Aldenkamp A, Overeem S. The role of personality traits in insomnia. Sleep Med Rev. 2010,14:61-8.
Bei B, Ong JC, Rajaratnam SM, Manber R. Chronotype and improved sleep efficiency independently predict depressive symptom reduction after group cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2015;11:1021-7.
Cervena K, Dauvilliers Y, Espa F, Touchon J, Matousek M, Billiard M, et al. Effect of cognitive behavioural therapy for insomnia on sleep architecture and sleep EEG power spectra in psychophysiological insomnia. J Sleep Res. 2004;13:385-93.
Krystal AD, Edinger JD. Sleep EEG predictors and correlates of the response to cognitive behavioral therapy for insomnia. Sleep. 2010;33:669-77.
Morin CM. Psychological and behavioral treatments for insomnia I: approaches and efficacy. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 5th ed. Philadelphia: Elsevier Saunders; 2011. p. 866- 83.
Troxel WM, Conrad TS, Germain A, Buysse DJ. Predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in older adults. J Clin Sleep Med. 2013;9:1281-9.
Vincent N, Penner S, Lewycky S. What predicts patients’ perceptions of improvement in insomnia? J Sleep Res. 2006;15:301-8.
Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301:2005-15.
Ruiter Petrov ME, Lichstein KL, Huisingh CE, Bradley LA. Predictors of adherence to a brief behavioral insomnia intervention: daily process analysis. Behav Ther. 2014;45:430-42.
Machado SS. Terapias cognitivas: um re-olhar sobre sua trajetória e pressupostos teóricos e tecnológicos. Rev Bras Psicoter. 2009;11:244-63.
Espie CA, MacMahon KM, Kelly HL, Broomfield NM, Douglas NJ, Engleman HM, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007;30:574-84.
Järnefelt H, Sallinen M, Luukkonen R, Kajaste S, Savolainen A, Hublin C. Cognitive behavioral therapy for chronic insomnia in occupational health services: analyses of outcomes up to 24 months post-treatment. Behav Res Ther. 2014;56:16-21.
Espie CA, Kyle SD, Williams C, Ong JC, Douglas NJ, Hames P, et al. A randomized, placebocontrolled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep. 2012;35:769-81.
Kaldo V, Jernelöv S, Blom K, Ljótsson B, Brodin M, Jörgensen M, et al. Guided internet cognitive behavioral therapy for insomnia compared to a control treatment - a randomized trial. Behav Res Ther. 2015;71:90-100.
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res. 2012;36:427-40.
Downloads
Published
How to Cite
Conference Proceedings Volume
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria allows the author (s) to keep their copyrights unrestricted. Allows the author (s) to retain their publication rights without restriction. Authors should ensure that the article is an original work without fabrication, fraud or plagiarism; does not infringe any copyright or right of ownership of any third party. Authors should also ensure that each one complies with the authorship requirements as recommended by the ICMJE and understand that if the article or part of it is flawed or fraudulent, each author shares responsibility.
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) - Debates em Psiquiatria is governed by the licencse CC-By-NC
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.