A problem-solving approach to the treatment of insomnia: selected case histories

The author presents case histories that demonstrate an approach to a spectrum of clinical scenarios that have common to them the complaint of insomnia. In the first, the physician is faced with an acute problem with an easily apparent, but superficial, etiology. The use of a benzodiazepine in this instance would be relatively noncontroversial. Its usage, without an exploration of the patient's perceptual frame, including psychosocial factors, would miss potentially important underlying problems. In the second case, the physician's concern about the habituating effects of benzodiazepines could have resulted in the underutilization of their benefits. The third case represents a scenario in which overutilization with resultant habituation was potentially a problem. It becomes apparent that an "either/or" generalization might hinder good patient outcome. Questioning around the symptom for purposes of gathering information regarding the patient's perceptual frame and the consequences of change may be useful in developing treatment strategies.