Assessment

​In this video, the therapist demonstrates a portion of a sleep-focused assessment with John, identifying the patient’s sleep schedule and perpetuating factors that may be contributing to difficulty falling and staying asleep, using a “walk me through your 24-hour day” approach. Notice how the therapist learns more about the patient’s sleep while simultaneously building rapport.

Using The CBT-I Coach APP

In this video, the therapist introduces the CBTI Coach application for a personal smartphone as an alternative form of sleep log and assists the patient in setting up a cue for data entry. The video incorporates screenshots and step by step instructions to help familiarize providers with this app.​

Reviewing The Sleep Log

This video shows the therapist turning the completed sleep log data from the CBTI Coach application into a collaborative review for specific problem areas that may guide treatment. This review not only provides feedback for the patient but also acts as psychoeducation for the patient. ​

Psychoeduaction The 3P'S

This video demonstrates the introduction of the 3P Model of Insomnia etiology to the patient, using a handout. The therapist guides the patient to consider personal examples of each aspect of the model, to prime for subsequent intervention in the next video based on this model.​

Psychoeduaction: Conditioned Arousal

The therapist in this video targets a “perpetuating factor” from the 3P Model-specifically, conditioned arousal, or the idea that the patient’s bed has become conditioned with wakefulness and worry, which is counterproductive restful sleep. He uses the patient’s experiences to recommend an initial intervention to set the stage for stimulus control (“use the bedroom for sleep and sex only”) to counter conditioned arousal.​

Introducing Stimulus Control

In this video, the therapist introduces stimulus control, identifies a significant barrier to the patient engaging fully in this intervention, and attempts to problem-solve the barrier.

Motivational Enhancement

This video follows the previous video by demonstrating use of motivational interviewing skills to increase the patient’s readiness to implement stimulus control, including a decisional balance activity, motivational and confidence rulers, and helping the patient develop a change plan.​

Assessment

In this video, the therapist demonstrates a portion of a sleep-focused assessment with Kim, identifying the patient’s sleep schedule and perpetuating factors that may be contributing to difficulty falling and staying asleep, using a “walk me through your 24-hour day” approach. Notice how the therapist assesses for details in a conversational style.​

Assessing Circadian Tendency

This clip from the sleep-focused assessment follows the therapist differentiating an intrinsic circadian preference for an early sleep schedule from the patient getting in bed early to chase sleep and out of bed at an early time for work obligations.​

Reviewing The Sleep Log

This video demonstrates how to review a patient’s baseline sleep log by soliciting the patient’s observations and providing therapist feedback on potential problem areas, prior to scoring the sleep log in the next video.

Teaching Sleep Log Scoring

In this video, the therapist collaboratively teaches the patient how to score the sleep log and determines sleep efficiency, confirms a diagnosis of insomnia, and uses the log as a starting point for next steps.

Sleepiness VS Tiredness

The therapist provides psychoeducation on the difference between feeling tired, or physically drained, and sleepy, or imminently able to go to sleep.​

Motivational Enhancement

In this video, the therapist assists the patient in setting realistic goals for sleep weaving in psychoeducation and using motivational interviewing skills such as reflecting, reframing, and checking in with the patient.

Introducing Sleep Restriction

This video demonstrates how to introduce sleep restriction by recommending a new sleep schedule based on the patient’s baseline total sleep time with a coaching approach. The therapist acknowledges the counterintuitive nature of the intervention, explores with the patient the treatment rationale using the sleep log as evidence for effectiveness, and develops a plan to work around potential barriers to implementation, such as what to do with increased time out of bed and weekends. ​

Behavioral Strategies For Adherence

The patient returns after the first week of implementing sleep restriction and stimulus control, and works with the therapist to problem solve adherence challenges, specifically getting out of bed once awake in the morning.​

Role Play Strategy

This video demonstrates use of a role play strategy as a cognitive intervention for unhelpful negative sleep-related beliefs. The therapist role plays a distressed coworker with sleep problems to elicit coaching from the patient on her understanding of CBTI strategies, reinforces the patient’s progress in treatment, and recommends the patient use skills demonstrated in role play for her own sleep beliefs.​

Booster Session

The therapist and patient meet again several months post-treatment to check current sleep quality and quantity, reinforce the patient’s use of relapse prevention strategies such as maintaining a consistent sleep schedule and getting out of the bed when awake if sleep problems recur, and discuss if/when to return to treatment.​

Reviewing Treatment Gains​

The therapist and patient review treatment progress by comparing goals at baseline with current report. The therapist uses psychoeducation to help set realistic expectations for further progress post-treatment.​

LT Rebert Maerz​

This monologue depicts an active duty psychologist sharing his experiences with and recommendations for treating sleep disturbances and insomnia while deployed with a specific unit.

Introducing The Sleep Log

In this video, the therapist orients the patient to the sleep log, and then assists patient in filling in the previous night’s sleep information as an example. The therapist and patient work together to make a plan for how to complete the log.​

Sleep Hygiene

The therapist reviews sleep hygiene strategies with the patient via a handout, putting particular emphasis on those most relevant to the patient’s situation, in this case caffeine, and helping patient take steps toward implementing the relevant strategies.​

Motivational Enhancement

The therapist uses a motivational interviewing style to respond to the patient’s expressed ambivalence about engaging in sleep restriction and stimulus control, including reviewing the cons of not engaging in behavioral treatment.​

Downward Arrow Technique

In this video, the therapist explores with the patient the underlying meaning of a negative sleep-related belief using the downward arrow technique and learns that this meaning may extend beyond surface sleep concerns. The therapist discusses how this belief may be impacted by poor sleep and vice versa, and discusses with the patient how to respond to the belief during the night.​

Assessment

In this video, the therapist demonstrates a portion of a sleep-focused assessment with John; he assesses not just how long it takes to fall asleep and how much time is spent awake at night, but what the patient is thinking or doing at those times, weekend variations, substances that may affect sleep, and daytime functioning. Notice how the therapist keeps the patient on track despite occasional circumstantial responses.​

Reviewing The Sleep Log

The therapist reviews the baseline sleep log with the patient, focusing on areas that are problematic for the patient’s sleep. Notice how the therapist does not confront the patient on unhelpful behaviors or make recommendations, instead simply identifying areas as a transition to stimulus control and sleep restriction in the next video.​

Introducing Stimulus Control & Sleep Restriction

In this video, the therapist introduces the concepts of stimulus control and sleep restriction with a conversational approach. The therapist acknowledges some of the challenges of these interventions, allowing the patient to voice concerns and addressing them in a non-confrontational style, and identifies activities to engage in when awake out of bed.

Motivational Enhancement

This video immediately follows the earlier video, in which patient expresses resistance to implement a consistent schedule across the week, particularly over the weekend. The therapist responds with motivational interviewing strategies, such as using a readiness ruler, encouraging the patient to voice his own change plans, and emphasizing personal control.​

Worry Time

The therapist reviews the patient’s efforts to engage in the recommended sleep schedule and identifies a challenge, the patient’s mental activation at bedtime related to current stressors. The therapist introduces worry time as a cognitive technique to address this mental activation.​

"Pizza Dough" Example

In this video, the therapist interactively uses the sleep-as-pizza-dough example to explain the idea of expanding time in bed in sleep restriction after initially consolidating sleep.​

Relapse Prevention

This video takes place during the patient’s last session, as the patient and therapist review CBTI psychoeducation and engage in relapse prevention, which involves coaching the patient to plan ahead for situations that might lead sleep problems to return and how to manage those situations.​

PFC ELI Cepeda

This monologue depicts an active duty Servicemember experiencing sleep problems while deployed. He shares the impact of his sleep problems, his efforts to manage problems with caffeine, and his reaction to sleep hygiene recommendations.​