Cognitive-Behavioral Therapy for Insomnia, Essay Example

Insomnia is a psychological disorder characterized by difficulty in “initiating or maintaining sleep, and experiencing non-restorative sleep despite appropriate opportunities for sleep” (Woodward, 2011, p. 43). This condition results in day-time psychological disorders such as fatigue, sleepiness, social dysfunction, and cognitive impairment. Cancer patients experience comorbid or secondary insomnia, which is usually associated with an existing medical condition. It progresses from transient to chronic state as a result of the side effects related to an acute stressor used in the diagnosis for cancer.

Cognitive-Behavioral Therapy is a behavior-modification technique that involves using different stimuli and conditioning effects to promote healthier behavior patterns in patients with psychological disorders. The Cognitive-Behavioral Therapy borrows from the concepts of behavior modification in B. F. Skinner’s classical conditioning, Ivan Pavlov’s operant conditioning, and Joseph Wolpe’s desensitization learning theories. The theories focus on reinforcing desirable behaviors, and CBT applies it in the treatment of insomnia to encourage those behavior patterns that increase the likelihood of initiating and maintaining sleep.

The central premise of CBT is that “maladaptive be­havior is caused by irrational or inappropriate beliefs and percep­tions developed from past experiences” (Woodward, 2011, p. 45). It results from an individual’s distorted perception of a current situation, rather than its reality. Accordingly, CBT employs a technique known as “cognitive restructuring,” which focuses on encouraging patients to adopt positive thoughts and behaviors. In the treatment for insomnia, CBT employs Spielman’s “Three Factor Model” to reduce insomnia-perpetuating factors. The first model is Stimulus Control Therapy (SCT), which argues that insomnia is a state of psychological conditioning that result from the patient’s associating of the bed or bedroom with inability to sleep. The goal of SCT, therefore, is to encourage patients to “re-associate the bed and bedroom with rapid sleep onset and develop a stable sleep-wake cycle” (Woodward, p. 46). The Sleep Restriction Therapy (SRT) premises that insomnia results from spending too much time in bed while awake. Thus, reducing the amount of bed-time causes sleep-deprivation, which in turn increases the “homeostatic drive to sleep” (Woodward, p. 46), and in so doing strengthen the association between bedroom/bed and sleeping. Finally, the Relaxation Training therapy aims to minimize physiological and cognitive arousal states that interfere with sleep. It involves practicing body-relaxation exercises such as flexing the muscles, and sitting still with eyes closed while focusing on peaceful mental scenes (guided imagery).

References

Woodward, S. C. (2011). “Cognitive-Behavioral Therapy for Insomnia in Patients with Cancer.” Clinical Journal of Oncology Nursing, 15 (4), 42-54.