Beyond Sleep Hygiene: CBT Solutions to Improve Outcomes and Resolve Insomnia in Clients with Anxiety, PTSD, Depression, and More

CPD

Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Handouts

Speaker

Colleen Carney, PhD Related seminars and products

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Colleen E. Carney, PhD, is on faculty in the department of psychology at Toronto Metropolitan University, where they are the director of the sleep and depression laboratory. They are a leading expert in psychological treatments for insomnia, particularly in the context of co-occurring mental health issues. Their work has been featured in The New York Times and they have over 100 publications on insomnia.

Dr. Carney frequently trains students and mental health providers in CBT for Insomnia at invited workshops throughout North America and at international conferneces. Dr. Carney is a passionate advocate for improving the availability of treatment for those with insomnia and other health problems. For more information, please visit www.drcolleen carney.com

Speaker Disclosures:
Financial: Dr. Colleen Carney has employment relationships with Toronto Metropolitan University and Duke University. They receive a grant from Canadian Institutes of Health Research and Sleep Research Consortium. Dr. Carney receives royalties as a published author. They receive a speaking honorarium and recording royalties from PESI, Inc. Dr. Carney has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Colleen Carney is a member of the Canadian Association of Cognitive and Behavioural Therapies, the Canadian Psychological Association, the Association for Behavioural and Cognitive Therapies (ABCT), the Canadian Sleep and Circadian Network, the Canadian Sleep Society, the Sleep Research Society, and the Canadian Association for Cognitive Behaviour Therapy.

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Objectives

1. Distinguish acute insomnia from chronic insomnia and identify treatment implications.
2. Conduct a thorough sleep assessment.
3. Analyze data from sleep diaries to inform treatment.
4. Employ stimulus control to strengthen the association between bed and sleep.
5. Conduct sleep restriction therapy to improve clients’ sleep drive.
6. Utilize cognitive strategies to reduce alarming sleep-related thoughts.

Outline

Sleep Disturbance Doesn’t Resolve on Its Own
Why Treating a Primary Mental Health Disorder Won’t Cure Insomnia

• Insomnia as a risk factor for behavioural health and medical disorders
• Treatment issues when insomnia is comorbid with depression, anxiety, and PTSD
• Sleep quality concerns with co-occurring chronic pain and illness
• What weakens sleep drive and disturbs circadian rhythms?
• Common thoughts and behaviours that contribute to sleep-interfering arousal
• How to teach clients about the 3 P’s - predisposing, precipitating, and perpetuating factors

Insomnia-Informed Assessment
How and What to Ask Your Clients

• Top questions for the initial interview
• Assessments for co-occurring sleep disorders
• Talking with clients about the impact of medications and drugs on sleep
• Evaluate sleep continuity, relevant sleep habits, and daytime symptoms of insomnia
• Sleep diary and other take-home assessment resources
• How to get clear, useable information about your clients’ sleep patterns

Treatment Planning with Cognitive Behavioural Therapy for Insomnia (CBT-I)
Behavioural Strategies to Improve Sleep and Outcomes for Mental Health Disorders

• Clinical practice guidelines and the state of research on insomnia treatment
• Who is a good candidate for CBT-I?
• Effective sleep hygiene for clients who haven’t addressed the basics
• Clock watching and its implications
• Strengthen the sleep drive and circadian clock with sleep restriction therapy (SRT)
• Psychoeducation on rationale and addressing clients’ fears to increase engagement
• How to set the sleep window and when to extend time-in-bed
• Rules for before-bed activities and strategies for waking up on time
• Address conditioned arousal with Stimulus Control (SC)
  • Overcoming obstacles to strengthening the association between bed and sleep
  • Counter-arousal strategies
  • Activities your clients can use during periods of nighttime wakefulness

Cognitive Strategies to Help Clients Change Sleep-Interfering Thoughts & Beliefs

• Create a buffer zone and worry schedule for your clients
• Tools to identify thoughts and beliefs that perpetuate sleep problems
• Combat intrusive thoughts during sleep time
• Help clients reduce sleep effort and worry about lack of sleep
• Strategies to restructure expectations and thoughts
• Behavioral experiments to evaluate sleep-related thinking

Clinical Considerations
Additional Factors for the Insomnia-Informed Clinician

• Best practices to address clients’ concerns about interventions
• Troubleshooting insufficient progress in CBT-I
• When to refer to a sleep specialist
• Limitations of the research and potential risks

Target Audience

• Counsellors
• Social Workers
• Psychologists
• Marriage & Family Therapists
• Physicians
• Addiction Counsellors
• Case Managers
• Psychiatric Nurses
• Nurses
• Occupational Therapists
• Other Mental Health Professionals