Meg Danforth, Colleen E. Carney – 3-Day Intensive Training: Cognitive Behavioral Therapy for Insomnia (CBT-I): Evidence-based Insomnia Interventions for Trauma, Anxiety, Depression, Chronic Pain, TBI, Sleep Apnea and Nightmares

Outline

• DAY 1: Assessment and the Basics of CBT-I
  • Assessment
    • Goals of assessment
    • Clinical tools for assessing insomnia
    • Screen for other sleep disorders
    • When to make a referral to a sleep clinic
    • Contraindications for CBT-I
  • Sleep and its Regulation
    • Normal sleep architecture
    • Two-process model of sleep: Circadian rhythm and sleep drive
    • The arousal system
    • What causes chronic insomnia?
    • Key perpetuating factors for chronic insomnia
      • Behaviors that interfere with “buildup” of sleep drive
      • Behaviors that interfere with the optimal timing of sleep
      • Conditioned arousal and physiological/ cognitive hyperarousal
    • Perpetuating factors and CBT-I
  • Step-by-Step Guide to CBT-I: Stimulus Control and Sleep Restriction Therapies
    • Stimulus Control (SC): Addressing conditioned arousal
      • Rules for re-associating the bed with sleep
      • Identify and overcome potential obstacles to adherence
    • Sleep Restriction Therapy (SRT): Restoring the sleep drive
      • How to present rationale
      • Calculate time-in-bed prescription
      • Placing the time-in-bed window
      • Identify and overcome potential obstacles to adherence
      • Sleep extension
    • Combining SC and SRT
    • The myth of sleep hygiene
  • Step-by-Step Guide to CBT-I: Cognitive Therapy and Counter-arousal
    • Counter-arousal strategies: Quieting an active mind
      • Establishing a buffer zone
      • Processing strategies (including constructive worry and rumination strategies)
      • Mindfulness and relaxation therapies
      • Cognitive therapy: Identify and change distorted thoughts about sleep
        • Thought Records
        • Behavioral Experiments
        • Socratic Questioning
  • Implementation Issues
    • Models of Delivery
      • Four session individual therapy format
      • Seven session group therapy format
      • Single session CBT-I
    • CBT-I and hypnotic medication
      • Practice guidelines: CBT-I as first line treatment for chronic insomnia
      • Combining CBT-I with sleep medication
        • Positive and negative effects of sleep medications
        • Use of ineffective sleep medications
        • Promote non-contingent use of sleep medication
        • Strategies to support hypnotic discontinuation
• DAY 2: Delivering CBT-I in the Context of Comorbidities
  • Depression
    • CBT-I and MDD
    • Troubleshooting adherence in depressed patients
      • Anhedonia
      • Sleep or bed as avoidance
      • Fatigue and fatigue management strategies
      • Rumination in depression
    • Case examples
    • Sleep and antidepressants
  • Anxiety
    • Sleep effort: Core target of CBT-I
      • Covert manifestations of sleep effort
      • Cognitive restructuring of sleep anxiety
      • Paradoxical Intention
    • Troubleshooting adherence with anxious clients
      • When SRT/SC increase anxiety
      • Counter control and sleep compression
      • High sleep anxiety vs high arousal
    • Panic Disorder and nocturnal panic
    • OCD and CBT-I
  • Trauma
    • Sleep and PTSD
    • CBT-I trials in PTSD
    • Behavioral targets in clients with insomnia vs PTSD
    • Common treatment challenges in clients with PTSD
    • Nightmares and nightmare treatments
  • Traumatic Brain Injury (TBI)
    • Comorbid TBI
      • Sleep and TBI
      • Efficacy of CBT-I in mild TBI (mTBI)
      • Modify insomnia treatment for mTBI
  • Chronic Pain
    • Efficacy of CBT-I for those with chronic pain
    • Chronic pain and stimulus control
    • Common treatment challenges in clients with chronic pain
    • Pain medications and other considerations
  • Hypnotic Discontinuation
    • Combined guided hypnotic taper approach
    • Factors sustaining hypnotic dependence
      • Unhelpful beliefs
      • Learning
    • Strategies to support client during hypnotic taper
      • Psychoeducation about psychological dependence and rebound insomnia
      • Cognitive therapy to target unhelpful beliefs
    • Sample taper schedules
• DAY 3: Co-Occurring Sleep Disorders and Advanced Case Formulation
  • Co-Occurring Sleep Apnea
    • Obstructive sleep apnea (OSA)
      • Morbidity and mortality of OSA
      • Relationship of nocturia and OSA
      • Sleep apnea treatments
    • Obstacles to treatment adherence
      • Physical comfort
      • Mechanical problems
      • Social and other factors
      • Psychological factors
    • Improve adherence
      • Work with stages of change
      • Respond to common concerns
      • CPAP desensitization for claustrophobia
    • Treating insomnia in patients with comorbid OSA
  • Circadian Rhythm Sleep Disorders
    • Using light to leverage circadian timekeeper
    • “Exogenous” circadian challenges
      • Cope with shift work
      • Adjust to jet lag
    • “Endogenous” circadian disorders: Advanced and delayed sleep phase
      • Phototherapy for delayed sleep phase
  • Imagery Rehearsal Therapy for Nightmares
    • Nightmares and nightmare disorder
      • Differential diagnosis
      • Assessment
        • Self-monitoring via nightmare log
        • Combine nightmare log and sleep diary
    • Imagery Rescripting and Rehearsal
      • Psychoeducation and rationale
      • Nightmares and trauma
      • Shaping imagery skills
      • IRT steps
    • Prazosin for nightmares
  • Advanced Case Formulation in CBT-I
    • Case conceptualization: Asking the right questions
    • Case Formulation Form
      • Factors weakening sleep drive
      • Factors weakening the clock
      • Evidence of hyperarousal
      • Unhelpful sleep behaviors
      • Comorbidities
    • Case Examples