Full Course Description
Certificate Course in Cognitive Behavioral Therapy for Insomnia (CBT-I): Evidence-based Insomnia Interventions for Trauma, Anxiety, Depression, Chronic Pain, & more
Program Information
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
Objectives
OBJECTIVES
- Apply assessment tools that screen for other sleep disorders and identify insomnia treatment targets as it relates to case conceptualization.
- Teach clients about the science of sleep and the causes of chronic insomnia for purposes of client psychoeducation.
- Ascertain key perpetuating factors for chronic insomnia to understand the etiology of chronic insomnia.
- Collaboratively design a sleep schedule with clients using a sleep diary to improve client’s sleep efficiency and daytime functioning.
- Combine stimulus control and sleep restriction therapy to address the three major causes of chronic insomnia.
- Utilize counter-arousal strategies to target hyper arousal in clients.
- Modify a client’s distorted beliefs about sleep using cognitive therapy techniques to improve adherence and decrease sleep related anxiety.
- Analyze three models of CBT-I delivery and implementation issues for different practice settings.
- Apply CBT-I treatment components to target perpetuating factors in clients with comorbid insomnia.
- Use cognitive and behavioral strategies to improve adherence with depressed clients.
- Modify treatment recommendations for clients who have symptoms of high sleep anxiety.
- Anticipate and resolve common treatment challenges in clients with PTSD such as sleep avoidance, fear of loss of vigilance and nightmare awakenings.
- Apply CBT-I techniques to clients with mild traumatic brain injury.
- Develop strategies to re-associate bed with sleep in clients with chronic pain.
- Combine CBT-I with a guided hypnotic taper to reduce rebound insomnia and psychological dependence in clients who wish to decrease or discontinue their use of sleep medication.
- Implement clinical treatment strategies to improve CPAP adherence in clients with co occurring obstructive sleep apnea.
- Combine behavioral interventions with evidence-based strategies, such as light therapy and strategically-timed melatonin, to “reset the clock” in clients with circadian rhythm sleep disorders.
- Use imagery rehearsal therapy to improve frequency and intensity of recurrent nightmares in clients with or without PTSD.
- Practice using advanced case formulation techniques to accurately select combination and order of CBT-I components.
Target Audience
Counselors, Social Workers, Nurses, Psychotherapists, Psychiatrists, Marriage and Family Therapists, Addiction Counselors, Case Managers, Other Mental Health Professionals
Copyright :
03/14/2018