Psychotherapeutic Treatment of Chronic Insomnia

A psychotherapeutic approach to the treatment of chronic insomniac patients is discussed. The therapist must actively explore and uncover areas of emotional distress rather than wait passively for the patient to bring them up. During treatment, the therapist consistently re-orients the patient toward expression of the internalized emotional conflicts that generate physiologic arousal and, finally, insomnia. Techniques used during the initial evaluation, interpretive interview, and psychotherapy sessions are described. In addition, issues related to symptomatic improvement, the role of the spouse or bed partner, and the use of adjunctive treatment modalities are discussed.