Contributions of Cognitive-Behavioral Approaches to the Clinical Management of Insomnia

Insomnia is a prevalent and costly health problem. Because psychological and behavioral factors often exacerbate sleep difficulties, these factors should be addressed when treating insomnia. This article reviews the benefits and limitations of cognitive-behavioral approaches for treating insomnia and summarizes recently developed evidence-based practice guidelines. The findings from controlled clinical trials indicate that 70% to 80% of patients with primary insomnia benefit from cognitivebehavioral interventions such as stimulus-control, sleep-restriction, relaxation, and cognitive therapies. These treatments mainly improve sleep continuity, enhance sleep satisfaction, and reduce emotional distress—changes that are well sustained over time. Despite these positive results, treatment response is not always optimal; only a few patients become good sleepers, and some patients do not respond at all. Because no single treatment method is effective for all patients and all insomnia subtypes, behavioral and pharmacologic approaches often need to be integrated. Recent findings from such studies are discussed, with emphasis on issues such as speed, magnitude, and durability of treatment effects. Finally, several clinical guidelines for implementing optimal treatment strategies are suggested.