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Cognitive behavioural therapy for insomnia (CBTi): From randomized controlled trials to practice guidelines to implementation in clinical practice

Major advances have taken place in the field of insomnia therapeutics over the last few decades. Whereas pharmacotherapy has long been the only treatment option for the management of insomnia, along with some generic sleep hygiene education used as an adjunct, cognitive behavioural therapy for insomnia (CBTi) is now recognized and accepted as first-line treatment not only by psychological and sleep organizations, but also by the medical professional community (Qaseem, Kansagara, Forciea, Cooke, & Denberg, 2016; Riemann et al., 2017). Despite such advances in the field, there is still a huge gap between evidence-based practice guidelines and current clinical practices. The reality is that very few patients with insomnia receive any treatment and, when they do, the predominant therapeutic approach is pharmacotherapy, and not always with drugs supported by evidence or even indicated for insomnia. Whether in Europe, North America or in other parts of the world, CBTi is rarely available and few patients have (the luxury of) access to this treatment modality. There is a huge imbalance between population needs and supply. One of the main reasons for this disparity is, although not exclusively, the lack of adequately trained clinicians to provide high-quality CBTi. An important challenge then has to do with how to enhance access and implementation of CBTi in various healthcare settings. The paper by Baglioni and colleagues (Baglioni et al., 2020), in this issue of JSR, proposes a template whereby the European Academy for CBTi promotes training opportunities, oversees training standards and regulates certification of providers. This is a much needed and welcome initiative in order to foster CBTi dissemination and implementation in clinical settings.