The Underlying Mechanism of CBT-I Intervention Timing for Chronic Insomnia: A Cross-Validation Based on the M-F-Y-F-M Spiral Ascension Model of the MFY Hypothesis

Author Information Baichen Yi Independent Researcher, Xi'an, Shaanxi, China ORCID: 0009-0008-6242-7743 Email: [email protected] Corresponding Author: Baichen Yi Abstract Cognitive Behavioral Therapy for Insomnia (CBT-I) is globally recognized as the first-line treatment for adult chronic insomnia with the highest level of evidence and strong recommendations from all major clinical guidelines. Almost all official guidelines explicitly mandate the operational sequence of "cognitive restructuring first, followed by behavioral intervention" for CBT-I implementation. However, existing theoretical frameworks in sleep medicine—including the 3P hypothesis, the two-process model of sleep regulation, and cognitive models of insomnia—can only describe the phenomena of insomnia chronicity and CBT-I efficacy, but fail to derive the underlying necessity of this intervention sequence from first principles, leading to inconsistent clinical practice, uneven treatment outcomes, and persistently high relapse rates. As the first cross-validation paper in the applied series of the MFY Three-Variable Steady-State Hypothesis, this paper adopts the M-F-Y-F-M Spiral Ascension Model proposed in the author’s foundational preprint as the overarching theoretical framework, focusing on testing the clinical validity and mechanistic alignment of the core single-round repair loop Y→F→M in the context of chronic insomnia, thereby filling the long-standing theoretical gap in the underlying mechanism of CBT-I intervention timing. The core incremental claim of this work is that the efficacy of all CBT-I modules can be uniformly attributed to the single-round closed-loop repair within the M-F-Y-F-M Spiral Ascension Model: guiding behavioral calibration through expectation reconstruction, and ultimately restoring the self-organization capacity of the sleep homeostasis ontology. The critical reason why intervention timing is non-negotiable is that the sleep homeostasis ontology (Anchor M) is a non-directly intervenable emergent state, not an endpoint that can be directly reached by subjective will. Reversing the intervention sequence (behavior first, cognition later) impairs long-term efficacy because the upstream driver of behavioral deviation (distorted expectation Y) remains unaddressed, rendering behavioral improvement superficial and prone to relapse once external constraints are lifted. This paper is registered with DOI: 10.5281/zenodo.19603354, and is a cross-validation extension of the author’s foundational preprint (DOI: 10.5281/zenodo.19491590), with full alignment of core theoretical framework, variable definitions, and closed-loop rules. Preprint Statement This is a preprint and has not been peer-reviewed. All conclusions are theoretical derivations and matching test results at the hypothesis level, and do not represent the final academic publication conclusions, nor do they claim absolute truth or clinical practice standards. Copyright License This preprint is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). You may copy and redistribute the material in any medium or format, provided that you give appropriate credit to the original author, provide a link to the license, and indicate if changes were made. You may not use the material for commercial purposes, nor may you remix, transform, or build upon the material and distribute the modified material. Full license text: https://creativecommons.org/licenses/by-nc-nd/4.0/ Special Translation Authorization Notwithstanding the above NoDerivatives clause, the author explicitly authorizes any individual or institution to translate the full text or partial content of this preprint into other languages for non-commercial purposes. All translated versions must retain the original core logic, clearly indicate the original source, author information, and the DOI of this preprint. All translated versions must not be used for commercial purposes, and must not alter the original core arguments. Ethical and Risk Warning This paper only presents exploratory clinical hypotheses based on cross-system logical isomorphism, and does not constitute any practical suggestions for clinical diagnosis, treatment, rehabilitation training, health management, or psychological intervention. All clinical diagnosis and treatment behaviors must be carried out by qualified professionals in formal institutions in accordance with relevant domestic guidelines and ethical norms. Conflict of Interest Statement The author declares no conflicts of interest related to this paper.