Cognitive and behavioral interventions for parasomnias

Abstract

The ultimate goal of cognitive and behavioral therapy is to improve mental and physical health by correcting maladaptive patterns of thought and behavior. This chapter describes cognitive and behavioral interventions for parasomnias, along with the evidence for the effectiveness of these therapies. Cognitive and behavioral interventions for parasomnias may be condition-specific, such as use of the urine alarm for sleep enuresis or imagery rehearsal training (IRT) for nightmares. Other interventions are more general, such as providing education about principles of good sleep-hygiene or use of cognitive reframing for sleep disruption associated with anxiety and depressive disorders. The evidence-based literature on cognitive and behavioral treatments included in this chapter is summarized for sleep enuresis, sleepwalking, sleep terrors, nightmares, nocturnal panic, rhythmic movement disorder, isolated sleep paralysis, exploding head syndrome, catathrenia, sleep-related eating disorder, and rapid eye movement (REM) sleep behavior disorder. The majority of cognitive and behavioral therapeutic techniques actively engage the patient in homework assignments and self-administered protocols. These interventions have the potential to improve a patient’s sense of self-efficacy and may generalize to other aspects of mental health and behavior. Case examples and a summary of practical points are also provided to demonstrate how the evidence is applied in clinical practice.