Dismantling CBT for Insomnia
Supplemental Materials
Comparative Efficacy of Behavior Therapy, Cognitive Therapy, and Cognitive Behavior
Therapy for Chronic Insomnia: A Randomized Controlled Trial
by A. G. Harvey et al., Journal of Consulting and Clinical Psychology
http://dx.doi.org/10.1037/a0036606
Table S1
Week-By-Week Schedule for Behavior Therapy (BT), Cognitive Therapy (CT), and Cognitive
Behavior Therapy (CBT)
Behavior Therapy (BT)
Cognitive Therapy (CT)
Cognitive Behavior
Therapy (CBT)
Week 1
1. Set agenda and review
housekeeping rules about
scheduling /cancellation.
2. Treatment overview.
What does BT for insomnia
involve? What to expect from
this treatment?
3. Nature of self-management
approach: Collaboration, stress
the active role of patient in
treatment.
4. Review sleep diary and
reinforce self-monitoring.
5. Set treatment
goals/objectives.
6. Review/summarize findings
of insomnia assessment.
7. Review conceptual model of
insomnia (Spielman). Relate
this model to the patient’s
personal sleep problem history.
8. Individual case
conceptualization/functional
analysis to identify behavioral
factors contributing to
insomnia. Introduce the
behavioral model.
Items 1, 3, 4, 5, 6, 7, 9 and 10
are identical to BT.
Differences:
a. Treatment overview. What
does CT for insomnia
involve?
What to expect from this
treatment?
b. Individualized case
conceptualization by
deriving a personalized
version of the cognitive model
for the night. Introduce the
cognitive model.
c. Deliver intervention for:
‘Misconceptions about the
cause of insomnia’ (this
becomes a rolling
intervention).
d. Introduce worry
intervention by defining
negative automatic thoughts,
introducing 3 column form,
introducing thinking traps
handout (this becomes a
rolling intervention).
Combination of BT and CT
except:
i. Individualized case
conceptualization by
deriving a personalized
version of the cognitive
model for the night and the
day. Introduce the cognitive
model.
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Dismantling CBT for Insomnia
9. Administer the CEQ
10. Review homework
assignments.
Week 2
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Introduce sleep restriction
procedure and rationale.
5. Return to conceptual model
of insomnia – emphasize only
the behavioral perpetuating
factors.
6. Review homework
assignments.
Items 1, 2, 3, 6 are identical to Combination of BT and CT
BT. Differences:
except (a) was covered in
a. Individualized case
Week 1.
conceptualization for the day.
Reinforce the cognitive
model.
b. Continue intervention for
worry. Introduce the
‘Extended negative automatic
thoughts’ form.
c. Deliver intervention for:
‘Misconceptions of insomnia
consequences’ (this becomes a
rolling intervention).
d. Introduce the role of other
helpful and unhelpful
strategies for managing
unwanted thoughts.
e. Devise at least one
experiment related to
management of thoughts.
Week 3
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Evaluate compliance with
recommended sleep window
and review/identify methods to
enhance compliance with sleep
window.
5. Set new sleep window for
upcoming week.
6. Introduction of stimulus
control procedures.
7. Review PSG summary from
pre-treatment assessment.
8. Review basic facts about
Items 1, 2, 3, 7, 8, 9 are
Combination of BT and CT.
identical to BT. Differences:
a. Review ‘Extended negative
automatic thoughts’ form.
b. Review experiment.
c. Draft individualized
summary on the ‘Management
of unwanted thought’ handout.
d. Continue intervention for
unhelpful beliefs. Give a
rationale for the Survey
Experiment. Devise survey
together and plan for
administering the survey.
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Dismantling CBT for Insomnia
sleep and changes in sleep
patterns over the lifespan.
9. Review of homework
assignments.
Week 4
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Evaluate compliance with
recommended sleep window
and review/identify methods to
enhance compliance with sleep
window.
5. Set new sleep window for
upcoming week.
6. Review of stimulus control
procedures.
7. Review of homework
assignments.
Items 1, 2, 3, 7 are identical to
BT. Differences:
a. Continue worry
intervention. Review
‘Extended negative automatic
thoughts’ form. Refine
individualized summary on
the ‘Management of unwanted
thought’ handout.
b. Continue intervention for
unhelpful beliefs. Summarize
progress on Survey
Experiment.
c. Begin intervention for:
‘Unrealistic sleep needs and
daytime functioning’ (this
becomes a rolling
intervention).
d. Introduce handout entitled
“CBT handout on beliefs and
attitudes about sleep”.
e. Begin the intervention for
monitoring. Define
monitoring.
Identify the different types of
monitoring/attentional bias
engaged in. Assist your
patient to develop an
awareness of the presence of
monitoring and how it can
function to maintain insomnia
by triggering negative
automatic thoughts, negative
emotion and safety behaviors.
Assist your patient to
experience the effects of
droping monitoring via an
experiment.
Combination of BT and CT.
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Dismantling CBT for Insomnia
Note. Add several questions
about daytime energy levels
and functioning to the sleep
diary for the coming week in
order to prepare for the
daytime focus in Session 5.
Week 5
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Chart progress and check on
initial goal attainment. Provide
feedback regarding progress
and compliance with treatment.
Emphasize specific problem
areas that need more attention.
Revise initial treatment goals as
needed.
5. Review of home practice and
problems with all behavioral
procedures.
6. Review methods to enhance
compliance with homework
assignments.
7. Set new sleep window for
upcoming week.
8. Give Sleep Hygiene handout.
9. Review homework
assignments.
Items 1, 2, 3, 4, 8, 9 are
identical to BT. Differences:
a. Finish Survey Experiment
and continue progress on
intervention for ‘Unrealistic
sleep needs and daytime
functioning’ (this becomes a
rolling intervention).
b. Begin the intervention for
the daytime including
devising the Energy
Generating Experiment.
Review the diary of sleep and
energy during the day. Devise
and complete the Generating
Energy Experiment. Begin
deriving a table that lists
‘Actions that can be taken
during the day to increase the
adverse effects of poor sleep’
and ‘Actions that can be taken
during the day to decrease the
adverse effects of poor sleep’.
Combination of BT and CT.
Week 6
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Review of home practice and
problems with all behavioral
procedures.
5. Review methods to enhance
compliance with homework
assignments.
6. Set new sleep window for
upcoming week.
Items 1, 2, 3, 8 are identical to
BT. Differences:
a. Review the results of the
Energy Generating
b. Take the opportunity to
reinforce previous work on
‘Misperception of insomnia
consequences’
c. Setup Fear of Poor Sleep
Experiment.
d. Start the intervention for
Combination of BT and CT.
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Dismantling CBT for Insomnia
7. Review conceptual models of
insomnia and individual case
conceptualization.
8. Review homework
assignments.
safety behaviors.
e. Begin to target
‘Misconceptions about sleeppromoting practices’ theme.
Week 7
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Set new sleep window. Start
increasing time in bed (above
sleep time) so that it gradually
gets closer to 6.5 to 7 hours per
night.
5. Start focus on maintaining
treatment gains and relapse
prevention.
6. Review of homework
assignments.
Items 1, 2, 3, 5, 6 are identical Combination of BT and CT.
to BT. Differences:
a. Review the results of the
Fear of Poor Sleep
Experiment.
b. Continue deriving a table
that lists ‘Actions that can be
taken during the day to
increase the adverse effects of
poor sleep’ and ‘Actions that
can be taken during the day to
decrease the adverse effects of
poor sleep’
c. Address misperception of
sleep.
Week 8
1. Set agenda.
2. Self-monitoring.
3. Review sleep diary.
4. Adjust sleep window for
upcoming weeks.
5. Continue focus on
maintaining treatment gains and
relapse prevention.
6. Review of homework
assignments.
7. Closure.
Items 1, 2, 3, 5, 6 are identical
to BT. Differences:
a. Final progress on rolling
interventions.
Combination of BT and CT.
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