Integration of cognitive-behavioral therapy and pharmacotherapy in the treatment of insomnia

Donna M. Sudak, Drexel University College of Medicine
Jacqueline Kloss, Drexel University College of Medicine
Jessica Zamzow, Drexel University College of Medicine


Insomnia is a widespread public health concern that can present alone or in the context of other psychiatric and medical conditions. Both cognitive-behavioral therapy for insomnia (CBT-I) and pharmacotherapy, including benzodiazepines (BZs) and benzodiazepine-receptor antagonists (BZRAs), are efficacious for the treatment of insomnia. Hypnotics and CBT-I each offer different long- and shortterm advantages and disadvantages. Recent research examining the efficacy of combining CBT-I and hypnotic therapies aim to capitalize on the relative benefits of each form of treatment. In this article we synthesize relevant empirical evidence for the efficacy of hypnotics and CBT-I when used as independent therapies; the advantages and disadvantages of using combined approaches to treat insomnia; and the use of combined treatment among older adults and patients with psychiatric comorbidities. Optimal delivery methods for combined treatments (e.g., best sequencing and combination protocols) have been investigated, but require further research in order to inform clear practice guidelines. © 2014 International Association for Cognitive Psychotherapy.