Altering Unhelpful Beliefs About Sleep with Behavioral and Cognitive Therapies

Multi-component treatment of insomnia is widely practiced; although, the additive benefit of a cognitive therapy component to specifically target unhelpful beliefs about sleep has not been conclusively determined. A chart review study at a sleep medicine clinic of 45 insomnia patients evaluated scores on the Dysfunctional Beliefs and Attitudes Scale (DBAS-16) before, during, and after cognitive behavioral therapy for insomnia (CBTi). Treatment followed standard practice, which consisted of behavioral therapy approaches during the first half of treatment and cognitive therapy during the latter portion. DBAS-16 scores improved significantly after behavioral treatment, t(44) = 6.02, P < .001, d = .9, and improved significantly again after the cognitive component of treatment, t(19) = 7.11, P < .001, d = 1.59. A comparison of the change scores, however, demonstrated no significant difference in the effects of behavioral and cognitive therapies, t(19) = 5.1, P < .562, d = .17, which suggests that cognitive therapy did not produce a greater change compared to behavioral components. Analysis of the DBAS-16 individual items suggests that the two treatment components—behavioral and cognitive therapies—may affect unhelpful beliefs about sleep differently. These findings support the need for future research to explore the effectiveness of selecting insomnia treatment components based on individual presentation.