Effective Psychological Interventions in Sleep Disorders: From Insomnia to Nightmares and Pediatric Sleep

After an extensive period of study, analysis, and collaborative work with the clinical team, at Centre de Psicologia Jaume Primer – Psicòlegs Girona we have developed the following material with the aim of offering a clear, rigorous, and practical overview of the main evidence-based psychotherapeutic interventions.

This data table presents a comprehensive and comparative overview of the most relevant interventions for addressing insomnia and related sleep disorders. The summarized information is based on randomized controlled trials (RCTs), meta-analyses, and systematic reviews, evaluating not only symptom reduction but also remission rates, clinically significant improvement, and treatment dropout rates.

The key approaches included in this compilation are:

• Cognitive behavioral therapy for insomnia (CBT-I): Considered the gold standard for insomnia treatment and established as a first-line intervention. Its primary focus is on modifying maladaptive thought patterns and behaviors, incorporating techniques such as sleep restriction, stimulus control, and sleep hygiene. Evidence shows high effectiveness in reducing symptoms and improving sleep latency, efficiency, and overall sleep quality in adults, including those with comorbid conditions such as anxiety or trauma.
• Psychodynamic / Psychoanalytic and short-term Psychodynamic Psychotherapy (STPP): Scientific evidence indicates that it can be highly effective in addressing insomnia associated with unconscious conflicts or underlying psychopathology (such as trauma or anxiety), leading to improvements in hypervigilance and personality structure within weeks. It emphasizes unconscious processes, early relational experiences, and the development of self-awareness, particularly in adults and adolescents experiencing difficulties initiating or maintaining sleep.
• Eye movement desensitization and reprocessing (EMDR): A technique originally developed for treating PTSD that uses bilateral stimulation (eye movements, tapping, or tones) to facilitate the reprocessing of traumatic memories without requiring detailed verbalization of the content. Several studies report particularly high success rates in managing trauma-related insomnia and nightmares, improving REM sleep architecture and reducing sleep latency within 3–8 sessions in adults and patients with PTSD.
• Imagery rehearsal therapy (IRT) and integrated protocols: This compilation also includes specialized approaches such as IRT for recurrent or post-traumatic nightmares, which involves rewriting and mentally rehearsing positive endings to nightmares, with demonstrated effectiveness in reducing frequency and intensity (moderate to large effect sizes). Additionally, integrated protocols such as 2NITE combine CBT-I with prolonged exposure therapy, allowing simultaneous intervention for insomnia and PTSD (or traumatic nightmares), particularly in populations such as veterans, showing superior outcomes in sleep efficiency and stress response.

This compilation facilitates identifying which treatments are most effective for different patient profiles, taking into account moderating factors such as childhood trauma, comorbidity, and individual preferences. Overall, the table constitutes a clinical and training tool of high value, designed to promote understanding of the real-world efficacy and ecological validity of contemporary psychotherapies in both public health settings and private practice.