Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jul 26:3:87-99.
doi: 10.2147/NSS.S12975. Print 2011.

Behavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health

Laurin J Mack  1 , Bruce D Rybarczyk
Affiliations

Behavioral treatment of insomnia: a proposal for a stepped-care approach to promote public health

Laurin J Mack et al. Nat Sci Sleep. .

Abstract

Chronic insomnia is a highly prevalent condition that has psychological and medical consequences for those who suffer from it and financial consequences for both the individual and society. In spite of the fact that nonpharmacologic treatment methods have been developed and shown to be as or more effective than medication for chronic insomnia, these methods remain greatly underutilized due to an absence of properly trained therapists and a general failure in dissemination. A stepped-care model implemented in a primary-care setting offers a public health solution to the problem of treatment accessibility and delivery of behavioral treatments for insomnia. Such a model would provide graduated levels of cognitive behavioral intervention, with corresponding increases in intensity and cost, including self-help, manualized group treatment, brief individual treatment, and finally, individualized behavioral treatment provided by a specialist. To provide such a systematic approach, future research would need to confirm several aspects of the model, and a cadre of professionals would need to be trained to administer manualized care in both group and individualized formats.

Keywords: chronic insomnia; cognitive behavioral therapy; primary care; stepped care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A proposed model for an insomnia clinical pathway in primary care. Abbreviation: CBT-I, cognitive behavioral therapy for insomnia.
Figure 2
Figure 2
A model for stepped-care treatment for chronic insomnia in primary care indicating how patients might move through the cognitive-behavioral treatment levels. As treatments become progressively more individualized and intense, they also become more costly to the individual and the health care system. Abbreviation: CBT-I, cognitive behavioral therapy for insomnia.
See this image and copyright information in PMC

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. Text revision.
    1. Drake CL, Roehrs T, Roth T. Insomnia causes, consequences, and therapeutics: an overview. Depress Anxiety. 2003;18:163–176. - PubMed
    1. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. 1987;10:541–553. - PubMed
    1. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Does cognitive–behavioral insomnia therapy alter dysfunctional beliefs about sleep? Sleep. 2001;24:591–599. - PubMed
    1. Perlis ML, Giles DE, Mendelson WB, Bootzin RR, Wyatt JK. Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res. 1997;6:179–188. - PubMed