that some components of CBT are mor

that some components of CBT are more effective than others.
CBT for insomnia is typically a short treatment, with success
being reported for treatment approaches ranging from two to six
sessions (e.g., Backhaus, Hohagen, Voderholzer, & Riemann,
2001; Verbeek, Schreuder, & Declerck, 1999). Even a selfadministered
program of bibliotherapy involving six booklets
mailed weekly to participants has been shown to be effective
(see Mimeault & Morin, 1999, for a complete description of
this program). Bastien, Morin, Ouellet, Biais, and Bouchard
(2004) recently investigated CBT delivered in different modalities
(i.e., face-to-face individual sessions, group sessions,
telephone calls) and found that all modalities led to gains (when
compared with baseline self-reports) that were maintained at a
6-month follow-up. Moreover, one does not need a high level
of expertise to effectively use CBT. Espie, Inglis, Tessier, and
Harvey (2001 ) found that CBT could be effectively delivered in
six group sessions by specially trained, primary care nurses.
In sum, CBT is not only useful, it is also quite cost-effective
for the client and can be accomplished with ease and in a timely
manner, thereby requiring minimal obligation on the part of
the clinician. It typically involves certain components: sleep
education, sleep hygiene, sleep restriction, stimulus control,
and cognitive therapy.
Sleep education. Sleep education simply provides clients
with information about sleep. For instance, Verbeek etal. (1999)
stressed that clients should be aware of what constitutes good
and poor sleep, how much sleep is needed, how age affects sleep,
and how insomnia develops and is maintained. Sleep education
may be especially important for older adults who need to
recognize and adapt to developmental changes to sleep through
such means as building nap times into their daily schedule and
finding tasks or hobbies to complete in the early morning.
Sleep hygiene. Sleep hygiene is a self-regulation technique
that addresses the poor sleep habits that interfere with good
sleep (Gatchel & Oordt, 2003). Sleep hygiene instructions
(see Appendix) provide commonsense instructions for making
small lifestyle changes that may aid the client in initiating
and maintaining sleep. This intervention is very popular;
however, although it may suffice for some clients, Espie et
al. (1998) reported that sleep education and sleep hygiene
instructions were not enough to lead to improvements and
that sleep scheduling (i.e., sleep restriction) was necessary
for treatment gains to be evident.
Sleep restriction. Sleep restriction therapy was developed in
response to the observation that chronic insomnia is perpetuated
by an excessive amount of time spent in bed (Spielman,
Saskin, & Thorpy, 1987). Often, people with insomnia try to
compensate for lost sleep or for boredom by remaining in bed
longer; this extra time in bed simply causes more wake time,
less deep sleep, and more light sleep (Hauri, 2000; Wohlgemuth
& Edinger, 2000). The purpose of this treatment is to
consolidate clients' sleep, decreasing both the time to fall
asleep and awakenings after sleep onset. Clients' need to sleep
is increased by the slight sleep deprivation that is imposed.
thereby deepening and consolidating sleep (Wohlgemuth
& Edinger, 2000). Nevertheless, it is this sleep deprivation
that makes compliance with this treatment difficult for some
clients. However, Wohlgemuth and Edinger noted that this
treatment also lessens the frustration that is associated with
remaining in bed for extended periods and inability to sleep,
which may encourage clients to comply with it. This treatment
component is recommended for clients when their napping
and/or excessive time in bed seem to be contributing to sleep
difficulties (Wohlgemuth & Edinger, 2000). (For details of the
typical sleep restriction prescription, see Appendix.)
Stimulus control. L. Harvey, Inglis, and Espie (2002) recommended
combining stimulus control therapy with sleep
restriction therapy to maximize benefits because they found
that stimulus control therapy was the best predictor of improvements
in sleep. Stimulus control therapy was originally
used to change problem behaviors (e.g., overeating). Applied
to treating insomnia, stimulus control therapy (Bootzin, 1975)
was designed to reassociate the bed, the bedroom, and bedtime
activities with sleep, rather than with arousal. Stimulus control
is based in opérant conditioning learning theory, where the
bedroom has become a discriminative stimulus associated
with an absence of reinforcement, specifically reduced sleep
(i.e., the bedroom has become an antecedent following which
sleep is less likely to occur). Therefore, all activities other than
sleep (and sex) are not permitted in the bedroom in order to
reestablish the bedroom as a positive discriminative stimulus
signalling the availability of reinforcement, specifically sleep
(Bootzin, 1975). (For stimulus control instructions to the client,
see Appendix.)
Cognitive restructuring. Cognitive interventions are
based on cognitive therapy techniques used with depression
and anxiety. Cognitive restructuring attempts to change the
belief that poor sleep will lead to devastating consequences
(Smith, Smith, Nowakowski, & Perlis, 2003). The goal of
cognitive restructuring is to have clients realize that their
beliefs about sleep and the consequences of poor sleep are
distorted. (See Appendix for one approach to cognitive
restructuring for insomnia.)
Paradoxical intention. This cognitive strategy is used to
alleviate difficulty with falling asleep (Broomfield & Espie,
2003). Because individuals with insomnia often experience
anxiety at sleep onset, paradoxical intention is thought to work
by eliminating the effort to sleep and its associated cognitive
and affective arousal, thereby reducing anxiety. Broomfield
and Espie found, as expected, that this technique reduced both
sleep effort and bedtime anxiety; it also reduced subjective
sleep-onset latency. Moreover, a shorter sleep-onset latency was
correlated with anxiety reduction, indicating that it is through
the reduction of anxiety at sleep onset that paradoxical intention
reduces insomnia (Broomfield & Espie, 2003). However,
it may be equally true that the reduction in sleep-onset latency
consequently reduced clients' anxiety. (See Appendix for different
ways for a client to implement this technique.)

Hasil (Bahasa Indonesia) 1:

that some components of CBT are more effective than others.CBT for insomnia is typically a short treatment, with successbeing reported for treatment approaches ranging from two to sixsessions (e.g., Backhaus, Hohagen, Voderholzer, & Riemann,2001; Verbeek, Schreuder, & Declerck, 1999). Even a selfadministeredprogram of bibliotherapy involving six bookletsmailed weekly to participants has been shown to be effective(see Mimeault & Morin, 1999, for a complete description ofthis program). Bastien, Morin, Ouellet, Biais, and Bouchard(2004) recently investigated CBT delivered in different modalities(i.e., face-to-face individual sessions, group sessions,telephone calls) and found that all modalities led to gains (whencompared with baseline self-reports) that were maintained at a6-month follow-up. Moreover, one does not need a high levelof expertise to effectively use CBT. Espie, Inglis, Tessier, andHarvey (2001 ) found that CBT could be effectively delivered insix group sessions by specially trained, primary care nurses.In sum, CBT is not only useful, it is also quite cost-effectivefor the client and can be accomplished with ease and in a timelymanner, thereby requiring minimal obligation on the part ofthe clinician. It typically involves certain components: sleepeducation, sleep hygiene, sleep restriction, stimulus control,and cognitive therapy.Sleep education. Sleep education simply provides clientswith information about sleep. For instance, Verbeek etal. (1999)stressed that clients should be aware of what constitutes goodand poor sleep, how much sleep is needed, how age affects sleep,and how insomnia develops and is maintained. Sleep educationmay be especially important for older adults who need torecognize and adapt to developmental changes to sleep throughsuch means as building nap times into their daily schedule andfinding tasks or hobbies to complete in the early morning.Sleep hygiene. Sleep hygiene is a self-regulation techniquethat addresses the poor sleep habits that interfere with goodsleep (Gatchel & Oordt, 2003). Sleep hygiene instructions(see Appendix) provide commonsense instructions for makingsmall lifestyle changes that may aid the client in initiatingand maintaining sleep. This intervention is very popular;however, although it may suffice for some clients, Espie etal. (1998) reported that sleep education and sleep hygieneinstructions were not enough to lead to improvements andthat sleep scheduling (i.e., sleep restriction) was necessaryfor treatment gains to be evident.Sleep restriction. Sleep restriction therapy was developed inresponse to the observation that chronic insomnia is perpetuatedby an excessive amount of time spent in bed (Spielman,Saskin, & Thorpy, 1987). Often, people with insomnia try tocompensate for lost sleep or for boredom by remaining in bedlonger; this extra time in bed simply causes more wake time,less deep sleep, and more light sleep (Hauri, 2000; Wohlgemuth& Edinger, 2000). The purpose of this treatment is toconsolidate clients' sleep, decreasing both the time to fallasleep and awakenings after sleep onset. Clients' need to sleepis increased by the slight sleep deprivation that is imposed.thereby deepening and consolidating sleep (Wohlgemuth& Edinger, 2000). Nevertheless, it is this sleep deprivationthat makes compliance with this treatment difficult for someclients. However, Wohlgemuth and Edinger noted that thistreatment also lessens the frustration that is associated withremaining in bed for extended periods and inability to sleep,which may encourage clients to comply with it. This treatmentcomponent is recommended for clients when their nappingand/or excessive time in bed seem to be contributing to sleepdifficulties (Wohlgemuth & Edinger, 2000). (For details of thetypical sleep restriction prescription, see Appendix.)Stimulus control. L. Harvey, Inglis, and Espie (2002) recommendedcombining stimulus control therapy with sleeprestriction therapy to maximize benefits because they foundthat stimulus control therapy was the best predictor of improvementsin sleep. Stimulus control therapy was originallyused to change problem behaviors (e.g., overeating). Appliedto treating insomnia, stimulus control therapy (Bootzin, 1975)was designed to reassociate the bed, the bedroom, and bedtimeactivities with sleep, rather than with arousal. Stimulus controlis based in opérant conditioning learning theory, where thebedroom has become a discriminative stimulus associatedwith an absence of reinforcement, specifically reduced sleep(i.e., the bedroom has become an antecedent following whichsleep is less likely to occur). Therefore, all activities other thansleep (and sex) are not permitted in the bedroom in order toreestablish the bedroom as a positive discriminative stimulussignalling the availability of reinforcement, specifically sleep(Bootzin, 1975). (For stimulus control instructions to the client,see Appendix.)Cognitive restructuring. Cognitive interventions arebased on cognitive therapy techniques used with depressionand anxiety. Cognitive restructuring attempts to change thebelief that poor sleep will lead to devastating consequences(Smith, Smith, Nowakowski, & Perlis, 2003). The goal ofcognitive restructuring is to have clients realize that theirbeliefs about sleep and the consequences of poor sleep aredistorted. (See Appendix for one approach to cognitiverestructuring for insomnia.)Paradoxical intention. This cognitive strategy is used toalleviate difficulty with falling asleep (Broomfield & Espie,2003). Because individuals with insomnia often experienceanxiety at sleep onset, paradoxical intention is thought to workdengan menghilangkan upaya untuk tidur dan yang terkait kognitifdan afektif gairah, sehingga mengurangi kecemasan. Broomfielddan Espie menemukan, seperti yang diharapkan, bahwa teknik ini mengurangi keduatidur kecemasan usaha dan tidur; juga mengurangi subjektiftidur onset latency. Selain itu, adalah pendek tidur onset latensiberkorelasi dengan pengurangan kecemasan, menunjukkan bahwa hal itu melaluipengurangan kecemasan pada awal tidur niat itu paradoksmengurangi insomnia (Broomfield & Espie, 2003). Namun,mungkin sama-sama benar bahwa penurunan tidur onset latensiAkibatnya mengurangi kecemasan klien. (Lihat lampiran untuk berbedacara untuk klien untuk menerapkan teknik ini.)

Hasil (Bahasa Indonesia) 2:

bahwa beberapa komponen CBT lebih efektif daripada yang lain.
CBT untuk insomnia biasanya pengobatan singkat, dengan keberhasilan
yang dilaporkan untuk pendekatan pengobatan mulai dari dua sampai enam
sesi (misalnya, Backhaus, Hohagen, Voderholzer, & Riemann,
2001; Verbeek, Schreuder , & Declerck, 1999). Bahkan selfadministered
program bibliotherapy melibatkan enam buku
dikirimkan mingguan untuk peserta telah terbukti efektif
(lihat Mimeault & Morin, 1999, untuk penjelasan lengkap
program ini). Bastien, Morin, Ouellet, Biais, dan Bouchard
(2004) baru-baru ini diselidiki CBT disampaikan dalam modalitas yang berbeda
(yaitu, tatap muka setiap sesi, sesi kelompok,
panggilan telepon) dan menemukan bahwa semua modalitas menyebabkan keuntungan (bila
dibandingkan dengan awal laporan diri) yang dipertahankan pada
6 bulan follow-up. Selain itu, orang tidak perlu tingkat tinggi
keahlian untuk secara efektif menggunakan CBT. Espie, Inglis, Tessier, dan
Harvey (2001) menemukan bahwa CBT bisa efektif disampaikan dalam
enam sesi kelompok dengan yang dilatih khusus, perawat perawatan primer.
Singkatnya, CBT tidak hanya berguna, itu juga cukup hemat biaya
untuk klien dan dapat dicapai dengan mudah dan dalam waktu
cara, sehingga membutuhkan minimal kewajiban pada bagian dari
dokter. Ini biasanya melibatkan komponen tertentu: tidur
pendidikan, kesehatan tidur, pembatasan tidur, kontrol
stimulus,. Dan terapi kognitif
Tidur pendidikan. Pendidikan tidur hanya menyediakan klien
dengan informasi tentang tidur. Misalnya, Verbeek dkk. (1999)
menekankan bahwa klien harus menyadari apa yang merupakan baik
dan buruk tidur, berapa banyak tidur yang dibutuhkan, bagaimana usia mempengaruhi tidur,
dan bagaimana insomnia yang berkembang dan dipertahankan. Pendidikan tidur
mungkin sangat penting untuk orang dewasa yang lebih tua yang perlu
mengakui dan beradaptasi dengan perubahan perkembangan untuk tidur melalui
sarana seperti membangun kali tidur siang ke dalam jadwal sehari-hari mereka dan
menemukan tugas atau hobi untuk menyelesaikan di pagi hari.
Tidur kebersihan. Kebersihan Tidur adalah teknik self-regulation
yang membahas kebiasaan kurang tidur yang mengganggu baik
tidur (Gatchel & Oordt, 2003). Instruksi kebersihan tidur
(lihat Lampiran) menyediakan petunjuk akal sehat untuk membuat
perubahan gaya hidup kecil yang dapat membantu klien dalam memulai
dan mempertahankan tidur. Intervensi ini sangat populer,
namun, meskipun mungkin cukup untuk beberapa klien, Espie et
al. (1998) melaporkan bahwa pendidikan tidur dan kesehatan tidur
petunjuk tidak cukup untuk menyebabkan perbaikan dan
bahwa penjadwalan tidur (yaitu, pembatasan tidur) itu diperlukan
untuk keuntungan pengobatan menjadi jelas.
Batasan tidur. Terapi pembatasan tidur dikembangkan di
tanggapan terhadap pengamatan bahwa insomnia kronis diabadikan
oleh jumlah yang berlebihan waktu yang dihabiskan di tempat tidur (Spielman,
Saskin, & Thorpy, 1987). Seringkali, orang dengan insomnia mencoba untuk
mengkompensasi kehilangan tidur atau untuk kebosanan dengan tetap di tempat tidur
lagi; ini waktu ekstra di tempat tidur hanya menyebabkan lebih banyak waktu bangun,
tidur kurang dalam, dan lebih banyak tidur ringan (Hauri, 2000; Wohlgemuth
& Edinger, 2000). Tujuan dari perawatan ini adalah untuk
mengkonsolidasikan tidur klien, mengurangi baik waktu untuk jatuh
tertidur dan terbangun setelah onset tidur. Kebutuhan klien 'tidur
meningkat dengan kurang tidur sedikit yang dikenakan.
Sehingga memperdalam dan mengkonsolidasikan tidur (Wohlgemuth
& Edinger, 2000). Namun demikian, itu adalah kurang tidur ini
yang membuat kepatuhan dengan pengobatan ini sulit bagi beberapa
klien. Namun, Wohlgemuth dan Edinger mencatat bahwa ini
pengobatan juga mengurangi frustrasi yang berhubungan dengan
sisa di tempat tidur untuk waktu yang diperpanjang dan ketidakmampuan untuk tidur,
yang dapat mendorong klien untuk mematuhinya. Perawatan ini
komponen dianjurkan untuk klien saat tidur siang mereka
dan / atau waktu yang berlebihan di tempat tidur tampaknya akan memberikan kontribusi untuk tidur
kesulitan (Wohlgemuth & Edinger, 2000). (Untuk rincian
resep pembatasan tidur khas, lihat Lampiran.)
Kontrol Stimulus. L. Harvey, Inglis, dan Espie (2002) direkomendasikan
menggabungkan terapi kontrol stimulus dengan tidur
terapi pembatasan untuk memaksimalkan manfaat karena mereka menemukan
bahwa terapi kontrol stimulus adalah prediktor terbaik perbaikan
dalam tidur. Terapi kontrol stimulus awalnya
digunakan untuk mengubah masalah perilaku (misalnya, makan berlebihan). Diterapkan
untuk mengobati insomnia, terapi kontrol stimulus (Bootzin, 1975)
dirancang untuk reassociate tempat tidur, kamar tidur, dan tidur
kegiatan dengan tidur, bukan dengan gairah. Kontrol stimulus
berbasis di teori pengkondisian operan pembelajaran, di mana
kamar tidur telah menjadi stimulus diskriminatif terkait
dengan tidak adanya penguatan, khususnya mengurangi tidur
(yaitu, kamar tidur telah menjadi berikut yg yang
tidur kurang mungkin terjadi). Oleh karena itu, semua kegiatan selain
tidur (dan seks) tidak diizinkan di kamar tidur untuk
membangun kembali kamar tidur sebagai stimulus diskriminatif positif
menandakan ketersediaan penguatan, khususnya tidur
(Bootzin, 1975). (Untuk petunjuk control stimulus ke klien,
lihat Lampiran.)
Restrukturisasi kognitif. Intervensi kognitif yang
didasarkan pada teknik terapi kognitif digunakan dengan depresi
dan kecemasan. Restrukturisasi kognitif mencoba untuk mengubah
keyakinan bahwa kurang tidur akan menyebabkan konsekuensi yang menghancurkan
(Smith, Smith, Nowakowski, & Perlis, 2003). Tujuan dari
restrukturisasi kognitif adalah memiliki klien menyadari bahwa mereka
keyakinan tentang tidur dan konsekuensi dari kurang tidur yang
terdistorsi. (Lihat Lampiran untuk satu pendekatan untuk kognitif
restrukturisasi untuk insomnia.)
Tujuan yang berlawanan. Strategi kognitif ini digunakan untuk
meringankan kesulitan dengan jatuh tertidur (Broomfield & Espie,
2003). Karena individu dengan insomnia sering mengalami
kecemasan saat onset tidur, niat paradoks diduga bekerja
dengan menghilangkan upaya untuk tidur dan kognitif yang terkait
gairah dan afektif, sehingga mengurangi kecemasan. Broomfield
dan Espie menemukan, seperti yang diharapkan, bahwa teknik ini mengurangi baik
upaya tidur dan tidur kecemasan; itu juga mengurangi subjektif
tidur-onset latency. Selain itu, lebih pendek tidur-onset latency itu
berkorelasi dengan pengurangan kecemasan, menunjukkan bahwa melalui
pengurangan kecemasan saat onset tidur bahwa niat paradoks
mengurangi insomnia (Broomfield & Espie, 2003). Namun,
mungkin juga benar bahwa pengurangan tidur-onset latency
akibatnya mengurangi kecemasan klien. (Lihat Lampiran untuk berbeda
cara untuk klien untuk menerapkan teknik ini.)