No, CBT-i Is NOT The Gold Standard to Treat Insomnia
If you read up on sleep as much as me, you might have seen a lot of bold claims out there and might be frustrated why none of them seem to work for you.
But besides for the YouTube meditations on new Amazon sleep supplements, that which is being boosted in your doctors office and in by most mainstream mental health workers is that if you suffer from insomnia, CBT-i, Cognitive Behavioral Therapy for Insomnia is considered the gold standard when it comes to treatment. That's quite a honor to win the gold medal!
It's true, CBT-i works for a lot of people, but what happens when it doesn't work for you? Do you throw your hands up and say your case is hopeless and you are stuck with a life of exhaustion and frustration?
Absolutely NOT! CBT-i is only the beginning, and any therapist that is not brave enough to recognize its limitations and explore beyond its boundaries is not going to be successful at treating challenging cases of insomnia.
Even if you've never heard of the term of CBT-i, you're probably familiar with its principles. Set bed and wake up time, no looking at the clock, no napping, bed for sleep and intimacy only, only stay awake in bed for 20 minutes... for many people this works but it has two key limitations.
1) For people who already struggle with bedtime anxiety, all of these rules can actually make things worse. Their bedtime process becomes so rigid that they try so hard to sleep and it backfires on them.
2) The main reason why I feel CBT-i is not the gold standard is it doesn't focus enough on getting to the root of the cognitive issues that go into insomnia, negative labels, racing thoughts, anxious emotions, etc.
Even in some of the top CBT-i insomnia workbooks I've read, they focus so much on the externals of sleep and they limit the discussion of the deeper cognitive issues to write down your thoughts and emotions and watch them dissipate with time.
Really? That's it?
I believe the cutting edge of insomnia treatment has to be much more comprehensive than this. In new therapy models involving ACT-i (Acceptance and Commitment Therapy for Insomnia) and other nuanced, customized approaches, they are finding success for CBT-i burnouts one after the other.
The psychological world is doing a disservice to itself and its clients by blindly branding CBT-i with the gold standard label when in fact, new more progressive therapies are quickly overpassing it.