Cognitive Approaches to Insomnia

Abstract

The clinical use of the word "insomnia" does not refer to the night or two of poor sleep we all have now and then, especially associated with a stressful life event. Instead, insomnia is a chronic difficulty that involves difficulty getting to sleep, maintaining sleep, or waking in the morning not feeling restored. It is one of the most prevalent psychological health problems, with between 4% and 22% of people reporting chronic insomnia (Ancoli-Israel & Roth, 1999; Chevalier et al., 1999). The consequences for the sufferer are severe and include: functional impairment, work absenteeism, impaired concentration and memory, and increased use of medical services (Roth & Ancoli-Israel, 1999). Further, there is evidence that insomnia significantly heightens the risk of having an accident (Ohayon, Caulet, Philip, Guilleminault, & Priest, 1997) and significantly heightens the risk of subsequently developing another psychological disorder, particularly an anxiety disorder, depression, or substance-related disorder (see Harvey, 2001; McCrae & Lichstein, 2001). Not surprisingly then, it is regarded as a serious public health problem. The direct and indirect costs associated with insomnia in the US are estimated to be between $US 30 and 35 billion (Chilcott & Shapiro, 1996). Our first goal in presenting this special issue on cognitive approaches to insomnia is to broaden the field's notion of the role of cognitive processes in insomnia. It has long been recognized that intrusive and worrisome thoughts (often referred to as "cognitive arousal") contribute to patients' difficulties initiating or maintaining sleep. As will be apparent in all of the articles presented in this special issue, many other cognitive processes are likely to contribute to the experience of insomnia, and the scientific exploration of such processes is a priority. Two articles in lhis issue discuss specific cognitive processes in insomnia. Broomfield, Gumley, and Espie (2005) highlight the role of attentional bias, sleep effort, metacognitive beliefs, and thought control. Belanger, Morin, Gendron, and Biais (2005) further explore thought-control strategies and examine their association with sleep disturbance. Through a comparison between people with insomnia who either do or do not have generalized anxiety disorder with good sleepers, this paper furthers our understanding of thought phenomena that are specific to insomnia. Our second goal in presenting this special issue is to stimulate more research on the role of cognitive therapy in the treatment of insomnia. To date, cognitive therapy has not been tested as a single treatment component for insomnia. Two articles in this special issue identify potentially promising new treatment directions developed to specifically reverse cognitive maintaining processes. First, Lundh (2005) proposes an acceptance and mindfulness-based treatment that emphasizes cognitive deactivation and the acceptance of spontaneously occurring physiological and mental processes. Then, Harvey (2005) proposes a cognitive therapy treatment that aims to reverse five cognitive maintaining processes: worry, selective attention and monitoring, distorted perception of sleep and daytime functioning, unhelpful beliefs about sleep, and the use of safety behaviors. …