The Effects of Cognitive Behavioral Therapy for Insomnia on Multidimensional Perfectionism

• Published in: Behavior therapy 2023-03, Vol.54 (2), p.386-399
• Main Authors: Johann, Anna F., Feige, Bernd, Hertenstein, Elisabeth, Nissen, Christoph, Benz, Fee, Steinmetz, Lisa, Baglioni, Chiara, Riemann, Dieter, Spiegelhalder, Kai, Akram, Umair
• Format: Article
• Language: English
• Subjects: Cognitive Behavioral Therapy; Humans; insomnia; objective sleep; Perfectionism; personality; Polysomnography; Sleep; Sleep Initiation and Maintenance Disorders
• ISSN: 0005-7894; 1878-1888
• DOI: 10.1016/j.beth.2022.10.001

•Perfectionism was related to dysfunctional cognition and sleep-effort at baseline.•Patients receiving treatment presented an increase in total perfectionism scores posttreatment.•Organizational behavior and parental expectations increased in those receiving treatment.•Patients receiving treatment displayed a reduction in doubts about action posttreatment. Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep among individuals with insomnia. The effects of cognitive behavioral therapy for insomnia (CBT-I) on perfectionism was also examined. This was a secondary analysis of a randomized controlled trial on CBT-I. Forty-three insomnia patients were randomized to treatment (receiving CBT-I) or waitlist control groups. Sleep was recorded using polysomnography at baseline. Participants completed measures of perfectionism, dysfunctional beliefs about sleep, sleep-effort and pre-sleep arousal at baseline and posttreatment. Total perfectionism scores and doubts about action, concern over mistakes and personal standards were each significantly related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep at baseline. Patients receiving treatment displayed increased total perfectionism scores posttreatment d = .49. In those receiving treatment, levels of organization d = .49 and parental expectations d = .47 were significantly increased posttreatment, relative to baseline. In line with the literature, our results confirm that perfectionism is related to insomnia. Here, insomnia was related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep. The propensity to maintain a high standard of order and organization may be elevated following CBT-I, considering the treatment protocol expects patients to strictly adhere to a set of clearly defined rules. Levels of parental expectations may be increased following CBT-I since the patient-therapist-relationship may trigger implicit expectations in patients which are reminiscent of their relationship to their parents.