2015 Principles and Practice of CBT-I: Cognitive Behavioral Therapy for Insomnia

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Cognitive Behavioral Treatment for Insomnia (CBT-I) is an effective alternative to sleep medication and works with mild to severe and chronic insomnia. CBT-I is an empirically validated approach that can lead to positive results long after treatment has ended.

While this course is primarily focused on CBT-I, 2-3 hours will also be spent on the medical management of insomnia and will provide a comprehensive overview of what it takes to practice Behavioral Sleep Medicine (BSM).

• CBT-I can help clients who have taken sleep medication for years
• CBT-I is as efficacious and effective as pharmacotherapy in the short run, and is more durable in the long run
• CBT-I is effective because it treats the cause of insomnia, not the symptoms as medication does

The program should position clinicians to be ready to conduct practicum cases with supervision from credentialed BSM individuals (or established experts). Following this course and an additional period of practice and training in sleep medicine (the equivalent of 30-100 hours), the individual may be able to establish eligibility for the credentialing exam that is in development by the SBSM and related agencies. For more information on the credentialing process, watch: www.behavioralsleep.org.

Objectives

1. Define sleep continuity variables and understand how to define chronic insomnia with regard to diagnostic criteria, severity and chronicity
2. Discuss the consequences of insomnia as they relate to medical and psychiatric co-morbidities of insomnia as well the cost to public health, personal safety, and quality of life
3. Explain the two process model of normal sleep wake regulation and describe the 3 key treatment implications of the model
4. Explain both the 3 and 4 factor versions of the Behavioral Model (Spielman Model) of insomnia and discuss the key implications of the model and its relevance for treatment
5. Summarize the various pharmacological approaches to insomnia and discuss the relative efficacy of CBT-I and pharmacotherapy
6. Practice a thorough sleep assessment, understand how to use a sleep diary and when polysomnography is needed, and discuss other available assessment tools in insomnia
7. Discuss how insomnia evolves into a primary and co-morbid condition, how it requires specific and targeted treatment, and who is a good candidate for Cognitive Behavioral Therapy for Insomnia (CBT-I)
8. Discuss and describe the major components of CBT-I and begin to understand how to handle some basic resistances, as well as describe the existing literature that supports CBT-I as a well-established, efficacious, and front line treatment for primary and secondary insomnia

Outline
Day One:

• Sleep 101: Overarching Framework
• Signs and Symptoms of Sleep Disorders
• Definition of Insomnia
• Etiology & Pathophysiology of Insomnia (Basic model)
• Treating Insomnia - Part I
• Treating Insomnia - Part II
• Determination of Whether CBT-I is Indicated

Day Two:

• CBT-I Session-by-Session Review Orientation
• Session I - Intake Evaluation
• Session II - Treatment Initiation
• Sleep Restriction Procedures and Rationale
• Stimulus Control Procedures and Rationale
• Session III - Sleep Hygiene
• Sessions IV, V, & VI - Titration and Compliance

Day Three:

• Session VII - Cognitive Therapy for Insomnia Related Catastrophic Thinking
• Session VIII - Relapse Prevention
• Practice Management & Billing