Novel psychotherapies for insomnia

Summary Insomnia disorder, characterized by a complaint of reduced sleep quality or quantity and associated daytime impairment, is highly prevalent and associated with reduced quality of life and productivity. Cognitive behavioural therapy for insomnia (CBT‐I) is the current first‐line treatment for chronic insomnia disorder. Here, we outline our perspective for the future optimization of psychotherapeutic treatment for insomnia. We identified the following areas as the most promising: first, optimizing efficacy of the CBT‐I protocol; second, developing diagnostic and therapeutic approaches for non‐responders and partial responders; and third, advancing widespread implementation of psychotherapy for insomnia. More specifically, we outline how the current CBT‐I protocol could be optimized through an improved understanding of treatment mechanisms, and discuss the potential of adaptive treatment strategies. Another promising approach for improving the current CBT‐I protocol is using add‐ons such as physical exercise or circadian‐based interventions. Both may be promising in certain subgroups of patients with insomnia. In terms of non‐response, we identify acceptance and commitment therapy for insomnia (ACT‐I) as a promising treatment for non‐responders to CBT‐I. ACT‐I, however, still needs to be evaluated in actual non‐responders to CBT‐I. Implementing CBT‐I in clinical practice is still one of the major challenges at hand. We outline how brief treatment, targeted treatment for challenging patient groups, and digital treatment may help improve implementation. For a future research agenda, we suggest that further research into treatment mechanisms, randomized–controlled trials in non‐responders to CBT‐I, and a focus on implementation science have a potential to bring the field forward.