After nine years of psychotherapy, including three years of DBT, chronic insomnia remained untreated and continued to contribute to severe anxiety, depression, and suicidality. This case example explores how directly treating insomnia can improve both sleep and broader mental health outcomes.
by Brian Curtis, PhD, DBSM
Prior to sleep-focused treatment, a recent client had completed 9 years of psychotherapy, including 3 years of Dialectical Behavior Therapy (DBT), yet continued to struggle with chronic insomnia, suicidality, severe anxiety, and depression.
Here is one of their takeaway insights as we reviewed treatment progress and formally concluded our work together: “I can’t believe just how much sleep impacts my mental health.”
Over 2.5 months (intake + 7 weekly sessions), we integrated Cognitive Behavioral Therapy for Insomnia (CBT-I), Mindfulness-Based Therapy for Insomnia (MBT-I), Acceptance and Commitment Therapy for Insomnia (ACT-I), and DBT skills within the structured DBT-Sleep protocol.
· Ambien 20 mg →0 mg (following prescriber-guided taper)
· ISI: 27/28 (severe insomnia) → 1/28 (absence of insomnia)
· ESS: 11/24 (mild excessive daytime sleepiness) → 0/24 (low normal)
· PHQ-9: 13/27 (mild depression with suicidal ideation) → 1/27 (minimal depression with no suicidal ideation)
· GAD-7: 17/21(severe anxiety) → 1/21 (minimal anxiety)
· Total sleep time: 7 hours 29 minutes → 8 hours 31 minutes
· Time to fall asleep: 38 minutes → 5 minutes
· Sleep efficiency: 70% → 92%
· Subjective sleep quality: 2.6/4 → 3.4/4
When chronic insomnia is not directly assessed and treated, it can persist as an independent risk and maintaining factor for emotion dysregulation, anxiety, depression, and suicidality, even after years of high-quality therapy
When sleep stabilizes, many other treatment targets become more accessible. This is often life-changing and can be life-saving.
