An Insomnia Treatment in Brief

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Cognitive behavioral therapy for insomnia (CBT-I) has become the gold standard in drug-free treatments for insomnia. Between 70 and 80 percent of the people who try it see results: They fall asleep faster and have fewer awakenings. Their sleep quality improves and they feel more rested in the morning. The gains are often long lasting.

But CBT-I is not a quick fix for insomnia. Improvements in sleep occur gradually over 6 to 8 weeks of treatment, and not everyone can or wants to commit to attending weekly therapy sessions for 6 to 8 weeks. Treatment is costly, too.

Also, the number of therapists trained to provide CBT-I is relatively small. In some parts of the United States there are none at all. (Recently a woman from Billings, Montana, wrote to me asking if I could help her find a qualified therapist within driving distance of her home. Using an online locator, I could not find a single treatment provider in all of Montana or any of 4 nearby states!)

With these problems in mind, researchers have created and are now testing a briefer form of CBT-I called brief behavioral treatment for insomnia (BBTI). BBTI isn’t widely available yet. But with health insurance companies clamoring for providers to rein in costs, BBTI is the wave of the future.

How Is BBTI Different from CBT-I?

The therapies are more similar than different. The word cognitive might imply a psychological approach to treating insomnia, yet the key components of CBT-I are behavioral: sleep restriction (reducing time in bed) and stimulus control (keeping wakeful activities outside the bedroom). Sleep restriction and stimulus control form the backbone of both CBT-I and BBTI.

In CBT-I, the therapist also addresses psychological aspects of insomnia: negative beliefs about sleep, for example, or catastrophic thinking about insomnia. Clients are guided through a process designed to help them arrive at a more realistic mindset. (Read my blog on changing negative thoughts to get a sense of what the cognitive component of CBT-I involves.)

As described by researchers at the University of Pittsburgh, BBTI is an overtly behavioral approach to improving sleep. It holds that insomniacs can set our bodies’ sleep systems to right by simply changing habits.

A Shorter Course

BBTI is completed in 4 weeks. Therapist and patient meet twice during the course of treatment. There are also 2 phone conferences lasting 20 minutes or less.

While the treatment itself may be shorter than full-blown CBT-I, progress toward better sleep occurs gradually. But the results of the few studies conducted on brief behavioral treatments for insomnia show, at least in the short term, that the outcomes are similarly positive. University of Pittsburgh researchers also found that BBTI was equally efficacious in improving the sleep of people who were using sleeping pills as those who were not.

Patients also get a workbook. It contains supplementary information about the forces controlling sleep and waking and lays out rules for better sleep and adjustments to make as sleep improves.

BBTI May Have Broader Appeal

Pittsburgh investigators claim this strictly behavioral (as opposed to psychological and behavioral) approach to treating insomnia may be more acceptable in primary care settings–the first place many insomnia sufferers go for help. Healthcare professionals can be more quickly trained to administer BBTI. Treatments that are not “psychological” may be more attractive to people with insomnia, too.

Sleep specialists have been experimenting with briefer behavioral treatments for insomnia for several years. Now as before, the biggest problem seems to be the lack of professionals prepared to help those in need.