Cognitive Behavioral Therapy for Insomnia in the military (CBTi-M)

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.