CBT-I Cognitive Behavioral Techniques & Sleep Interventions 2 — Questions and Answers
Question 1: Which cognitive distortion is most commonly targeted in CBT-I when a patient believes 'If I don't get 8 hours I'll be useless tomorrow'?
- Catastrophizing (Correct answer)
- Mind reading
- Fortune telling
- Personalization
Correct answer: Catastrophizing
Catastrophizing involves magnifying the consequences of sleep loss beyond what evidence supports, and is a primary cognitive target in CBT-I.
Question 2: A patient using stimulus control therapy should be instructed to do which of the following if they cannot fall asleep after approximately 20 minutes?
- Get out of bed and go to another room (Correct answer)
- Take a sleep aid
- Use progressive muscle relaxation in bed
- Increase the thermostat to feel warmer
Correct answer: Get out of bed and go to another room
Stimulus control requires leaving the bed when awake to prevent the bed from becoming associated with wakefulness and arousal.
Question 3: In the context of CBT-I, what is 'sleep effort' and why is it problematic?
- Trying hard to fall asleep, which increases arousal and inhibits sleep onset (Correct answer)
- Scheduling extra time in bed to compensate for lost sleep
- Using white noise machines to block environmental stimuli
- Practicing sleep hygiene rules consistently every night
Correct answer: Trying hard to fall asleep, which increases arousal and inhibits sleep onset
Paradoxically, effortful attempts to sleep activate the arousal system, making sleep onset more difficult — a key concept addressed through paradoxical intention.
Question 4: Which technique involves instructing a patient to stay awake as long as possible without actively trying to sleep?
- Paradoxical intention (Correct answer)
- Sleep restriction therapy
- Stimulus control
- Cognitive restructuring
Correct answer: Paradoxical intention
Paradoxical intention reduces performance anxiety around sleep by removing the pressure to fall asleep, often leading to faster sleep onset.
Question 5: A CBT-I therapist asks a patient to keep a two-week sleep diary before starting treatment. What is the PRIMARY purpose of this baseline period?
- To calculate sleep efficiency and set an accurate initial sleep window (Correct answer)
- To identify which medications are disrupting sleep
- To determine the patient's chronotype for scheduling
- To assess the severity of daytime fatigue symptoms
Correct answer: To calculate sleep efficiency and set an accurate initial sleep window
Baseline sleep diary data is used to calculate average total sleep time, which then determines the prescribed sleep window in sleep restriction therapy.
Question 6: When delivering psychoeducation about sleep homeostasis in CBT-I, which analogy best explains sleep drive?
- Hunger that builds throughout the day and is satisfied by eating (sleeping) (Correct answer)
- A thermostat that automatically adjusts body temperature
- A battery that charges during REM sleep only
- A clock that resets each morning regardless of behavior
Correct answer: Hunger that builds throughout the day and is satisfied by eating (sleeping)
Sleep drive (Process S) builds proportionally with time awake, analogous to hunger building with time since the last meal — a relatable psychoeducation metaphor.
Question 7: Which of the following best describes the '3P model' used in CBT-I case conceptualization?
- Predisposing, precipitating, and perpetuating factors (Correct answer)
- Physical, psychological, and pharmacological components
- Primary, partial, and persistent insomnia types
- Prevention, psychoeducation, and practice phases
Correct answer: Predisposing, precipitating, and perpetuating factors
The 3P model (Spielman) organizes insomnia etiology into predisposing vulnerabilities, precipitating triggers, and perpetuating behaviors that maintain chronic insomnia.
CBT-I Cognitive Behavioral Techniques & Sleep Interventions 2
Which cognitive distortion is most commonly targeted in CBT-I when a patient believes 'If I don't get 8 hours I'll be useless tomorrow'?