Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
The 3P model
Why a stressful month can turn into a bad year of sleep, and why the fix targets your habits, not the original stress.
In short
- Predisposing factors set how close to the line you live.
- Precipitating factors (a stressor) push you over it. That’s acute insomnia.
- Perpetuating factors (how you cope) keep you over the line after the stressor fades. That’s chronic insomnia.
- CBT-I works on the perpetuating part, which is the part you can change.
See it move
Spielman’s 3P model
Tap a stage or press Play. Tap a colored band to see what it means.
Illustration of the idea in Spielman, Caruso & Glovinsky (1987). The heights are made up to show the shape, not measured.
The three Ps
Predisposing
Traits you bring: a nervous system that revs easily, a worrying style, being a light sleeper. They don’t cause insomnia; they lower the bar.
Precipitating
The trigger. Stress at work, grief, a breakup, illness, pain, a new baby, a move. Usually it fades.
PerpetuatingThe target of CBT-I
What you do to cope, which makes sense in the moment and backfires: spending extra time in bed, napping, sleeping in, lying awake trying harder, worrying about tomorrow. Spielman’s team names too much time in bed, anticipatory anxiety and worry about daytime deficits as typical ones. (Spielman et al. 2011)
The thinking side
Harvey’s cognitive model adds the mental loop.
The loop
Worry about sleep and its daytime cost raises arousal. Arousal makes you scan for threat: the clock, your heartbeat, how tired you feel. You overestimate how little you slept. Then come safety behaviors (cancelling plans, napping, extra caffeine), which keep the worry alive. Many people also believe that worrying helps them cope. (Harvey 2002)
What breaks it
Cognitive work in CBT-I: testing the beliefs, dropping the safety behaviors, a worry time earlier in the evening, and getting out of bed instead of fighting it. CBT-I →
Sources
All sources, linked3 references⌄
- Spielman AJ, Caruso LS, Glovinsky PB (1987). A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 10(4):541–553. pubmed.ncbi.nlm.nih.gov/3332317/
- Spielman AJ, Yang C-M, Glovinsky PB (2011). Sleep restriction therapy. In Perlis M, et al. (eds), Behavioral Treatments for Sleep Disorders. Elsevier (chapter hosted by the Penn CBT-I program). www.med.upenn.edu/cbti/assets/user-content/documents/BTSD%20Spielman%20Chapter%20on%20SRT.pdf
- Harvey AG (2002). A cognitive model of insomnia. Behav Res Ther 40(8):869–893. pubmed.ncbi.nlm.nih.gov/12186352/
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