Manuals

This Actigraphy (Actiware) Scoring Hierarchy Manual was developed for use by our laboratory to make decisions and provide reliability between our scorers of our Actigraph Spectrums using Actiware software for our own research (1R12AI085558-01A2; PIs: Taylor & Kelly). We later added additional scoring instructions for naps for a second NIH grant (R01AI128359-01; PIs: Taylor & Kelly). These instructions have been utilized and slightly modified for two other DoD/VA grants (W81XWH-13-2-0065; 1I01CU000144-01; W81XWH-10-1-0828; PI: Taylor).

Although this was developed for use by our research team, others have asked to use them for their own purposes and have requested citations. So, we decided to make them publicly available for anyone interested. However, it is still a living document and has so far only focused on sleep. 

Please cite as: 
Rijsketic, J.M., Dietch, J.R., Wardle-Pinkston, S. & Taylor, D.J. (2020). Actigraphy (Actiware) Scoring Hierarchy Manual. Retrieved from insomnia.arizona.edu/actigraphy.

This Cognitive Behavioral Therapy for Insomnia in the Military (CBTi-M) manual was developed using the best available scientific evidence, clinical experience, and feedback from both civilian and military therapists and patients. CBT-I in general is efficacious and effective (for a review, see Mitchell, Gehrman, Perlis & Umscheid, 2012), and the treatment described in this manual has demonstrated effectiveness (Taylor et al., 2017; Taylor, Peterson et al., 2018). Support for this manual was provided by the Department of Defense grants W81XWH-10-1-0828 & W81XWH-17-1-0165 (PI: Taylor).

Although this manual was developed for use by providers for active duty military, the principles and strategies presented here were drawn from previous studies in civilian samples and are also appropriate to use with veterans and the general population. This manual was meant to be used by individuals trained and licensed to provide psychotherapy and trained in emergency management procedures should they encounter a psychiatric emergency. Consistent with American Psychological Association ethical guidelines, providers should not practice outside their scope of expertise and training.

The treatment described in this manual is designed to be administered over six 1-hour weekly sessions. The material is presented in a session-by-session format, with the following manuals provided separately:

1. Therapist materials: This manual is designed to optimize treatment delivery, and describes the session structure, flow, and activities, and provides sample text that can be used by the therapist. Additional material (e.g., printable figures, optional patient handouts) are offered in the appendices.

2. Patient materials: This manual is designed to 1) optimize patient receipt and enactment of the topics covered in the session and 2) provide the patient with detailed descriptions of the rationale and instructions, with Home Practice assignments.

3. Fidelity rating scales: This manual is designed to optimize treatment fidelity by providing forms and instructions for conducting treatment fidelity ratings of video recorded sessions.

Assessment
The therapist assessment of the patient’s mental and medical health, sleep and wake history and current functioning, and specifically insomnia complaints should be conducted prior to the initial session. Sleep disorders can be assessed using the Structured Clinical Interview for Sleep Disorders-Revised (SCISD-R), which is available for free at https://insomnia.arizona.edu/scisd. This is important to ensure that the patient is appropriate for Insomnia Treatment. 

Citation
When using the manual for research, please provide the following citations.

Taylor, D.J., Peterson, A.L., Goodie, J.L., Grieser, E., Hryshko-Mullen, A.S., Rowan, A., Wilkerson, A., Pruiksma, K.E., Dietch, J.R., Hall-Clark, B., & Fina, B. (2019). Cognitive-Behavioral Therapy for Insomnia in the military: Therapist guide. Retrieved from http://insomnia.arizona.edu/CBTI-M

Taylor, D.J., Peterson, A.L., Goodie, J.L., Grieser, E., Hryshko-Mullen, A.S., Rowan, A., Wilkerson, A., Pruiksma, K.E., Dietch, J.R., Hall-Clark, B., & Fina, B. (2019). Cognitive-Behavioral Therapy for Insomnia in the military: Patient guide. Retrieved from http://insomnia.arizona.edu/CBTI-M

Taylor, D.J., Wilkerson, A., Hryshko-Mullen, A.S., & Goodie, J.L. (2019). Cognitive-Behavioral Therapy for Insomnia in the military: Rating scales. Retrieved from http://insomnia.arizona.edu/CBTI-M

Consultation for Providers Learning Cognitive Behavioral Therapy for Insomnia or for Nightmares

Overview

Providers who attend a formal training for CBT for insomnia or for nightmares may find themselves wanting support as they learn to implement these interventions with clients who are also likely experiencing a range of co-occurring behavioral health concerns. In an effort to support providers and to disseminate these interventions, Dr. Pruiksma is offering group consultation for licensed clinical providers and supervised trainees who have attended a formal training in CBT for insomnia or for nightmares (specifically Exposure, Relaxation, and Rescripting Therapy [ERRT]), either in-person or through the web-based provider training at www.cbtiweb.org.

What is Cognitive Behavioral Therapy for Insomnia (CBT-I)?

Cognitive behavioral therapy for insomnia (CBT-I) is well established as the first-line treatment for the management of chronic insomnia as indicated by practice guidelines published by several organizations (i.e., the National Institutes of Health, the American College of Physicians, the American Academy of Sleep Medicine, and the U.S. Department of Veterans Affairs and Department of Defense [VA/DoD]). CBT-I is a multi-component treatment that is designed to help individuals develop healthy sleep habits to alleviate insomnia and learn to manage sleep over the long term.

What is Cognitive Behavioral Therapy for Nightmares: Exposure, Relaxation, and Rescripting Therapy (ERRT)?

Although research examining behavioral treatments for nightmares is more limited than for CBT-I, the American Academy of Sleep Medicine position paper for the treatment of nightmare disorder in adults states that a cognitive behavioral therapy called Exposure, Relaxation, and Rescripting Therapy (ERRT) “may be used for the treatment of PTSD-associated nightmares” (p. 1041; and a similar approach called Imagery Rehearsal Therapy [IRT] is recommended). ERRT is a trauma-focused, multi-component treatment that incorporates components of CBT-I and treatment for PTSD and to reduce the frequency and severity of nightmares.

Consultation Format

Consultation will be conducted via video teleconference in a group format with 4-10 consultees who are learning to implement CBT-I, ERRT, or a combination of the two approaches.

Qualifications of the Consultant

Kristi Pruiksma, PhD is an Associate Professor and licensed clinical psychologist in the Department of Psychiatry and Behavioral Sciences at The University of Texas Health Science Center at San Antonio. Her clinical and research work focuses on providing treatment, conducting clinical research, and supporting dissemination of evidence-based treatments for sleep disorders and posttraumatic stress disorder (PTSD). In her role, she has served as a principal investigator, research therapist, supervisor, and trainer for the STRONG STAR Research Consortium and the Consortium to Alleviate PTSD (strongstar.org) which are multidisciplinary and multi-institutional research consortia funded by the U.S. Departments of Defense (DoD) and Veterans Affairs (VA) to develop and evaluate the most effective early interventions possible for the detection, prevention, diagnosis, and treatment of combat-related posttraumatic stress disorder (PTSD) and related conditions in active-duty military personnel and recently discharged veterans. Projects have included randomized clinical trials examining CBT-I, ERRT, a combination of CBT-I and ERRT, and sequencing sleep treatments with PTSD treatments among active duty military personnel.

Dr. Pruiksma has received intensive training in three distinct areas of expertise including (a) Group and individual Cognitive Processing Therapy (CPT) for combat-related PTSD with intensive supervision by the developer of the therapy, Patricia Resick, PhD, ABPP, (b) Cognitive Behavior Therapy for Nightmares (i.e., Exposure, Relaxation, and Rescripting Therapy) with intensive supervision by Joanne Davis, PhD, one of the developers of this intervention, and (c) Cognitive Behavioral Therapy for Insomnia (CBT-I) under the supervision Daniel Taylor, PhD, CBSM, ABSM, and previous supervision and training by Richard Bootzin, PhD, and Patricia Haynes, PhD, three of the world’s experts in CBT-I. Dr. Pruiksma has authored or co-authored over 30 peer-reviewed publications and book chapters related in these fields and is a featured therapist on the web-based provider training for CBT-I, cbtiweb.org. Dr. Pruiksma also has several years of experience providing consultation to providers.

Fee

At the current time, the fee for consultation is $400 for weekly consultation for 4 months ($25 per consultation session).

Sign me up!

Interested providers contact Dr. Pruiksma at pruiksma@uthscsa.edu.

This Cognitive Behavioral Therapy for Insomnia and Nightmares in the Military (CBTi-I&N) manual was developed using the best available scientific evidence, clinical experience, and feedback from both civilian and military therapists and patients. We developed CBT-I&N for use in a grant (W81XWH-13-2-0065; 1I01CU000144-01: PI Taylor) to examine the efficacy of adding this treatment before or after Cognitive Processing Therapy (CPT) for PTSD, versus just more CPT (methods paper; Taylor et al., 2020). The primary outcomes of this study are pending publication, but the outcomes were overwhelmingly positive for the effect of CBT-I&N on insomnia, nightmares and PTSD symptoms. 

Although this manual was developed for use by providers for active duty military, the principles and strategies presented here were drawn from previous studies in civilian samples and are also appropriate to use with veterans and the general population. This manual was meant to be used by individuals trained and licensed to provide psychotherapy and trained in emergency management procedures should they encounter a psychiatric emergency. Consistent with American Psychological Association ethical guidelines, providers should not practice outside their scope of expertise and training.

The treatment described in this manual is designed to be administered over six 1-hour weekly sessions. The material is presented in a session-by-session format, with the following manuals provided separately:

For a copy of the manual, we expect individuals to complete the www.CBTiweb.org training as well as additional CBT for nightmares training (Soon to be available on www.CBTiweb.org and then www.CBTNweb.org). 

If you feel you already have sufficient training in CBTi and CBTN, please contact Dr. Kristi Pruiksma at pruiksma@uthscsa.edu.

Contemporary Clinical Trials Reference:

Taylor, D. J., Pruiksma, K. E.,* Mintz, J., Slavish, D.C.,* Wardle-Pinkston, S.,* Tyler, H., Dondanville, K. A., Young-McCaughan, S., Scullin, M.K., Nicholson, K.L., Litz, B.T., Dietch, J.R.,* Williamson, D.E., Keane, T.M., Peterson, A.L., & Resick, P.A., for the Consortium to Alleviate PTSD. (2020). Treatment of comorbid sleep disorders and posttraumatic stress disorder in active duty military: Design and methodology of a randomized clinical trial. Contemporary Clinical Trials, 99, Article 106186. https://doi.org/10.1016/j.cct.2020.106186

Please use the following when referencing the manuals:

Pruiksma, K. E., Taylor, D. J., Davis, J., Dietch, J. R., Peterson, A. L., Balliett, N., Goodie, J. L., Miller, K., Grieser, E., Friedlander, J., Hryshko-Mullen, A. S., Rowan, A., Wilkerson, A., Hall-Clark, B., Fina, B., Hummel, V., Casady, T., Tyler, H. (2021). Cognitive-Behavioral Therapy for Insomnia and Nightmares in the military: Therapist guide. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX.  

Pruiksma, K. E., Taylor, D. J., Davis, J., Dietch, J. R., Peterson, A. L., Balliett, N., Goodie, J. L., Miller, K., Grieser, E., Friedlander, J., Hryshko-Mullen, A. S., Rowan, A., Wilkerson, A., Hall-Clark, B., Fina, B., Hummel, V., Casady, T., Tyler, H. (2021). Cognitive-Behavioral Therapy for Insomnia and Nightmares in the military: Patient guide. Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX.