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Sleep–Wake Disorders Including Insomnia

Sleeping well is a fundamental prerequisite for good mental health. Interventions targeting sleep quality have demonstrated translational effects upon symptoms of other mental health conditions (e.g., Sheaves et al., 2018). Cognitive behavioral therapy for insomnia (CBT-I) is an effective evidence-based treatment for sleep difficulties. Read more

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Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive distortions (or ‘unhelpful thinking styles’) are ways that our thoughts become biased. Different cognitive biases are associated with di ... https://www.psychologytools.com/resource/cognitive-distortions-unhelpful-thinking-styles-common/

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Social Isolation

Social Isolation

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/social-isolation/

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Unhelpful Thinking Styles (Archived)

Unhelpful Thinking Styles (Archived)

NOTE: Two improved versions of this resource are available here: Cognitive Distortions – Unhelpful Thinking Styles (Common) and Cognitive Disto ... https://www.psychologytools.com/resource/unhelpful-thinking-styles-archived/

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Audio Collection: Psychology Tools For Relaxation

Audio Collection: Psychology Tools For Relaxation

The Psychology Tools For Relaxation Audio Collection is designed to help anyone experiencing stress or heightened physiological arousal. The audio col ... https://www.psychologytools.com/resource/psychology-tools-for-relaxation-audio-collection/

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Progressive Muscle Relaxation

Progressive Muscle Relaxation

Progressive relaxation training originated in the 1930’s as a treatment for tension and anxiety. Edmund Jacobsen developed a systematic and lengthy ... https://www.psychologytools.com/resource/progressive-muscle-relaxation/

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Behavioral Experiment (Portrait Format)

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

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Abandonment

Abandonment

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/abandonment/

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Mistrust/Abuse

Mistrust/Abuse

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/mistrust-abuse/

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Guidelines For Better Sleep

Guidelines For Better Sleep

Some sleep experts recommend that sleep hygiene issues be attended to as one component of treatment for poor sleep. This sleep hygiene information wor ... https://www.psychologytools.com/resource/guidelines-for-better-sleep/

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Behavioral Experiment

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

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Pessimism

Pessimism

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/pessimism/

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Nightmare Exposure And Rescripting

Nightmare Exposure And Rescripting

Imagery rescripting is an effective treatment for intrusive and unwanted memories. Nightmare Exposure And Rescripting employs similar techniques and c ... https://www.psychologytools.com/resource/nightmare-exposure-and-rescripting/

Exercises

Sleep Diary

Sleep Diary

Many clients report that their sleep is disturbed, and this can be a cause or consequence of many mental health conditions. This Sleep Diary enables c ... https://www.psychologytools.com/resource/sleep-diary/

Worksheets

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Checklist For Better Sleep

Checklist For Better Sleep

Some sleep experts recommend that sleep hygiene issues be attended to as one component of treatment for poor sleep. This sleep hygiene worksheet is in ... https://www.psychologytools.com/resource/checklist-for-better-sleep/

Exercises

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Catastrophizing

Catastrophizing

The Catastrophizing information handout forms part of the cognitive distortions series. It is designed to help clients and therapists to work more eff ... https://www.psychologytools.com/resource/catastrophizing/

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Progressive Muscle Relaxation (Audio)

Progressive Muscle Relaxation (Audio)

Progressive Muscle Relaxation is an audio exercise from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed to help anyone exper ... https://www.psychologytools.com/resource/progressive-muscle-relaxation-audio/

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Learning To Relax (CYP)

Learning To Relax (CYP)

Stress and tension are prevalent complaints amongst children and young people. Teaching relaxation exercises can engender a beneficial sense of contro ... https://www.psychologytools.com/resource/learning-to-relax-cyp/

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Entitlement

Entitlement

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/entitlement/

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Sleep Restriction

Sleep Restriction

Sleep restriction is behavioral intervention used in the treatment of insomnia. It is an evidence based treatment for insomnia, both as a standalone t ... https://www.psychologytools.com/resource/sleep-restriction/

Exercises

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Relaxed Breathing Exercise 1 (Audio)

Relaxed Breathing Exercise 1 (Audio)

Relaxed Breathing Exercise 1 is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. The aim of this breathing exercise is t ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-1-audio/

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Progressive Muscle Relaxation (Archived)

Progressive Muscle Relaxation (Archived)

NOTE: An improved version of this resource is available here: Progressive Muscle Relaxation. Older versions of a resource may be archived in the event ... https://www.psychologytools.com/resource/progressive-muscle-relaxation-edition-1/

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Combined Relaxation Exercise (Audio)

Combined Relaxation Exercise (Audio)

The Combined Relaxation Exercise is an audio track from the Psychology Tools For Relaxation Audio Collection. It is designed to help anyone experienci ... https://www.psychologytools.com/resource/combined-relaxation-exercise-audio/

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Peaceful Place (Audio)

Peaceful Place (Audio)

The Peaceful Place exercise guides the listener through a short imagery exercise designed to facilitate the visualization of soothing imagery and noti ... https://www.psychologytools.com/resource/peaceful-place-audio/

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Overcoming Insomnia (Second Edition): Workbook

Overcoming Insomnia (Second Edition): Workbook

Overcoming Insomnia comes in two volumes. This page is for the Client Workbook. Click on the following link to access the accompanying Therapist Guide ... https://www.psychologytools.com/resource/overcoming-insomnia-workbook/

Treatments That Work™

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Exercise For Mental Health

Exercise For Mental Health

Exercise is an evidence-based treatment for depression and anxiety and research suggests that, in the treatment of depression, exercise interventions ... https://www.psychologytools.com/resource/exercise-for-mental-health/

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Overcoming Insomnia (Second Edition): Therapist Guide

Overcoming Insomnia (Second Edition): Therapist Guide

Overcoming Insomnia comes in two volumes. This page is for the Therapist Guide. Click on the following link to access the Client Workbook. It is ... https://www.psychologytools.com/resource/overcoming-insomnia-therapist-guide/

Treatments That Work™

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Nightmare Rescripting (Audio)

Nightmare Rescripting (Audio)

Nightmare rescripting is an evidence based treatment for nightmares, with medium to large effect sizes on nightmare frequency, distress, intensity, an ... https://www.psychologytools.com/resource/nightmare-rescripting-audio/

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Sleep Hygiene (Audio)

Sleep Hygiene (Audio)

The Sleep Hygiene audio track is taken from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed to teach the principles of effec ... https://www.psychologytools.com/resource/sleep-hygiene-audio/

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Cognitive Behavioral Model Of Insomnia (Harvey, 2002)

Cognitive Behavioral Model Of Insomnia (Harvey, 2002)

Insomnia is a highly prevalent sleep disorder characterized by difficulty initiating or maintaining sleep, or having non-restorative sleep for at leas ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-insomnia-harvey-2002/

Information handouts

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Relaxed Breathing Exercise 4 (Audio)

Relaxed Breathing Exercise 4 (Audio)

Relaxed Breathing Exercise 4 is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. Slow, relaxed, diaphragmatic breathing ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-4-audio/

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Relaxed Breathing Exercise 2 (Audio)

Relaxed Breathing Exercise 2 (Audio)

Relaxed Breathing Exercise 2 is an audio track taken from the Psychology Tools For Overcoming PTSD Audio Collection. The aim of this breathing exercis ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-2-audio/

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Relaxed Breathing Exercise 3 (Audio)

Relaxed Breathing Exercise 3 (Audio)

Breathing Exercise 3 uses the imagery of breathing air of different colours to help the listener make their breathing slower, deeper, and more regular ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-3-audio/

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Recovering From A Nightmare (Audio)

Recovering From A Nightmare (Audio)

The Recovering From A Nightmare exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. Many people with PTSD have ... https://www.psychologytools.com/resource/recovering-from-a-nightmare-audio/

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Recognizing Insomnia Disorders

Recognizing Insomnia Disorders

Insomnia is characterized by persistent difficulty with sleep initiation, duration, consolidation, or quality that occur despite adequate opportunitie ... https://www.psychologytools.com/resource/recognizing-insomnia-disorders/

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Links to external resources

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

Assessment

  • Epworth Sleepiness Scale (ESS) | Johns | 1991
    • Scale
      Primary Link Archived Link
    • Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. sleep, 14(6), 540-545.
  • Pittsburgh Sleep Quality Index (PSQI) | Buysse, Reynolds, Monk, Berman, Kupfer | 1989
    • Scale
      Primary Link Archived Link
    • Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193-213.

Guides and workbooks

Information Handouts

Presentations

Treatment Guide

  • Overcoming insomnia: a 5 session, interactive CBT program for overcoming insomnia | 2005
  • Cognitive behavioral therapy for insomnia (CBTi) treatment manual | Munoz, Miranda, McQuaid, Sze, Otilingham
    Archived Link
  • Cognitive-Behavioral Insomnia Therapy | Jack Edinger
    Primary Link Archived Link
  • Getting better sleep workbook | Good Thinking
    Primary Link Archived Link

Worksheets

Recommended Reading

  • Imagery rehearsal therapy: principles and practice | Krakow, B., & Zadra, A. | 2010
    Primary Link Archived Link
  • van Straten, A., & Cuijpers, P. (2009). Self-help therapy for insomnia: a meta-analysis. Sleep Medicine Reviews, 13(1), 61-71
    Primary Link Archived Link
  • Sheaves, B., Isham, L., Bradley, J., Espie, C., Barrera, A., Waite, F., … & Freeman, D. (2018). Adapted CBT to stabilize sleep on psychiatric wards: a transdiagnostic treatment approach.Behavioural and cognitive psychotherapy,46(6), 661-675.
    Primary Link Archived Link
  • Okajima, I., Komada, Y., & Inoue, Y. (2011). A meta‐analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms, 9(1), 24-34
    Primary Link
  • Kyle, S. D., Aquino, M. R. J., Miller, C. B., Henry, A. L., Crawford, M. R., Espie, C. A., & Spielman, A. J. (2015). Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: a systematic examination of CBT-I trial content.Sleep medicine reviews,23, 83-88.
    Primary Link Archived Link
  • Edinger, J. D., & Means, M. K. (2005). Cognitive–behavioral therapy for primary insomnia. Clinical Psychology Review, 25(5), 539-558
    Primary Link Archived Link

What Are Sleep Problems?

Symptoms Associated with Poor Sleep and Insomnia

Insomnia disorder is characterized by a complaint of dissatisfaction with sleep quantity or quality, associated with one or more of:

  • difficult initiating sleep
  • difficulty maintaining sleep
  • early-morning awakening with inability to return to sleep

Nightmare disorder is characterized by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams which usually involve efforts to avoid threats to survival, security, or physical integrity. The individual rapidly becomes oriented and alert upon awakening. The dreams are not better explained by the presence of other conditions such as post-traumatic stress disorder.

Psychological Models and Theory of Insomnia

A range of psychological models of insomnia are reviewed in detail in Talbot and Harvey (2010).

Spielman’s Three-P Model of Insomnia (Spielman, Saskin, & Thorpy, 1987)

Spielman’s three-factor model is a diathesis-stress theory that includes predisposing, precipitating, and perpetuating factors influencing insomnia. Perpetuating factors are the typical targets for treatment and include: maladaptive coping skills, and an extension of time in bed. Spielman’s three-P model led to the development of the sleep restriction technique for insomnia.

Bootzin’s Stimulus Control Model of Insomnia (1972)

The stimulus control model of insomnia proposes that the particular response elicited by a stimulus depends upon its conditioning history. Insomnia is said to occur when sleep stimuli (e.g., bed, bedroom, bedtime) are no longer uniquely paired with sleep, but have been paired with other activities (e.g., worrying, being awake, reading). Stimulus control therapy is an effective intervention derived from stimulus control theory.

Espie’s Psychobiological Inhibition Model of Insomnia (2002; Espie, Broomfield, MacMahon, Macphee, & Taylor, 2006)

Espie’s psychobiological inhibition model of insomnia proposes that homeostatic and circadian processes are involuntary and the normal default result is good sleep. Good sleep is maintained by regular sleep habits, sleep-related physiological de-arousal, and sleep-related cognitive de-arousal. According to this model, insomnia is the result of interruptions to or failures of these maintenance processes. An updated version of the model proposes that people can interfere with automatic processes resulting in good sleep by: selectively attending to sleep, explicitly intending to sleep, trying to sleep. Interventions derived from the model target these dysfunctional processes (Espie et al., 2006).

Harvey’s Cognitive Model of Insomnia (2002)

Harvey proposes that insomnia is maintained by a cascade of five critical cognitive processes including: worry (accompanied by arousal and distress); selective attention and monitoring; misperception of sleep and daytime deficits from lack of sleep; unhelpful beliefs; and counterproductive safety behaviors. Treatment interventions for insomnia targets these maintaining mechanisms.

Evidence-Based Psychological Approaches for Working with Insomnia

Evidence-based psychological approaches for working with insomnia include:

  • sleep restriction therapy
  • stimulus control therapy
  • cognitive behavioral therapy for insomnia (CBT-I)

Resources for Working with Sleep–Wake Disorders Including Insomnia

Psychology Tools resources available for working therapeutically with sleep–wake disorders including insomnia include:

  • psychological models of sleep–wake disorders including insomnia
  • information handouts for sleep–wake disorders including insomnia
  • exercises for sleep–wake disorders including insomnia
  • CBT worksheets for sleep–wake disorders including insomnia
  • self-help programs for sleep–wake disorders including insomnia

References

  • Bootzin, R. R. (1972). Stimulus control treatment for insomnia. Proceedings of the American Psychological Association, 7, 395–396.
  • Espie, C. A. (2002). Insomnia: Conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53, 215–243.
  • Espie, C. A., Broomfield, N. M., MacMahon, K. M., Macphee, L. M., & Taylor, L. M. (2006). The attention-intention-effort pathway in the development of psychophysiologic insomnia: A theoretical review. Sleep Medicine Review, 10(4), 215–245.
  • Harvey, A. G. (2002). A cognitive model of insomnia. BehaviourResearch and Therapy, 40(8), 869–894.
  • Sheaves, B., Freeman, D., Isham, L., McInerney, J., Nickless, A., Yu, L. M., … & Barrera, A. (2018). Stabilisingsleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): An assessor-blind pilot randomisedcontrolled trial. Psychological Medicine,48(10), 1694–1704.
  • Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed.Sleep, 10(1), 45–56.
  • Talbot, L. S., & Harvey, A. G. (2010). Psychological models of insomnia. In M. J. Sateia and D. Buysse (Eds.), Insomnia: Diagnosis and Treatment(pp. 42–49). Boca Raton, FL: CRC Press.

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