CBT and CBT-I
Cognitive Behavioral Therapy (CBT) and Cognitive Behavioral Therapy for Insomnia (CBT-I) in San Diego
Cognitive Behavioral Therapy (CBT) helps people understand patterns among thoughts, behaviors, emotions, habits and physical responses. Cognitive Behavioral Therapy for Insomnia (CBT-I) applies these principles specifically to chronic insomnia and sleep patterns.
Dr. Freeman uses CBT and CBT-I in a practical, collaborative way. The goal is not to hand the patient a worksheet and expect the patient to fit a formula. Dr. Freeman and the patient identify patterns connected to the patient’s concerns, choose focused strategies and review how they work in daily life.
Treatment at a Glance
- 1. Who may benefit: People who want a practical, skills-oriented treatment for patterns involving thoughts, behaviors, emotions, physical responses, habits or chronic insomnia.
- 2. Treatment focus: Identifying patterns that maintain distress, testing more useful responses and reviewing what works in daily life.
- 3. Approaches: Cognitive Behavioral Therapy (CBT) for a range of concerns and specialized Cognitive Behavioral Therapy for Insomnia (CBT-I) for chronic sleep problems.
- 4. Appointments: In person in San Diego and by teletherapy throughout California when clinically appropriate.
- 5. Related care: Insomnia treatment, anxiety treatment, chronic pain treatment and trauma treatment.
What Is Cognitive Behavioral Therapy?
CBT begins with the idea that thoughts, actions, emotions and physical responses influence one another. When a pattern becomes repetitive, it can maintain anxiety, low mood, pain-related distress, avoidance, sleep difficulty or other problems.
Treatment helps patients notice the cycle and practice a more useful response. Dr. Freeman uses cognitive restructuring to examine thoughts that increase negative emotional activation, develop more rational alternatives and support a more functional understanding of the situation. Behavioral strategies then help patients test those alternatives in daily life.
What Is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
CBT-I is a specialized, evidence-based form of cognitive behavioral treatment for insomnia. It addresses sleep schedules, time awake in bed, sleep-related beliefs, conditioned arousal and behaviors that may keep chronic insomnia going.
CBT-I is not simply a list of sleep-hygiene rules. Many people have already tried reducing caffeine, avoiding screens or darkening the room. Those steps can help, but chronic insomnia often requires more direct work on the cycle of wakefulness, effort and fear surrounding sleep.
How CBT and CBT-I Differ
CBT Is a Broader Framework
CBT can be applied to anxiety, depression, chronic pain, health concerns, trauma-related patterns and other problems. The techniques depend on what is maintaining the difficulty and what the patient wants to change.
CBT-I Is Designed for Insomnia
CBT-I uses sleep-specific assessment and strategies. The focus remains on insomnia even when anxiety, trauma, pain or another condition is also present.
Core Elements of Cognitive Behavioral Therapy for Insomnia (CBT-I)
Sleep Restriction and Stimulus Control
A consistent, individualized schedule can strengthen the relationship between time in bed and sleep. Recommendations should account for health, safety, work demands and the patient’s response.
Stimulus Control
Stimulus-control strategies help rebuild the bed as a cue for sleep rather than worry, frustration, work or prolonged wakefulness.
Cognitive Work Around Sleep
Patients often develop rigid rules or catastrophic predictions about sleep. CBT-I helps test those beliefs and reduce performance pressure without pretending that poor sleep has no consequences.
Simplified Sleep Observation
Dr. Freeman generally avoids detailed, highly structured sleep diaries because intensive tracking can increase obsession or catastrophic thinking about sleep. When observation is useful, he favors simplified broad estimates that provide enough information to guide treatment without turning sleep into another performance test.
Behavioral Experiments
Patients may test a new schedule, change a bedtime habit or respond differently after a poor night. Dr. Freeman and the patient review the result and refine the plan rather than treating the exercise as pass or fail.
Hypnosis and Arousal-Reduction Strategies
Clinical hypnosis, mindfulness and relaxation may be incorporated when reducing arousal, changing conditioned responses or strengthening coping supports the treatment plan.
Relapse Prevention
Treatment should prepare patients for future disruptions. The aim is to recognize the cycle early and use learned skills before several difficult nights become another long episode.
Cognitive Behavioral Therapy, CBT-I and Medication
Some patients want skills that help them rely less heavily on sleep medication. Dr. Freeman does not prescribe. When appropriate, he coordinates systematic reduction of benzodiazepines or other sedative-hypnotics with the patient’s primary-care or prescribing clinician. He also supports appropriate use of SSRIs, mood stabilizers and other psychiatric medication when they contribute to the patient’s care.
For chronic insomnia, CBT-I is widely described as the gold-standard behavioral treatment and is commonly recommended as a first treatment option. It addresses sleep-specific thoughts and behaviors, including conditioned wakefulness, time awake in bed and pressure to force sleep, rather than relying on sleep-hygiene advice alone.
Medication and psychotherapy are not an either-or choice for every patient. CBT or CBT-I may be used alongside medication when clinically appropriate. Medication changes remain the responsibility of the prescribing clinician.
What Active, Collaborative Treatment Looks Like
Patients may be asked to observe patterns, practice a skill, change a habit or complete a structured exercise between sessions. At the next appointment, Dr. Freeman and the patient review what happened and decide what to keep, change or stop.
Dr. Freeman explains why he is recommending an approach and how it connects to the patient’s goals. Patients are encouraged to ask questions, raise concerns and say when a strategy does not fit their health or circumstances.
Dr. Freeman's Clinical Perspective
Dr. Freeman uses CBT as a process of observation, testing and adjustment rather than a set of slogans or worksheets. Thoughts are considered together with behavior, emotion, physical response and context. The patient and Dr. Freeman identify a pattern, choose a focused experiment and review what the result teaches them.
CBT-I uses the same practical spirit but applies sleep-specific methods to insomnia. A general discussion of stress is not the same as changing the timing, habits, conditioned arousal and sleep-related predictions that can maintain chronic insomnia.
Insight is useful, but lasting change usually requires practice. Patients may test a different behavior, observe what happens and bring that information back to treatment. This process helps turn an idea discussed in session into a skill that can be used in daily life and maintained after treatment ends.
When Medical or Additional Care May Be Needed
CBT and CBT-I are not identical programs for every patient. Assessment may indicate that another psychotherapy approach, medical evaluation, medication consultation or a higher level of care is needed instead of or alongside cognitive behavioral treatment.
Dr. Freeman does not prescribe medication. Medication decisions and changes remain the responsibility of the prescribing clinician, with coordination when appropriate and authorized.
Frequently Asked Questions
Is CBT just positive thinking?
No. CBT examines patterns and tests more useful responses. It does not ask you to deny real problems, symptoms or consequences.
Is CBT-I the same as sleep hygiene?
No. Sleep hygiene may be one small part of care. CBT-I directly addresses schedules, conditioned wakefulness, time awake in bed, sleep beliefs and other maintaining factors.
Does Treatment Include Between-Session Practice?
There is often practice between sessions. The purpose is to test skills in real life. Dr. Freeman and the patient review the result collaboratively rather than treating the exercise as a test.
Can CBT-I help when trauma, anxiety or pain affects sleep?
It may. Insomnia can be treated directly while related concerns receive appropriate treatment. The plan depends on which patterns are most important to address first.
How long does CBT-I take?
Many focused courses of CBT or CBT-I fall within approximately 8 to 12 sessions. More time may be appropriate when sleep, anxiety, pain or trauma concerns occur with complex psychiatric or medical conditions. Treatment duration and results cannot be guaranteed.
Related Services
Insomnia and Sleep Problems Treatment
Learn how specialized psychological treatment addresses chronic insomnia, nighttime arousal and sleep-related habits.
Anxiety Treatment
Explore practical treatment for worry, avoidance, physical arousal and anxiety that affects daily life.
Chronic Pain and Behavioral Medicine
See how behavioral medicine can complement medical care for chronic pain, sleep disruption and daily functioning.
Trauma and Post-Traumatic Stress Disorder (PTSD) Treatment
Learn about paced treatment for trauma reactions, nightmares, hypervigilance and PTSD symptoms.
Related Reading From Dr. Freeman’s Blog
These articles offer practical background on CBT-I and the cognitive and behavioral patterns that can maintain insomnia.
- CBT and CBT-I
What Is CBT-I? A Complete Guide to Cognitive Behavioral Therapy for Insomnia By Dr. Charles R. Freeman, Ph.D. CBT-I for insomnia...
How CBT-I Treats Chronic Insomnia By Dr. Charles R. Freeman, Ph.D. How CBT-I treats chronic insomnia is practical: it changes...
Yes, the way you think can make sleep, anxiety, PTSD symptoms, and emotional distress worse. That does not mean your...
Authoritative Information
The National Institute of Mental Health’s overview of psychotherapy describes ways treatment may address thoughts, emotions and behavior while being tailored to the person’s needs.
Read the National Heart, Lung, and Blood Institute’s overview of insomnia treatment. This federal resource includes general information about behavioral treatment for insomnia.
Review the 2025 VA/DoD clinical guidance for chronic insomnia and obstructive sleep apnea. The guidance identifies CBT-I as the gold-standard behavioral treatment for chronic insomnia.
About Dr. Charles R. Freeman, Ph.D.
Dr. Freeman is a California-licensed psychologist in San Diego with over 35 years of clinical experience. His practice specializes particularly in insomnia and sleep problems and also includes anxiety, trauma and PTSD, chronic pain and behavioral medicine, CBT, CBT-I and Eye Movement Desensitization and Reprocessing (EMDR). Appointments are available in person in San Diego and by teletherapy throughout California when clinically appropriate.
View California psychology license PSY #25414 or learn more about Dr. Freeman’s background and clinical approach.
Clinical Content Information
Clinical content by Dr. Charles R. Freeman, Ph.D., a California-licensed psychologist with over 35 years of clinical experience. View California psychology license PSY #25414.
Find Out Whether CBT or CBT-I Fits
Patients do not need to select a therapy method before contacting Dr. Freeman. A consultation can address the problem, what has already been tried and whether CBT, CBT-I or another approach may be appropriate.