Whereas CBT-I (Cognitive Behavioral Therapy for Insomnia) is a relatively straightforward treatment to deliver, providing this treatment with complex cases, particularly those with comorbid health conditions can be a challenge. Introductory workshops are helpful in learning how to integrate CBT into non-sleep specialty settings, but once a treatment provider begins practicing in CBT, they can see some difficult cases where a fixed, manualized approach is insufficient. Although CBT-I is efficacious in those with comorbid conditions, there are some situations in which some flexibility and adaptation is necessary.
This challenge can be addressed by learning a case formulation approach that is relevant across disciplines and clinical settings and provides the flexibility and efficiency of delivery without compromising on empirical support. Learning a case formulation approach results in a sharpened understanding of sleep regulation and allows practitioners to select aspects of the intervention most likely to produce a response. Selecting only necessary aspects of treatment limits the amount of time needed for the protocol and allows the therapist to select strategies that complement already existing treatment. For example, challenging beliefs that vigilance is necessary in trauma-focused therapy is complemented by strategies that address bed avoidance in PTSD. Or, increasing activity in chronic pain treatment protocols is complemented by CBT-I advice about stimulus control, how to rest in a way that is not sleep interfering. A case formulation approach provides relevant strategies to handle the types of complex cases therapists are most likely to encounter in clinical practice.
Dr. Carney encourages attendees to bring their toughest cases to discuss, and all attendees will receive a case formulation form that can be used to guide assessment and treatment decisions in future cases.
At the end of this conference, participants will be able to:
List the three causes of chronic insomnia
Match the main components of CBT-I to the three causes of insomnia
Devise a new sleeping schedule with clients collaboratively
Deliver the treatment rationale interactively with clients
Apply the treatment techniques to those with comorbidities
Complete a Case Formulation Form to guide treatment
Colleen E. Carney, PhD, is an Associate Professor in the Psychology Department at Ryerson University and the Director of the Sleep and Depression Laboratory. She is one of leading experts in the treatment of insomnia, particularly in the context of co-occurring illness. She has over 100 publications on the topic of insomnia, including the only Cognitive Behavior Therapy workbook written expressly for comorbid insomnias as well as the only CBT-I case formulation book. Dr. Carney is a passionate advocate for improving access to effective treatment.