CBT-I Sleep Restriction & Stimulus Control Therapy 2

Question 1

What is the primary theoretical basis of stimulus control therapy for insomnia?

Accepted Answer

Classical conditioning: the bed has become a conditioned stimulus for wakefulness and arousal

Answer

Operant conditioning: sleep is reinforced by removing aversive wakefulness experiences

Answer

Cognitive restructuring: maladaptive beliefs about sleep are challenged and modified

Answer

Behavioral activation: increasing daytime activity strengthens the homeostatic sleep drive

Question 2

Which of the following is a core instruction of stimulus control therapy?

Accepted Answer

Go to bed only when genuinely sleepy, not simply because it is your usual bedtime

Answer

Take a 20-minute afternoon nap to supplement insufficient nighttime sleep

Answer

Stay in bed and rest quietly if you are unable to fall asleep, to avoid stimulating yourself further

Answer

Use the bedroom for calming activities like light reading to associate it with relaxation

Question 3

According to stimulus control therapy, what should a patient do if they are unable to fall asleep or return to sleep within approximately 15-20 minutes?

Accepted Answer

Get out of bed and go to another room, engaging in quiet activity until sleepy

Answer

Take a prescribed sleep aid medication to facilitate sleep onset

Answer

Practice progressive muscle relaxation while remaining in bed until drowsy

Answer

Turn on a very dim light and read in bed until feeling sufficiently drowsy

Question 4

Why does stimulus control therapy restrict the use of the bed to sleep and sex only?

Accepted Answer

To strengthen the conditioned association between the bed and the sleepy state

Answer

To reduce physical discomfort caused by spending excessive time in bed

Answer

To decrease overall TIB and build homeostatic sleep pressure as in sleep restriction

Answer

To prevent the body temperature dysregulation caused by prolonged mattress contact

Question 5

Which of the following patient behaviors is most problematic from a stimulus control perspective?

Accepted Answer

Watching television in bed for 90 minutes before attempting to fall asleep

Answer

Drinking a glass of water at the bedside table before attempting sleep

Answer

Reading a novel in a living room recliner for 20 minutes before going to bed

Answer

Taking a warm bath approximately 90 minutes before the target bedtime

Question 6

What role does maintaining a consistent rise time play in stimulus control therapy?

Accepted Answer

It anchors the circadian rhythm and helps regularize the sleep-wake cycle

Answer

It increases morning melatonin secretion to improve evening sleep onset

Answer

It compensates for lost nighttime sleep by ensuring adequate morning rest

Answer

It reduces morning anticipatory anxiety by providing a predictable daily schedule

Question 7

A patient asks whether they can listen to a relaxing podcast in bed before sleeping. As a CBT-I therapist applying stimulus control principles, what is the most appropriate response?

Accepted Answer

Discourage it, as listening in bed pairs the sleep environment with a non-sleep activity

Answer

Allow it, since relaxation is a key facilitator of sleep onset

Answer

Permit it only if the content is non-stimulating and the volume is low

Answer

Recommend using earphones so the device itself is kept outside the bedroom