Table 2.

Description of Individual Treatment Components Commonly Included as part of the Multi-component Cognitive Behaviour Therapy for Insomnia

Therapy	Content	Objective(s)	Level of recommendation*
Stimulus control therapy	Stimulus control therapy involves 5 main instructional procedures: (i) go to bed only when sleepy, (ii) use the bed/bedroom for only sleep and sex, (iii) get out of bed when fails to fall asleep within 15–20 minutes, (iv) maintain a regular sleep-wake schedule, and (v) avoid daytime naps	To train the patient to re-associate the bed and bedroom with rapid sleep onset	Standard†
Sleep restriction	Sleep restriction involves cutting the amount of time in bed down to the actual amount of time asleep	To increase sleep pressure and consolidate sleep by introducing a mild form of sleep deprivation	Guideline‡
Relaxation training	Relaxation training involves techniques (e.g., progressive muscle relaxation) that aim at reducing sleep-interfering somatic or cognitive tension at or around bedtime	To deactivate the arousal system and facilitate sleep onset	Standard
Paradoxical intention	Paradoxical intention involves instructing the patient to remain awake and avoid any effort/intention to fall asleep	To reduce sleep effort and performance anxiety that inhibits sleep onset	Guideline
Biofeedback	Biofeedback involves providing visual or auditory feedback to patients to help increase their control over some biological responses (e.g., blood pressure, muscle tension, heart rate)	To reduce somatic arousal and self-efficacy	Guideline
Cognitive therapy	Cognitive therapy involves identifying and challenging patient's unhelpful cognitions about sleep and replacing them with more helpful substitutes, through the flexible use of a range of discussion techniques (e.g., reappraisal of threat, attention shifting, hypothesis testing)	To alter unhelpful beliefs and attitude about sleep and to reduce patients' emotional distress associated with sleep.	No recommendation level
Sleep hygiene education	Sleep hygiene education involves teaching the patients the potential beneficial or detrimental impact of certain environmental (e.g., noise, lighting, ventilation, temperature and level of comfort of the bedroom), dietary (e.g., meal times, consumption of stimulants, alcohol and sleep aid) and behavioural (e.g., exercise, daytime napping) factors on sleep	To increase awareness of environmental factors and health practices that may either promote or interfere with sleep	No recommendation level
Imagery training	Imagery training involves the use of visualisation techniques to focus patients' attention on pleasant or neutral images.	To reduce pre sleep cognitive arousal or shift the focus of attention away from distressing sleep-interfering thoughts	No recommendation level

Notes.

^*Level of recommendation in the American Academy of Sleep Medicine Report; Morgenthaler, T. et al. (2006). Practice parameters for the psychological and behavioural treatment of insomnia: An update. An American Academy of Sleep Medicine Report. Sleep, 29 (11), 1415–9.

^†“Standard” is defined as “this is a generally accepted patient-care strategy, which reflects a high degree of clinical certainty”

^‡“Guideline” is defined as “this is a patient-care strategy, which reflects a moderate degree of clinical certainty”