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What is CBT for Insomnia (CBT-I)?

  • Writer: Sleep Psychologist
    Sleep Psychologist
  • 4 days ago
  • 6 min read

Updated: 2 days ago


Cognitive Behavioural Therapy for Insomnia (CBTI) has gained recognition as an effective treatment option for those struggling with sleep disturbances. It is now the gold standard treatment for acute and chronic insomnia by the National Institute of Clinical Excellence (NICE) Guidelines. As a structured intervention, it addresses the thoughts and behaviours that contribute to insomnia. This article will explore the pros and cons of CBTI, providing insight into how this approach can be beneficial or challenging for individuals seeking better sleep.


What is CBTI?


Cognitive Behavioural Therapy for Insomnia focuses on modifying sleep-related thoughts and behaviours. Unlike medication, which addresses symptoms in the short-term, CBTI aims to identify and correct the underlying issues contributing to insomnia. It typically involves several sessions with a trained sleep practitioner who will introduce core psycho-education around sleep science, followed by recommended active core strategies to try between sessions.


The Advantages of CBT for Insomnia


1. Long-term effectiveness


One of the significant benefits of CBTI is its long-term effectiveness. Research has shown that many individuals experience sustained improvement in sleep quality even after the CBTI has ended with lasting effects. This lasting impact contrasts sharply with pharmacological treatments, where symptoms often return once medication is discontinued.



2. Medication Free Side Effects


Another advantage of CBTI is the absence of medication-related side effects. Many people who struggle with insomnia may be wary of adverse effects from sleeping pills, which can include dependency, grogginess the next day, and other health concerns. CBTI provides a non-invasive, drug-free solution that equips individuals with tools for managing their sleep difficulties.



3. Personalised approach


CBTI can be tailored to meet the specific needs of individuals. Unlike generic treatments, it addresses the unique patterns and triggers of a person's insomnia. By working with a trained sleep practitioner, individuals can explore their sleep habits in detail and develop strategies suited to their circumstances, enhancing the potential for positive outcomes. Insomnia can often go hand in hand with chronic health conditions, so learning to support sleep and rest around a health condition can be highly beneficial.




4. Preventative


CBTI not only helps individuals manage their current insomnia but also equips them with skills for handling future episodes. Once effective techniques are learned individuals are better prepared to cope with any new challenges that may arise, promoting confidence and overall mental and physical well-being. CBTI can often reduce the typical preoccupation of not sleeping once someone feels equipped to apply the strategies learned in a way that is supportive to them.



5. Supports overall mental health


Engaging in CBTI can also have positive effects on overall mental health. Sleep disturbances are often interlinked with anxiety and depression. By improving sleep patterns through CBTI, individuals may notice an improvement in their daily mood, cognitive function, and overall quality of life. Sleep is never perfect, but with the right support can be close to good enough.



Disadvantages of CBTI for Insomnia


1. Time commitment


One of the drawbacks of CBTI is the time commitment required. Therapy typically consists of multiple sessions, along with prescribed homework and practice outside the clinical setting. For individuals with busy lifestyles, finding time to attend sessions and engage in self-directed practice can be challenging. Attending a group CBTI course can be a good way of connecting with others and sharing the experience together.


2. Initial discomfort


Some participants may experience initial discomfort or frustration during the process. CBTI is a 'long game' not a short term fix like medication. Therefore, techniques may initially lead to feelings of tiredness or increased anxiety around sleep, as individuals adapt to new strategies. While these feelings are typically temporary, they can deter some people from fully committing to the therapy. Things often may feel a little worse before they get better, which is only a natural part of the process of change. By applying a more gradual approach, such as, sleep compression discomfort can be minimised. A thorough screening prior to starting CBTI is an important part of the process which allows sleep practitioners to tailor CBTI sessions sensitively, however sometimes it can be that timing of CBTI is not right for a range of life circumstances.




3. Requires motivation and willingness to change


CBTI is most effective when individuals are ready, willing and able to engage with the process. For those who are not committed to learning something new or who prefer a quick fix to their insomnia, CBTI may not yield the desired results. The collaborative nature of this support relies on the individual's active participation and effort.



4. Access to trained professionals


The availability and expertise of trained CBTI professionals can vary significantly. In some areas, finding a skilled sleep practitioner may be challenging, leading individuals to rely on self-help materials that may not provide the same effectiveness as direct mentoring with a trained professional. However, with the increase in recognition of the value of CBTI, finding suitable practitioners will be easier. There is a rising recognition in the insomnia professional community that formalising CBTI competency among practitioners would be beneficial so that practice can be a little more standardised and with levels of expertise and areas of particular strength.



5. Not a one-size-fits-all solution


Finally, it's essential to recognise that CBTI might not work for everyone. As with many interventions evolution in practice is common. Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Therapy for Insomnia MBTI has been found to be helpful for some; the so called 'Third Wave' psychological interventions. At Sleep Psychologist we use an integrative approach which is the strength of a clinical psychologist, drawing from a range of psychological models and tailoring these to the person. While many individuals benefit from the standard CBT approach, certain more complex cases of insomnia may stem from medical conditions or other factors that require alternative treatments or a very tailored specialist approach. A thorough assessment and individualised approach is crucial in determining the most suitable option for each person.



Conclusion


Cognitive Behavioural Therapy for Insomnia (CBTI) presents a range of benefits and drawbacks that individuals should consider when seeking treatment for sleep disturbances. With its long-term effectiveness, absence of side effects, and tailored approach, many find CBTI to be a valuable tool in improving sleep quality and overall mental health.


However, it is essential to weigh the potential challenges, such as the time commitment and initial discomfort, alongside the motivation to engage with the support. As with any treatment, a personalised screening and assessment is crucial in determining whether CBTI is the right choice for each individual.


Ultimately, whether CBTI aligns with your needs, understanding its pros and cons can empower you to make informed decisions about your sleep health.


CBTI with Sleep Psychologist

If you would like to join a 5 week course lead by Dr Gabriella Romano please complete a Contact Form and we will gladly welcome you. Please note that the group is only really suitable for adults with mild health conditions.






References

  1. BMJ Best Practice (2023) Insomnia. BMJ Publishing Group. https://bestpractice.bmj.com

  2. Bootzin, R. R., & Epstein, D. R. (2011). Understanding and treating insomnia. Annual review of clinical psychology, 7, 435–458.

    https://www.annualreviews.org/doi/10.1146/annurev.clinpsy.3.022806.091516

  3. Belanger, L., Savard, J., & Morin, C. M. (2006). Clinical management of insomnia using cognitive therapy. Behavioral sleep medicine, 4(3), 179–198.

    http://www.tandfonline.com/doi/abs/10.1207/s15402010bsm0403_4

  4. Davidson, J.R., Dickson, C. and Han, H. (2019) Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes. British Journal of General Practice. 69(686), e657-e664. [Abstract] [Free Full-text]

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  8. Perlis, M.L., Posner, D., Riemann, D., et al. (2022) Insomnia. Lancet 400(10357), 1047-1060. [Abstract]

  9. Riemann, D., Espie, C.A., Altena, E., et al. (2023) The European insomnia guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research 32(6), e14035. [Abstract] [Free Full-text]

  10. Wilson, S., Anderson, K., Baldwin, D., et al. (2019) British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. Journal of Psychopharmacology 33(8), 923-947. [Abstract] [Free Full-text]

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