Why choose behavior therapy instead of medication?
Medications can have significant utility; however, for some people medications are inappropriate, unusable or unwanted. Indeed, many people prefer to resolve their insomnia through non-pharmacologic interventions. Behavior therapy has been demonstrated to be as effective, and often more effective for the treatment of insomnia when compared with pharmacotherapy (Morin, 2006; Jacobs, 2004; Smith, 2002; Edinger, 2001; Morin, 1999).
My treatment approach
The evidenced-based treatment protocol available at this office may be delivered in either an individual or small group setting which is appropriate for adults and adolescents. Behavioral insomnia in children typically requires individualized family interventions. The multi-session protocol has a separate initial assessment session that consists of social history, review of medical history, several psychological inventories, and instructions for collecting baseline data via sleep diary or actigraphy. The treatment protocol includes four main components set in the context of a social conditioning model (behavioral, cognitive, relaxation, and sleep hygiene). Several sessions are devoted to integrating these four components and developing relapse prevention skills. Follow-up booster sessions are available.
Results in this office closely parallel the findings of Smith (2002) with sleep onset latency reduced 40-50%, night time awakenings reduced about 50%, and quality of sleep improved 30-40% (i.e., rested upon awakening). The 2005 NIH State-of-the-Science Conference and the just published AASM “practice parameters” conclude that the evidence supports the efficacy of cognitive-behavioral therapy in the treatment of insomnia (Morgenthaler, 2006).
Referrals are accepted from healthcare professionals for both primary and secondary insomnia.
Insomnia and sleep statistics
- The American Academy of Sleep Medicine (AASM) estimates that about one third of the adult population reports insomnia symptoms.
- The National Sleep Foundation’s 2002 Sleep America Poll found that 35% of adults report experiencing insomnia every night and 58% reported insomnia at least a few nights per week.
- According to NIH (1989) 3% of the adult population in the United States has chronic primary insomnia.
- Other estimates place the rate at about 10% overall; 12% for women.
- Among those 65 or older the prevalence rates range from 20% to 30%.
- Additionally, many children and adolescents experience chronic behavioral insomnia.
- Morgenthaler, T, et al. Practice parameters for the psychological and behavioral treatment of Insomnia; An update. An American Academy of Sleep Medicine Report. Sleep, 2006, 29 (11), 1415-1419
- Morin, CM, Bootzin, RR, Buysse, DJ, Edinger, JD, Espie, CA, Lichstein, KL Psychological and Behavioral treatment of insomnia: Update of recent evidence (1998-2004). Sleep, 2006, 29 (11), 1398-1414.
- Jacobs, GD, Pace-Schott, EF, Stickgold, R, and Otto, MW. Cognitive behavioral therapy and pharmacotherapy for insomnia. Arch. Internal Med., 2004, 164, 1888-1896.
- Smith, MT, Perlis, ML, Park, A, Smith, MS, Pennington, J, Giles, DE, and Buysse, DJ. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am. J. Psychiatry, 2002, 159,5-11.
- Edinger, JD, Wohlgemuth, WK, Radtke, RA March, GR, and Quillian, RE. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA, 2001, 285, 1856-64.
- Morin, CM, Colecchi, C, Stone, J, Sood, R, and Brink, D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. J AMA, 1999, 281, 991-9.