Scholarlink

<p>Insomnia following trauma exposure is strongly intertwined with posttraumatic stress disorder (PTSD) yet frequently persists despite successful trauma-focused treatment. This clinical review reframes trauma-related insomnia as a disorder of threat perception in which nocturnal wakefulness is maintained by conditioned fear of sleep-related cues, heightened monitoring, and impaired safety and extinction learning in the sleep context. Drawing on clinical research in PTSD, emotional learning and memory, and behavioral sleep medicine, the review describes how hyperarousal, fear of sleep-associated vulnerability, biased interoceptive appraisal, and safety behaviors perpetuate insomnia and nighttime distress. The review translates this framework into trauma-informed adaptations of cognitive behavioral therapy for insomnia (CBT-I), emphasizing (1) stimulus control as graded safety/extinction learning, (2) sleep schedule stabilization delivered with careful titration and collaboration, (3) reduction of monitoring behaviors that function as safety strategies, and (4) targeted integration of nightmare-focused interventions when indicated. Evidence from randomized trials and clinical studies suggests that treating insomnia—either prior to or alongside trauma-focused psychotherapy—improves sleep outcomes and may enhance PTSD symptom reduction, treatment engagement, and retention (Pigeon et al. in Psychother Psychosom 91(1): 50–62, 2022; Taylor et al. in J Trauma Stress, 36(4): 712–726, 2023). The review concludes with assessment considerations, differential diagnosis (including trauma-associated sleep disorder), and research directions for testing trauma-specific CBT-I adaptations.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Insomnia as a Disorder of Threat Perception: Hyperarousal, Extinction, and Trauma-Informed Implications for CBT-I

  • 期刊论文

  • 发表日期：

    2026年4月29日

查看全文
  • Bruce D. Forman

摘要

Insomnia following trauma exposure is strongly intertwined with posttraumatic stress disorder (PTSD) yet frequently persists despite successful trauma-focused treatment. This clinical review reframes trauma-related insomnia as a disorder of threat perception in which nocturnal wakefulness is maintained by conditioned fear of sleep-related cues, heightened monitoring, and impaired safety and extinction learning in the sleep context. Drawing on clinical research in PTSD, emotional learning and memory, and behavioral sleep medicine, the review describes how hyperarousal, fear of sleep-associated vulnerability, biased interoceptive appraisal, and safety behaviors perpetuate insomnia and nighttime distress. The review translates this framework into trauma-informed adaptations of cognitive behavioral therapy for insomnia (CBT-I), emphasizing (1) stimulus control as graded safety/extinction learning, (2) sleep schedule stabilization delivered with careful titration and collaboration, (3) reduction of monitoring behaviors that function as safety strategies, and (4) targeted integration of nightmare-focused interventions when indicated. Evidence from randomized trials and clinical studies suggests that treating insomnia—either prior to or alongside trauma-focused psychotherapy—improves sleep outcomes and may enhance PTSD symptom reduction, treatment engagement, and retention (Pigeon et al. in Psychother Psychosom 91(1): 50–62, 2022; Taylor et al. in J Trauma Stress, 36(4): 712–726, 2023). The review concludes with assessment considerations, differential diagnosis (including trauma-associated sleep disorder), and research directions for testing trauma-specific CBT-I adaptations.