**5.7 Cognitive-behavioral therapies**

Many behavioral sleep medicine interventions are based on cognitive-behavioral therapies (CBT). The focus is on systematically introducing behavioral changes that have been proven to improve sleep. This could include changes in sleep schedule and changes in the contingencies and reinforcers that promote sleep. The cognitive approach focuses on looking internally to examine, manage, or modify sleep interfering thoughts and beliefs that can interfere with sleep. Cognitive behavioral therapy for insomnia in the routine general practice setting improved sleep quality reduced hypnotic drug use and improved healthrelated quality of life at a favorable cost in chronic insomniacs. Randomized controlled trials (RCTs) report somewhat conflicting results on the effectiveness of CBT in patients with insomnia but one systematic review including six RCTs (282 people) found that group or individual cognitive behavioral therapy (including sleep hygiene stimulus control sleep restriction muscle relaxation and sleep education) significantly improved PSQI scores compared with no treatment immediately after treatment and at 3 months (*Montgomery &Dennis, 2004)*. Furthermore another meta-analysis involving 2102 patients in 59 trials found that sleep restriction and stimulus control therapies were more effective than relaxation techniques when used alone (*Edinger & Sampson., 2003)*.
