Aviva Psychology Services
CBT for Insomnia (CBT-I)
The first-line, evidence-based treatment for chronic insomnia to reset your relationship with sleep and restore restful nights.
When sleep becomes dreaded
You lie down exhausted and your mind starts racing. You watch the clock. You calculate how many hours you have left if you fall asleep right now. You finally drift off and then wake again at 3am, unable to get back to sleep. You drag yourself through the day and dread bedtime all over again.
Maybe you have tried everything. Sleep hygiene tips, supplements, medication. Some of it helps for a while. But the insomnia keeps coming back, and you are starting to wonder if your sleep is simply broken.
Your sleep is not broken. CBT-I is the first-line, evidence-based treatment for chronic insomnia, and it works by changing the patterns that keep insomnia going. If you are looking for CBT-I in Massachusetts with experienced doctoral-level psychologists, we invite you to explore whether Aviva might be the right fit.
What is CBT-I?
CBT-I is a structured, evidence-based treatment specifically designed to address chronic insomnia. It focuses on identifying and changing the thoughts and behaviors that cause or worsen sleep problems. Unlike sleep medications that address symptoms temporarily, CBT-I targets the underlying patterns that are maintaining insomnia.
CBT-I focuses on two main components. The cognitive component addresses maladaptive thoughts and worry patterns about sleep. The behavioral component addresses sleep schedules, time in bed, and bedtime routines. Together, these two components work to rebuild a healthy, sustainable relationship with sleep.
CBT-I is recognized by the American Academy of Sleep Medicine as the first-line treatment for chronic insomnia and has been found to be more effective than medication for long-term sleep improvement.
Who Can CBT-I help?
CBT-I is effective for a wide range of sleep-related concerns, including:
- Difficulty falling asleep at bedtime
- Frequent or prolonged awakenings during the night
- Waking earlier than desired and being unable to return to sleep
- Feeling unrefreshed after sleep regardless of duration
- Chronic insomnia lasting three or more months
- Sleep difficulties complicated by anxiety, depression, or chronic pain
- Dependence on sleep medication with a desire to reduce or discontinue use
CBT-I is often a good fit for individuals who have tried other approaches without lasting relief and who are ready to engage with a structured, active treatment process.
The CBT-I process and how it works
CBT-I is a prescriptive treatment with a defined process. Because some components can have a short-term impact on daily functioning, your psychologist will work with you to plan ahead and find a time to begin that is minimally disruptive to your life. The process involves five core components:
01 Sleep restriction
Sleep restriction limits the time you spend in bed in order to increase sleep efficiency. The goal is to consolidate sleep and reduce the time you spend awake during the night. While this can feel challenging initially, it is one of the most effective components of the treatment.
02 Stimulus control
Stimulus control reduces the time spent in bed while awake. This means limiting activities such as watching TV, reading, or scrolling that may happen in bed, with the goal of strengthening the association between your bed and sleep.
03 Cognitive restructuring
Cognitive restructuring involves identifying and challenging unhelpful thoughts and beliefs about sleep. Many people with chronic insomnia develop patterns of thinking about sleep that increase anxiety and perpetuate the problem. Your psychologist will help you examine and shift these patterns.
04 Psychoeducation on sleep hygiene
Your psychologist will provide education on the basic habits and environmental factors that support healthy sleep. This gives you a clear framework for the behavioral changes you will be making throughout treatment.
05 Relaxation technique
Relaxation techniques help your body and mind prepare for sleep. Your psychologist will introduce specific practices to reduce the physiological arousal that often accompanies chronic insomnia.
Why we use this approach
CBT-I is offered within our dedicated Insomnia Clinic by psychologists with specialized training in sleep and behavioral health. We use CBT-I because the evidence behind it is clear and consistent. It is the first-line treatment for chronic insomnia recommended by major medical and sleep organizations, and research consistently shows it produces more durable results than medication alone.
CBT-I also fits naturally within our broader approach to behavioral medicine. Sleep does not exist in isolation. It affects mood, pain, concentration, and emotional regulation. By addressing insomnia directly and effectively, we support the whole person, not just the symptom.
We value CBT-I's structure and transparency. Clients understand exactly what they are working on, why each component is being introduced, and what progress looks like. This clarity supports collaboration and helps clients become active participants in their own change process.
What does a CBT-I Session look like?
CBT-I sessions at Aviva are structured and goal-oriented. Your psychologist will typically begin by reviewing your sleep diary from the previous week, then focus on current concerns and progress toward your treatment goals. Tracking your sleep is an important part of the process and gives you and your psychologist real data to work with.
Sessions follow a defined sequence that moves through the five core components of CBT-I at a pace suited to your individual needs. Your psychologist will guide you through each stage, introduce new skills and behavioral targets, and determine together how to apply them between sessions.
The tone is collaborative and direct. Many clients appreciate knowing exactly what they are working on each week and being able to see measurable progress in their sleep diary data over time.
The right assessment
We always begin with a thorough assessment. Before any treatment protocol is introduced, your psychologist will take time to understand the full picture of your sleep concerns, including the physical, psychological, and social factors that may be contributing to your insomnia. This ensures that the treatment you receive is matched to what is actually driving your symptoms, not just the surface presentation.
Contact us
For more information and to assess fit, please contact us.
Benefits of CBT-I
Sleep improvement
CBT-I produces durable results by addressing the root causes of insomnia rather than managing symptoms temporarily.
Reduced reliance on medication
Many clients use CBT-I to reduce or discontinue sleep medication under the guidance of their psychologist and other treating providers.
Better daily functioning
Improved sleep quality has a direct impact on mood, concentration, pain tolerance, and overall quality of life.
CBT-I is recognized by the American Academy of Sleep Medicine and other major medical organizations as the first-line treatment for chronic insomnia. Research consistently shows that CBT-I produces better long-term outcomes than sleep medication, with lower relapse rates after treatment concludes.
Clients often report meaningful improvements in sleep onset, sleep duration, and nighttime awakenings within the first month of treatment. While outcomes vary by individual, most clients who complete a full course of CBT-I at Aviva see significant and lasting improvements in their sleep.
Is CBT-I the right fit for you?
CBT-I is likely a good fit:
- if you have been struggling with insomnia for three months or longer
- if your sleep difficulties happen at least three nights per week
- if the daytime effects (fatigue, mood, focus, function) are significant.
It is also a strong fit if you have tried sleep medication and want to taper off, or if you would prefer to avoid medication altogether.
CBT-I works for most people, including those whose insomnia coexists with anxiety, depression, chronic pain, or medical conditions. In fact, treating insomnia directly often improves these conditions as well, rather than waiting for them to resolve first.
CBT-I is structured and requires active participation. It involves keeping a brief daily sleep log, adjusting your sleep schedule for a period of time, and practicing specific skills between sessions. The work is short-term (typically 4 to 8 sessions), but it requires consistent effort while you are doing it.
If you are unsure whether CBT-I is the right starting point, your psychologist will discuss fit openly during the assessment and help you decide.
What to expect when you begin
Starting therapy can feel overwhelming, but we keep the process simple and supportive. Here’s what to expect:
Request an Appointment
Once you complete this form, we will reach out to schedule a complimentary 15-minute phone consultation to assess fit together.
Assessment and Planning
The first 2 to 4 sessions involve assessing your history, concerns, and goals. You and your psychologist will establish a treatment plan and discuss next steps.
Ongoing Weekly Sessions
Sessions are typically weekly for 55 minutes at a consistent time. You and your psychologist will work together at a pace that feels right for you.
FAQs about CBT-I
How long does CBT-I treatment take?
Following an initial assessment of 1 to 2 sessions, most clients complete CBT-I treatment within 4 to 8 sessions. If your insomnia is complicated by another condition, your psychologist will discuss a timeline that reflects your individual needs.
Is CBT-I more effective than sleep medication?
Research consistently shows that CBT-I produces better long-term outcomes than sleep medication, with lower relapse rates after treatment concludes. Unlike medication, CBT-I addresses the underlying patterns maintaining insomnia rather than managing symptoms temporarily.
Can CBT-I help if I am currently taking sleep medication?
Yes. CBT-I can be highly effective for individuals who are currently taking sleep medication. Your psychologist will discuss your goals regarding medication use and may collaborate with your prescribing provider as appropriate.
Is CBT-I available via telehealth?
Yes. We offer both in-person sessions at our offices in Boston and Northampton and telehealth sessions for clients across Massachusetts.
Ready to Reset Your Relationship With Sleep?
If you are considering CBT-I in Massachusetts, a consultation can help determine whether Aviva and CBT-I are the right fit for your goals. We will review your concerns, answer questions, and outline next steps if fitting.
