When Cognitive Behavior Therapy Doesn’t Work For Insomnia

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When you’ve tried everything to overcome insomnia, it can be mentally, emotionally, and physically draining. It’s difficult to hold onto hope that there’s a cure when you feel as though you’ve exhausted all of your options.

So, what do you do when Cognitive Behavior Therapy doesn’t work for insomnia? Explore Psychotherapy, Neuropsychological Evaluation, try changing therapists, and combine CBT with mindful meditation. Give alternative options that may help you finally get a good night’s sleep.

Psychotherapy: One of the most valuable options for finding the root cause of your insomnia. Psychotherapy uses various tools like psycho-education and experimental exercises to dive deep below the layers of your psyche, to address the deep-rooted cause of your insomnia that you may not know exists.

Neuropsychological Evaluation: A conducted series of tests, questionnaires, and executive functions to test your various cognitive abilities and figure out your strengths, weaknesses, and personality style in order to determine which treatment option is best for you.

Try Changing Therapists: In order to benefit from CBT, it is imperative that the patient and therapist have a connection. Before signing off on CBT, changing therapists can impact your entire practice.

Talk To Your Therapist About Medication: As an absolute last resort, various sleep medications in moderation can help to jumpstart your biological sleep routine again.

Cognitive Behavior Therapy, or CBT, is the default form of therapy for insomnia, but it’s important to acknowledge that it doesn’t work for everyone. If it has been ineffective in treating you, there are a multitude of possibilities as to why that is.

To break down what CBT actually is, let’s address what it is made up of: cognitive therapy and behavioral therapy.

Cognitive therapy focuses on changing one’s dysfunctional thought patterns, whilst behavioral therapy focuses on changing actions and behaviors that are making one’s environmental or situational adjustments inadequate. When these are the causes of insomnia, CBT is incredibly successful.

However, this form of therapy is most effective when you know what is causing your irrational thought patterns and maladaptive behavior. Keep in mind that CBT is only one form of mental health treatment, so it’s important to explore alternative options to determine what works for you.


While CBT focuses on management techniques for your problems that are causing insomnia, psychotherapy focuses on identifying what the problems actually are. It may feel like a backwards approach to try and design a strategy for overcoming an issue that you don’t understand (or even know exists), which is why seeking psychotherapy might work for you in lieu of cognitive behavioral therapy.

Psychotherapists help you find the cause of insomnia by identifying and recognizing the sources and underlying issues that are triggering it. In many cases, we need to explore current and past issues that are blocking our subconscious before learning how to manage the symptoms through CBT.

Getting a new perspective on deep-rooted issues is, often times, essential in order to implement changes. When you identify these issues, you’re setting free the barriers that aren’t allowing your mind to relax; thus creating stress or anxiety that may be linked to your inability to fall asleep.

As there isn’t one single form of mental health therapy, a psychotherapist can help you find which one you need. If a psychotherapist believes that your family or love life are the root cause of insomnia, they may refer you to couples or family counseling to work through it.

Neuropsychological Evaluation

There is substantial evidence supporting the direct connection between lack of sleep and cognition. As lack of sleep has a significant effect on brain functionality, brain functionality has a significant effect on lack of sleep. Therefore, often times to overcome insomnia, a neuropsychological evaluation may be the key to discovering the underlying cause so you can work through it accordingly.

A neuropsychological evaluation is a series of tests to assess your brain functionality. The evaluation examines different cognitive abilities to figure out your strengths, weaknesses, and personality style in order to determine which specific treatment is best for you.

Some of the cognitive abilities that a neuropsychological evaluation tests are attention, adaptive functioning, executive functioning, visual-spacial skills, and memory. All of these can potentially be linked to insomnia, if discovered to be a problem area.

To provide one example, adaptive functioning consists of your ability to deal with the personal and social demands of your environment; this includes how well you balance daily activities and taking care of yourself. If adaptive functioning is a problem area, it may cause stress or anxiety which are major contributing factors to insomnia.

Neuropsychological evaluations are highly deemed as the most comprehensive type of evaluation, as it’s the best method to understand the connection between cognitive and functional deficiencies; this allows you to not just recognize what the problem is, but why it’s a problem.

Try Changing Therapists

It sounds simple enough, but before you sign off on CBT, finding the right therapist may be the answer. The evidence supporting the importance of finding the right CBT therapist is exponential. Often times, when CBT isn’t working, it’s due to a lack of connection between the patient and therapist.

CBT has become so popular that some general practitioners have taken 4-day “training” courses in CBT so that they can treat their patients; needless to say, this isn’t enough time to acquire the proper education needed to conduct this specific form of therapy.

In a study published in the British Medical Journal, researchers came to the conclusion that CBT conducted by briefly trained general practitioners is unsuccessful. Therefore, it is imperative that you do your research on cognitive behavioral therapists in order to find the right, qualified one for you.

It’s equally important to keep in mind that a qualified CB therapist doesn’t necessarily mean they’re the therapist for you, so meeting with several before committing to one is vital. Find one you connect with, trust, and feel cared for by.

Additionally, determining the amount of CBT you need before deeming it ineffective is also an important factor. Various studies have concluded that 3-12 sessions are needed for mild insomnia, 12-24 sessions for moderate insomnia, and a minimum of 24 sessions for severe insomnia.

To get the most out of therapy, you need to acknowledge that the more you put in, the more you get out. Establish and premeditate what you want to get out of it, and how many sessions are needed to stay mentally and emotionally involved throughout the process. One session per week is most likely not enough.

Talk To Your Therapist About Medication

If you’ve exhausted (pun intended) your approaches to overcoming insomnia, and cognitive behavioral therapy has been ineffective, it may be time to consult your doctor or therapist about sleep medication. However, understanding the side effects and risks of addiction is crucial.

Before running down the medication path, determine whether you have insomnia or chronic insomnia. Insomnia can go away on its own, but if it’s persisted longer than three weeks, it’s likely chronic. Chronic insomnia is harder to treat, thus medication may be required to get your body back on a normal biological routine.

Medications should be considered after the cause of insomnia has been determined (hence why therapy is recommended first), and sleeplessness has begun to take a toll on your daily life demands. The specific type of medication prescribed should always depend on one’s medical or behavioral condition (i.e. if the cause is anxiety, anxiety medication is needed— as opposed to the cause being depression, in which antidepressants are needed).

A patient needs to acknowledge that sleep medication should not be taken long-term and, when you’re back on a normal sleep cycle, stopping medication should be gradual. Quitting sleep aids cold turkey may cause the insomnia to return.

Bonus Alternative: Combine CBT With Mindful Meditation

Before giving up on CBT, try pairing it with various forms of mindful meditation. This battles insomnia from two different methods at once. Mindful meditation comes in many forms, including a range of mental exercises such as breathing practices, sensory awareness, light therapy, journaling, and creating a biological pattern.

Studies show that CBT is most effective when patients incorporate journaling with the cognitive behavioral therapy, as an additional method of releasing mental and emotional brain barriers. Journaling after each session allows you to reflect and explore your emotions in correlation, which can help you to address the issue and how to resolve it.

Remember to keep up with improving your lifestyle whilst seeking whichever type of therapy is right for you; insomnia is an illness that greatly impacts every aspect of your life, and doing everything you can to overcome it needs to be your first priority.

Conclusively, if CBT isn’t working for your insomnia, I recommend seeking psychotherapy and/or a neuropsychological evaluation. Consider changing CB therapists, or it may also be beneficial to revisit CBT after seeking psychotherapy.

Remember, psychotherapy helps you define what the problem is, while CBT helps you cope with the problem. Both psychotherapy and CBT can be emotionally and mentally trying, so prepare yourself to put in a lot of work and potentially face some difficult issues you don’t know are plaguing you.

There isn’t a fix-all solution for insomnia, but if you explore all options then you’re almost certain to overcome it and return to a happier peace of mind!

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