Cognitive restructuring and imagery modification in insomnia disorder: a feasibility study
Sleep and Hypnosis: A Journal of Clinical Neuroscience and Psychopathology 2019;21(3):233-241
Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder. Although CBT-I shows distinct and robust effects, studies report a stable percentage of non-responders, and many patients do not reach remission. Therefore, new interventions for treatment are needed. Imagery interventions are increasingly popular in cognitive behavioural therapy and might be helpful in insomnia disorder. In this feasibility study, we treated three participants suffering from insomnia disorder with a combination of cognitive and imagery techniques. Participants identified their predominant distressing thoughts and inner images. Methods of cognitive restructuring were used to address automatic thoughts and appraisals. Inner images were evoked in detail and changed into desirable images during an imagery exercise. Participants practised the learned techniques daily for three weeks. One case is described in depth to illustrate the procedure. Sleep onset latency could be reduced by nearly 23%. Subjective insomnia severity and sleep quality could not be changed significantly. Imagery seems to be a promising possibility to enrich CBT-I.
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