Paradoxical Intention for Insomnia

Status: Strong Research Support

Description

Paradoxical intention is a cognitive technique that consists of persuading a patient to engage in his or her most feared behavior. In the context of insomnia, this type of therapy is premised on the idea that performance anxiety inhibits sleep onset. Paradoxically, if a patient stops trying to fall asleep and instead stays awake for as long as possible, the performance anxiety is expected to diminish; thus, sleep may occur more easily. In clinical practice, some patients are fairly reluctant to use this procedure, and compliance is often problematic. Sleep restriction therapy, a similar technique with a different rationale, may be more readily accepted by patients.

Key References (in reverse chronological order)

• Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29, 1398-1414. https://doi.org/10.1093/sleep/29.11.1398
• Broomfield, N.M., Espie, C.A. (2003). Initial insomnia and paradoxical intention: An experimental investigation of putative mechanisms using subjective and actigraphic measurement of sleep. Behavioural and Cognitive Psychotherapy, 31, 313-324. https://psycnet.apa.org/doi/10.1017/S1352465803003060
• Morin, C.M., Hauri, P.J., Espie, C.A., Spielman, A.J., Buysse, D.J., & Bootzin, R.R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22, 1134-1156. https://doi.org/10.1093/sleep/22.8.1134
• Morin, C.M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press. https://psycnet.apa.org/record/1993-98362-000

Clinical Resources

• Morin, C.M., & Espie, C. (2003). Insomnia: A clinical guide to assessment and treatment. New York: Kluwer Academic. https://link.springer.com/book/10.1007/b105845
• Lichstein, K.L. (2000). Relaxation. In Lichstein, K.L., & Morin, C.M. (Eds.), Treatment of late-life insomnia (pp. 185-206). London: Sage Publications. https://us.sagepub.com/en-us/nam/treatment-of-late-life-insomnia/book10626

Training Opportunities

The Sleep Research Society provides a variety of resources on training opportunities in basic clinical sleep research and sleep medicine: https://sleepresearchsociety.org/resources-page/.