Cognitive-Behavioral Therapy for Insomnia (CBT-I)

This two-day workshop provides training in the assessment of military-related sleep disturbance and treatment of insomnia via Cognitive Behavioral Therapy for Insomnia (CBT-I), an evidence-based approach to treating sleep problems. The workshop begins with a broad foundation of normal sleep, including sleep mechanisms and theories, which builds to instruction on sleep-focused differential assessment with a focus on functional analysis. From this perspective, we explore the etiology of insomnia and introduce clinical interventions within a step-by-step CBT-I protocol. Experiential and interactive elements develop practical skills for using Stimulus Control, Sleep Restriction, and cognitive therapy. Military case examples are incorporated to illustrate key concepts and techniques. Participants are expected to engage in case discussion and role-plays in class to practice CBT-I techniques, and attendance both days is required.

Course Outline:

I. Military Aspects

  1. Contrast between likelihood of having patients with insomnia and likelihood of having specialty training. Discussion about why there might be an increase in military, why contrast exists.
  2. Prevalence of insomnia (MSMR data, 3-4 slides)

II. Overview of Normal Human Sleep

  1. Theories About Sleep
  2. Sleep Regulation
  3. Homeostasis and Circadian Rhythm
  4. Sleep Architecture/Terminology
  5. Sleep Disorders Overview

III. Assessment of Sleep Disturbance

  1. Case Conceptualization
    i. includes impact of medications on sleep
  2. Overview of
    i. Clinical Interview
    ii. General Measures
  3. Differential Diagnosis
    i. includes assessment measures
    ii. includes Insomnia Diagnostic Criteria
    iii. includes OSA & EBTs for OSA

IV. Insomnia

  1. Diagnosis
  2. Impact
  3. Etiology
    i. includes mechanisms (e.g. hyperarousal)
  4. Integrative Model

V. CBT for Insomnia

  1. Overview of CBTI Components
    i. Psychoeducation
    ii. Session by Session Protocol
  2. Intro Sleep Log
  3. Session 1: Assessment
  4. Session 2
    i. Stimulus Control
    ii. Sleep Restriction
  5. Session 3: Sleep Hygiene
  6. Session 4: Relaxation
  7. Sessions 5+
    i. Cognitive Components
    1. Types of Maladaptive Cognitions
    a. Use of DBAS
    2. Thought Records
    3. Worry Control
  8. Final Session: Relapse Prevention
  9. Group CBTI
  10. Summary

VI. Special Populations Relevant to Military

  1. Sleep & PTSD
  2. Sleep & TBI
  3. Sleep Management During Deployment** for 1 day/optional 2 day in DoD settings
    i. Optimizing Performance
    ii. Provider Considerations

Learning Objectives:

​      1.       Articulate the prevalence of insomnia experienced by military personnel.
     2.   
Teach patients the Two-Process (Homeostatic & Circadian) Model of Sleep.
     
3.      Evaluate the four stages of sleep.
     
4.      Perform sleep-focused differential assessment.
     
5.      Plan an appropriate course of CBT-I treatment based on individualized case conceptualization.
     
6.      Incorporate recommended subjective sleep measures into assessment.
     
7.      Discriminate between subtypes of insomnia and the symptoms associated with such sleep disturbance.
     
8.      Communicate basic sleep principles and sleep hygiene to patient using psychoeducation.
     
9.      Score a patient’s baseline sleep log including calculations of sleep efficiency.
     
10.  Apply principles of stimulus control to patients with insomnia.
    
11.  Calculate sleep data to prescribe bedtime and wake time schedule using sleep restriction.
     
12.  Recommend strategies for implementing individual and group CBT-I.
     
13.  Employ adaptations of standard cognitive approaches to patients with insomnia.
     
14.  Justify the role of CBTI in cases of insomnia with co-morbidities.