Cognitive behavioral therapy and acceptance and commitment therapy for insomnia: Exploring the potential benefit of psychological flexibility and self-compassion combined with behavioral strategies

Abstract

Chronic insomnia is a prevalent sleep disorder with serious consequences on wellbeing and health that largely extend into daily functioning. Cognitive-Behavioral Therapy for Insomnia (CBT-I), an efficacious intervention for insomnia with solid empirical support, is the recommended first-line treatment. Given the complexity of factors and mechanisms involved in its aetiology and maintenance, advances in treatment protocols and modules are important. We will review the current knowledge on insomnia and examine how advancements in behavioral sleep medicine and third-wave therapies may apply to treatment. Specifically, we will outline how a treatment protocol based on Acceptance and Commitment Therapy (ACT), adapted to include insomnia-specific behavioral strategies and with an explicit focus on self-compassion, could be a potentially effective treatment. We believe that broadening treatment focus to target hyperarousal, metacognitions, dysfunctional though control strategies and provide self-compassion training may benefit treatment outcomes, increase sleep quality, reduce daytime symptoms, and improve quality of life.