Paradoxic Intention as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia

Markus Jansson-Fröjmark; Christina Sandlund; Annika Norell-Clarke

doi:10.1016/j.jsmc.2022.10.001

Paradoxic Intention as an Adjunct Treatment to Cognitive Behavioral Therapy for Insomnia

Sleep Med Clin. 2023 Mar;18(1):9-19. doi: 10.1016/j.jsmc.2022.10.001.

Authors

Markus Jansson-Fröjmark¹, Christina Sandlund², Annika Norell-Clarke³

Affiliations

¹ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Competence Center for Psychotherapy Research and Education, Liljeholmstorget 7, Stockholm 117 63, Sweden. Electronic address: markus.jansson-frojmark@ki.se.
² Department of Neurobiology, Care Sciences and Society, Academic Primary Health Care Centre, Karolinska Institutet, Solnavägen 1 E, Stockholm 113 65, Sweden.
³ Centre for Research on Children's and Adolescent's Mental Health, Karlstad University, 651 88 Karlstad, Sweden; Department of Law, Psychology and Social Work, Örebro University, Box 1252, Örebro 701 12, Sweden; Faculty of Health Sciences, Kristianstad University, Kristianstad SE-291 88, Sweden.

PMID: 36764790
DOI: 10.1016/j.jsmc.2022.10.001

Abstract

Paradoxic intention (PI) was one of the first psychological interventions for insomnia. Historically, PI has been incorporated in cognitive behavioral therapy for insomnia (CBT-I) or delivered as a sole intervention for insomnia. PI instructions have varied over the years, but a common denominator is the instruction to try to stay awake in bed for as long as possible. This article reviews and discuss treatment rationales and theoretic frameworks for PI, the current evidence base for PI, its clinical relevance, and considerations needed when PI is used as an adjunct treatment to CBT-I, or as a second-line intervention for insomnia.

Keywords: Cognitive behavior therapy; Insomnia; Paradoxic intention; Performance anxiety; Sleep intention.

Publication types

Review

MeSH terms

Cognitive Behavioral Therapy*
Humans
Intention
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome