Cognitive Behavioral Therapy Alone and With Medication for Persistent Insomnia
- Ripu D. Jindal, MD rjindal@toh.on.caUniversity of Ottawa School of MedicineOttawa, Ontario, Canada
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- COGNITIVE THERAPY
- COMBINED MODALITY THERAPY
- DRUG THERAPY
- PATIENT ADHERENCE
- RESEARCH DESIGN
- SLEEP INITIATION AND MAINTENANCE DISORDERS
- ZOLPIDEM
To the Editor: In their randomized controlled trial, Dr Morin and colleagues1 demonstrated the superiority of cognitive behavioral therapy (CBT) alone over CBT combined with intermittent, as-needed use of zolpidem for extended treatment of insomnia. These results should not be surprising.
Cognitive behavioral therapy for insomnia involves cognitive restructuring (whereby maladaptive thoughts are analyzed and replaced by more adaptive thoughts) and exposure response prevention (whereby patients learn not to respond maladaptively to feared situations). For instance, a maladaptive thought such as “If I don't sleep well tonight, tomorrow will be a disaster” may be replaced with the more adaptive “If I don't sleep well tonight, I would likely not be at my best tomorrow morning, but I have a lot of experience functioning with little sleep, so I will be okay.” Similarly, a therapist may review sleep physiology with patients so they will appreciate that a poor night's sleep …
