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A formulation based on Spielman's 3P model — mapping predisposing, precipitating, and perpetuating factors that maintain insomnia.
The 3P model explains why insomnia persists even after the original cause has gone. Predisposing factors made you vulnerable, a precipitating event triggered it, and perpetuating factors (the things you do to cope with poor sleep) are what keep it going. Understanding this model is key to CBT for insomnia — because the perpetuating factors are what you can change.
Use in the assessment and formulation phase of CBT-I to map predisposing, precipitating, and perpetuating factors. Spielman's 3P model helps clients understand why insomnia persists even after the original trigger has resolved.
Draw the 3P model collaboratively, explaining that while something triggered the sleep problem (precipitating), it's the coping strategies and habits developed in response (perpetuating) that keep it going. This reframes insomnia as maintained by changeable behaviours rather than being a permanent condition.
For clients with chronic insomnia of many years, spend more time on perpetuating factors as precipitating factors may be distant. For those with comorbid mental health conditions, identify which factors relate to insomnia specifically versus the comorbid condition.
If the client presents with symptoms suggesting a primary sleep disorder (e.g., sleep apnoea, restless legs syndrome, narcolepsy), refer for specialist assessment before proceeding with CBT-I. Screen for untreated obstructive sleep apnoea particularly in clients who snore or have daytime sleepiness despite adequate time in bed.
The most common perpetuating factors are excessive time in bed, irregular sleep-wake schedule, daytime napping, and safety behaviours (e.g., caffeine use, going to bed early). Identifying these provides the treatment targets for stimulus control and sleep restriction.
Suitable for clients working with insomnia, formulation, spielman, 3p model, cbt-i, perpetuating factors, sleep. This tool can be used as a standalone worksheet or as part of a structured homework plan.
Create a free account to access 10 worksheets per month.
The standard CBT-I sleep diary — record bed times, sleep times, wake times, and daytime functioning to track patterns and calculate sleep efficiency.
Identify and challenge dysfunctional beliefs about sleep that fuel insomnia-related anxiety and arousal.
The core stimulus control rules for CBT-I — rebuilding the association between bed and sleep.
Set and track your prescribed sleep window as part of sleep restriction therapy — with weekly adjustments based on sleep efficiency.