Cognitive Behavioral Therapy for Insomnia

This second edition updates our 2005 book. While the original continues to attract interest due to its concise yet comprehensive format, the aggregation of 21 years of research on cognitive behavioral therapy for insomnia (CBT-I) has substantially transformed the field. Most notably, insomnia has been reconceptualized. In 2005, insomnia was typically viewed as a symptom of other “primary” disorders, leading to two assumptions: (1) that treating the primary disorder would resolve insomnia, and (2) that behavioral treatment of insomnia in the presence of comorbidity would be ineffective. As a result, CBT-I was reserved for relatively rare cases of uncomplicated insomnia. These assumptions have now been debunked.

Research demonstrates that chronic insomnia frequently persists despite successful treatment of comorbid conditions and that CBT-I is nearly as effective for comorbid insomnia as it is for uncomplicated insomnia. More, CBT-I has meaningful “halo effects,” with responders often showing significant improvements in comorbid conditions. In depression, CBT-I outcomes may rival those of antidepressant medications or CBT for depression alone. Collectively, these findings support directly targeting chronic insomnia and the recommendation that CBT-I be a first-line therapy. This position has been codified by the American College of Physicians and endorsed by numerous professional organizations worldwide. We further argue that there is great clinical value to, when possible, treating insomnia first, as a gateway therapy that facilitates broader clinical improvement. Finally, this edition integrates over two decades of additional clinical experience, enriching both the clinical guidance and patient-centered communication presented throughout the manual. About the Authors (from the text).