Insomnia is widely recognized to be the most common sleep problem and is also a leading complaint in primary care settings. The consequences and morbidity associated with chronic insomnia can be substantial across several domains and can include increased health care utilization, impaired quality of life, increased risk of falls and hip fractures, increased risk of medical and psychiatric disorders, and ultimately worse outcomes for all co-morbid disorders.
Effective treatment of insomnia not only improves sleep quality and daytime functioning, but CBT-I has also now been shown to have direct beneficial impact on depression, anxiety, PTSD, chronic pain, and other behavioral and medical disorders. In addition, cognitive-behavioral treatments for insomnia have been shown to be of equal or greater effectiveness when compared to sedative hypnotic medication. These findings suggest that CBT-I should be considered a trans-diagnostic therapy that should be in every clinician’s tool box.
This workshop is designed to provide clinical and research faculty from multiple disciplines the core elements of cognitive-behavioral treatment for insomnia. The course starts by grounding participants in the basics of sleep medicine that undergird the practice of CBT-I. It goes on to present systematic, empirically validated treatment methods and essential information about the pathophysiology and etiology of insomnia necessary to inform assessment, diagnosis, treatment, and the handling of treatment resistance. The material is largely didactic but attempts also to give participants a “hands on” approach to the clinical delivery that allows CBT-I to become more than just a set of guidelines on a page.
ABOUT THE PRESENTERS:
Michael L. Perlis, Ph.D.
Associate Professor, Department of Psychiatry, University of Pennsylvania
Director, Behavioral Sleep Medicine Program, University of Pennsylvania
Associate Professor, School of Nursing, University of Pennsylvania
Dr. Perlis is internationally known for his work in the area of Behavioral Sleep Medicine (BSM). He is a coauthor of the first text book in this field and he is the senior author of a published CBT-I treatment manual and a larger text summarizing all BSM treatments. In addition, he conducts two annual CBT-I training workshops per year (the basic workshop has been ongoing for the last 10 years and the advanced workshop was first offered in 2014), has available a video mock case vignette DVD, and offers mini-fellowship BSM practica and supervision through his group at Penn. Note: The Basic CBT-I workshop has also been provided, on request, in England, Sweden, South Africa, Israel, Korea, Japan, Thailand, and Qatar, and the CBT-I manual has been translated into Spanish, Italian, Korean, Chinese, Thai, and Arabic. Dr. Perlis’ educational activities also include his service as a mentor to 95 trainees including 24 junior or peer faculty, 18 interns or post-doctoral fellows, 6 medical students, 12 graduate or post-masters students, and 35 undergraduates or post-baccalaureates. Most notable among his prior mentees (i.e., those who have gone on to independent research careers) include Sean Drummond PhD, Kenneth Wright PhD, Michael Smith PhD, Carla Jungquist PhD, Wilfred Pigeon PhD, Sheila Garland PhD, and Michael Grander, PhD.
He has published, as an author or co-author, more than 150 articles and chapters on sleep research related topics and he serves on the editorial boards of Sleep, the Journal of Sleep Research, the journal of Sleep Medicine Research, the journal of Behavioral Sleep Medicine, and the journal of Health Psychology. Dr. Perlis has also served as a member, or chair, of several committees and task forces of the Sleep Research Society and the American Academy of Sleep Medicine and he was the assistant chair for the training program of the SRS for five years. Finally, Dr. Perlis was one of the five organizing and founding members of the Society of Behavioral Sleep Medicine (SBSM). He also served as the SBSM’s first president (2010-2011).
In general, Dr. Perlis’s research pertains to insomnia and Behavioral Sleep Medicine. His specific research interests include: Behavior, cognitive, and physiologic factors in Acute and Chronic insomnia, Cortical arousal and conditioned CNS activation as a primary perpetuator of insomnia; Sensory and information processing and long term memory formation as key features of Insomnia Disorder as a hybrid state between wake and sleep; Sleep homeostasis effects on the frequency and severity of insomnia (and the patterning of insomnia over time); Insomnia as morbid risk factor for new onset and recurrent depression; The anti-depressant effects of CBT-I; The potential of conditioning and partial reinforcement with placebos (Behavioral; Pharmacotherapeutics) as a means to change how medical maintenance therapy is conducted; The relative efficacy of behavioral and pharmacologic treatments of insomnia.
Dr. Perlis’s work has been, and continues to be (Gods willing), funded by the National Institutes of Health. His grant portfolio (past and present) as a Principal investigator is comprised of 5 R01s, 3 R21s, 1 R56, 1K23, and 1 R03. In addition he has held 3 Pharma PI initiated grants, several foundation awards, and participated as a site investigator on 5 industry initiated pharma studies.
Donn Posner Ph.D., DBSM, CBSM
Dr. Donn Posner is the Founder and President of Sleep Well Consultants and has been consulting to organizations and individuals on a wide variety of sleep health issues including insomnia, circadian dysrhythmia, CPAP adherence, and parasomnias. He is also currently a consulting psychologist, for the Palo Alto VA, working on a number of grants exploring the effects of CBT-I in Gulf War Veterans and Veterans with insomnia and Mild Traumatic Brain Injury. In the previous 5 years, Dr. Posner served as an Adjunct Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and a clinical/research psychologist at the Palo Alto VA.
Prior to his role at the VA he spent 25 years serving as the Director of Behavioral Sleep Medicine for the Sleep Disorders Center of Lifespan Hospitals, and was a Clinical Associate Professor in the Department of Psychiatry and Human Behavior at the Warren Alpert School of Medicine at Brown University. For 20 of those years Dr. Posner had served as the primary supervisor for a rotation of the Behavioral Medicine track of the clinical psychology internship at Brown. The rotation focused on the assessment and treatment of Sleep and Anxiety Disorders, and was one of the few rotations of its kind in the US.
Dr. Posner is one of the authors of Cognitive Behavioral Treatment of Insomnia: ASession-by-Session Guide(New York: Springer/Verlag). The book is intended for clinical trainees, and non-insomnia sleep specialists, as well as more experienced clinicians from outside the sleep medicine field, who wish to learn how to provide empirically validated cognitive behavioral treatment for insomnia (CBT-I).
At the completion of this workshop, you will be able to:
1. Articulate the basics of sleep nomenclature including sleep period, phase, continuity, and architecture.
2. Discriminate acute insomnia from Insomnia Disorder and articulate the importance of treating the chronic form as a specifically targeted co-morbidity.
3. Evaluate the common medications used in the treatment of insomnia and understand their relative strengths and weaknesses.
4. Communicate the relative efficacy of pharmacotherapy and cognitive behavioral therapies for insomnia.
5. Communicate the evidence for the efficacy of CBT-I for both primary and co-morbid insomnia disorder.
6. Apply the principles of the Spielman model of insomnia and employ it in the delivery of CBT-I.
7. Apply the principles of Borbely’s two-process model of sleep regulation and demonstrate how to utilize this concept in the deployment of CBT-I.
8. Score and analyze patient sleep diary data, and create a treatment plan based upon the data in the course of CBT-I treatment.
9. Apply the techniques of Sleep Restriction therapy to the treatment of chronic Insomnia.
10. Apply the techniques of Stimulus Control to the treatment of chronic Insomnia.
11. Educate patients in sleep hygiene principles and tailor to individual needs.
12. Apply the techniques of cognitive therapeutic strategies to the treatment of chronic insomnia.
13. Calculate sleep efficiency and titrate patient sleep windows.
14. Anticipate, identify and problem solve common resistances in CBT-I.
15. Implement an action plan to establish optimal total sleep times.
16. Implement an action plan to prevent patient relapse.