Brief Behavioral Treatment for Insomnia (BBTI)
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Derived from Cognitive Behavioral Therapy for Insomnia (CBT-I), BBTI is an evidence-based, time-limited treatment for insomnia administrable in medical settings.
Derived from Cognitive Behavioral Therapy for Insomnia (CBT-I), BBTI is a briefer behavioral treatment for insomnia in medical settings that focuses on altering waking behaviors affecting sleep.
BBTI differs from standard CBT-I in a few important ways:
BBTI uses fewer in-person visits.
BBTI is quicker, using 2 in-person visits over 4 weeks versus 6-8 visits over 8 weeks.
BBTI focuses on targeting the behavioral (sleep habits) vs. cognitive features of insomnia.
WHO CAN USE BBTI?*
BBTI has demonstrated clinical efficacy among people with primary insomnia or insomnia comorbid with other psychiatric, medical, or sleep disorders.
4 manualized sessions with a licensed health provider (e.g. nurse, social worker, or other nonpsychologist). It consists of 2 in-person visits (sessions 1 and 3) and 2 telephone check-ins (sessions 2 and 4) typically lasting 20-30 minutes.
When patients presenting to primary care or other medical clinics experience distress or impairment due to difficulties falling asleep, staying asleep, or waking up too early.
Some primary care and integrated medical settings.
WHAT DOES CBTi INVOLVE?
WHEN CAN BBTI HELP?
WHERE CAN I ACCESS BBTI?
WHY BBTI?
Compared to CBT-I, BBTI uses fewer visits, shorter sessions, and provides a more feasible treatment format in the clinical settings where most people with insomnia seek care. It also increases access to treatment because a range of clinicians can deliver BBTI.
HOW DOES BBTI WORK?
WHAT DOES BBTI INVOLVE?
BBTI aims to modify waking behaviors that impact the two major physiological mechanisms that regulate sleep: the homeostatic and circadian drives. Its core treatment components include stimulus control and sleep restriction.
BBTI's core treatment components
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BBTI aims to modify waking behaviors that impact the two major physiological mechanisms that regulate sleep: the homeostatic and circadian drives. Its core treatment components include stimulus control and sleep restriction.
BBTI aims to modify waking behaviors that impact the two major physiological mechanisms that regulate sleep: the homeostatic and circadian drives. Its core treatment components include stimulus control and sleep restriction.
Other considerations
- *BBTI is typically contraindicated for people with bipolar disorder, psychotic disorders, or seizures because its mild sleep restriction component may worsen these conditions.
- BBTI may offer a first-line intervention for a majority of patients seen in primary care settings, whereas CBT-I may work best for patients requiring a “higher” dose of treatment delivered in a specialty care clinic. If sleep has not improved after 4 weeks, consider seeking a full course of CBT-I from a licensed behavioral sleep medicine provider.
BBTI aims to modify waking behaviors that impact the two major physiological mechanisms that regulate sleep: the homeostatic and circadian drives. Its core treatment components include stimulus control and sleep restriction.
BBTI aims to modify waking behaviors that impact the two major physiological mechanisms that regulate sleep: the homeostatic and circadian drives. Its core treatment components include stimulus control and sleep restriction.
(C) 2020, Christina Pierpaoli Parker, PhD
References:
Germain, A. & Buysse, D.J. (2011). Brief behavioral treatment of insomnia. In: Perlis, M., Alioa, M., Kuhn, B., eds. Behavioral Treatments for Sleep Disorders: A Comprehensive Primer of Behavioral Sleep Medicine Treatment Protocols. 1st ed. Cambridge, MA: Academic Press: 143-149.
Gunn, H.E., Tutek, J., & Buysse, D.J. (2019). Brief Behavioral Treatment of Insomnia. Sleep Medicine Clinics, 14(2), 235-243.
