Cognitive Behavioral Model of Insomnia

A licensed copy of Harvey's (2002) cognitive behavioral model of insomnia which describes a framework to address key components of this disorder.

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Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Overview

Insomnia is a highly prevalent sleep disorder characterized by difficulty initiating or maintaining sleep, or having non-restorative sleep for at least one month. Sleep problems are extremely common in people who suffer from mental health problems and there is increasing evidence that disturbed sleep can be a causal factor for many mental health difficulties. Harvey’s (2002) cognitive model of insomnia suggests that excessive worrying about a lack of sleep triggers autonomic arousal and emotional distress. This increased arousal leads to selective attention towards and increased monitoring of sleep-related threat cues, culminating in a biased perception of the sleep-related deficit.

The Cognitive Behavioral Model Of Insomnia can be used to conceptualize your client's insomnia. It is a useful framework for identifying safety behaviors and unhelpful beliefs about sleep or worry, both of which Harvey highlights as key exacerbating factors. This model proposes that cognitive processes contribute to the maintenance of insomnia, irrespective of whether the original cause was psychiatric, circadian, medical, or drug-induced.

Why Use This Resource?

Understanding the underpinnings of insomnia is important for effective intervention. This resource helps clinicians:

Understand the maintenance mechanisms associated with insomnia.
Explain key aspects of insomnia, such as excessive negative mental activity and arousal when attempting to sleep.
Develop appropriate case formulation for clients struggling with insomnia.

Key Benefits

Insight

Deepens understanding of how insomnia is maintained.

Education

Acts as an informative client handout.

Discussion

Promotes exploration of key factors in insomnia.

Learning

Supports clinician knowledge and supervision.

Who is this for?

Insomnia

Ideal for mental health professionals working with clients experiencing insomnia.

Integrating it into your practice

Learn

Understand more about the cognitive behavioral model of insomnia.

Organize

Use the model as a template to organize your case formulations.

Educate

Use your knowledge of the model to explain maintenance processes to clients.

Discuss

Engage clients in discussions about their beliefs and behaviors.

Tailor

Customize interventions based on individual maintenance mechanisms.

Reflect

Use in supervision to discuss case conceptualizations and treatment plans.

Theoretical Background & Therapist Guidance

Insomnia is one of the most prevalent sleep disorders, affecting around 10% of the population. There is a sound evidence base showing that it is an exacerbating factor many in psychological disorders, and it is frequently reported by people struggling with anxiety and depression (although it is not a primary symptom). Symptoms of insomnia may include struggling to fall asleep or initiate sleep, taking a long time to fall asleep (prolonged sleep onset time), waking repeatedly in the night, sleeping for only short periods in the night, and waking early and being unable to get back to sleep.

Harvey’s Cognitive Model Of Insomnia (2002) highlights the importance of negative cognitions related to sleep. These occur both at night-time, when the client is trying to fall asleep or finds themselves awake, and during the day, when they are preoccupied with how poor sleep may have affected them, or how they are going to sleep that night. Key components of this model include excessively negative cognitive activity, arousal and distress, selective attention and monitoring, and distorted perception of deficit.

What's inside

A graphical depiction of the model.
Insights into key maintenance mechanisms.
Guidelines for using the resource with clients.

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FAQs

Insomnia is characterized by persistent difficulty with falling asleep, staying asleep, or waking too early, despite adequate opportunity for sleep, leading to significant distress or impairment in daily functioning.

Clinicians use it to guide their case formulation, helping them to effectively target their interventions.

Yes, CBT for insomnia is effective as both a primary and comorbid condition treatment.

How This Resource Improves Clinical Outcomes

By applying the model, therapists and clients benefit from:

Targeted interventions focusing on key maintenance mechanisms.
Enhanced client engagement through increased understanding of their difficulties.
Improved treatment outcomes by addressing core psychological features.

Clinicians Who Use This Resource Also Use

Overcoming Insomnia (Second Edition): Therapist Guide

References And Further Reading

Ford, D. E., & Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention?. Jama, 262(11), 1479-1484.
Freeman, D., et al. (2017). The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The Lancet Psychiatry, 4(10), pp. 749-758.
Harvey, A. G. (2001). Insomnia: Symptom or diagnosis? Clinical Psychology Review, 21, 1037–1059.
Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40, 869–893.
Harvey, A.G., et al. (2015). Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. Journal of consulting and clinical psychology, 83 (3), p. 564.
Jansson-Fröjmark, M., Harvey, A.G. & Flink, I.K. (2020). Psychometric properties of the Insomnia Catastrophizing Scale (ICS). Cognitive Behaviour Therapy, 49 (2), pp. 120-136.
Morin, C. M., et al. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998–2004). Sleep, 29, 1398–1414.
Scott, A. J., et al. (2021). Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep medicine reviews, 60, 101556.
Stott, R., et al. (2021). Does adjunctive digital CBT for insomnia improve clinical outcomes in an improving access to psychological therapies service? Behaviour Research and Therapy, vol 144.
Tang, N.K.Y. & Harvey, A.G. (2004). Correcting distorted perception of sleep in insomnia: a novel behavioural experiment? Behaviour Research and Therapy, 42, pp. 27-39.

A Guide To Emotions

Cognitive Behavioral Model of Insomnia

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Professional version

Overview

Why Use This Resource?