Mixed Deck — All CBT-I Topics Flashcards

When a CBT-I client discloses that their insomnia is partly due to caring for a terminally ill spouse, the practitioner should:

Answer: Acknowledge the grief context and consider referral for bereavement support alongside CBT-I

Competent ethical practice involves recognizing comorbid psychosocial stressors and facilitating appropriate adjunct referrals while continuing evidence-based sleep treatment.

Which component of CBT-I is most challenging to implement in a group format?

Answer: Individually tailored sleep restriction with different prescribed windows for each patient

Sleep restriction requires individually calculated sleep windows based on each patient's sleep diary data, making it more complex to manage simultaneously across 6-10 patients.

Regular aerobic exercise has been shown to improve insomnia by:

Answer: Reducing anxiety, improving mood, and enhancing slow-wave sleep

Exercise reduces anxiety, improves mood, and increases slow-wave sleep, all of which benefit insomnia patients.

EMG biofeedback in insomnia patients typically targets which muscle group(s)?

Answer: Frontalis or trapezius muscles

The frontalis (forehead) and trapezius (neck/shoulder) muscles are commonly monitored as proxies for overall body tension.

The Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale measures:

Answer: Maladaptive sleep-related cognitions such as unrealistic sleep expectations and catastrophizing

The DBAS assesses the specific cognitive distortions about sleep that CBT-I cognitive restructuring aims to modify.

Which action best reflects the ethical principle of fidelity in CBT-I practice?

Answer: Honoring commitments made to clients about treatment structure and follow-up

Fidelity refers to trustworthiness and keeping promises, such as adhering to agreed-upon session schedules and treatment plans.

Long-term follow-up studies of CBT-I typically assess durability of outcomes at:

Answer: 6-12 months post-treatment

Most CBT-I trials assess durability at 6 and 12 months post-treatment, with some studies extending to 2 years.

A client objects to completing sleep diaries, citing privacy concerns. The practitioner's ethical response is to:

Answer: Explore the concerns, offer alternative methods, and document the discussion and outcome

Respecting client autonomy requires the practitioner to address concerns collaboratively, explore alternative monitoring strategies, and document the informed decision.

Which dietary factor, besides caffeine and alcohol, is most associated with sleep disruption?

Answer: Large or spicy meals close to bedtime

Heavy, spicy, or large meals close to bedtime can cause discomfort, heartburn, and metabolic activation that disrupts sleep.

What is stimulus control therapy in CBT-I?

Answer: Restricting the bed to sleep and intimacy only

Stimulus control therapy aims to re-associate the bed and bedroom with sleep and intimacy, breaking the learned association between the bed and wakefulness or frustration. By removing activities like eating, working, or watching TV from the bed, it helps to strengthen the cue for sleep when a person enters the bedroom.

Which relaxation technique involves focusing attention sequentially on different body regions?

Answer: Body scan meditation

Body scan meditation guides attention through each body part to cultivate non-judgmental awareness and relaxation.

What role does education play in CBT-I?

Answer: Increases understanding and compliance

Education is a foundational component of CBT-I, providing patients with crucial information about sleep science, the causes of insomnia, and the rationale behind various therapeutic techniques. A deeper understanding empowers patients to actively participate in their treatment, adhere to recommendations, and make informed lifestyle changes, ultimately improving treatment outcomes.

The typical response rate for CBT-I in randomized controlled trials is approximately:

Answer: 70-80%

Meta-analyses consistently show 70-80% of patients achieve clinically meaningful improvements with CBT-I.

Insomnia co-occurring with fibromyalgia is best treated with CBT-I that:

Answer: Integrates pain management strategies alongside standard CBT-I components

An integrated approach addressing both pain and sleep concurrently improves outcomes more than treating either condition alone.

The optimal bedroom temperature for sleep is approximately:

Answer: 60-67°F (15-19°C)

Core body temperature must drop to initiate sleep, and a cooler bedroom (60-67°F) facilitates this process.

Mindfulness-Based Therapy for Insomnia (MBT-I) combines which two approaches?

Answer: MBSR practices and standard CBT-I behavioral components

MBT-I integrates Mindfulness-Based Stress Reduction (MBSR) practices with standard CBT-I behavioral components.

Insomnia co-occurring with shift work differs from typical insomnia because it involves:

Answer: Circadian misalignment as a key etiological factor alongside conditioned arousal

Shift work insomnia requires addressing both the behavioral and circadian components, sometimes including light therapy and strategic napping.

What should therapists do if a conflict of interest arises?

Answer: Disclose and manage the conflict

Therapists have an ethical and professional obligation to prioritize client welfare. When a conflict of interest arises, disclosing it transparently to the client and actively managing it ensures that the therapist's judgment remains unbiased and the client's best interests are protected. This maintains trust and upholds professional standards.

A practitioner is approached to provide CBT-I via a telehealth platform that operates across multiple states. The primary ethical/legal consideration is:

Answer: Whether the practitioner holds licensure or an exemption in each state where clients are located

Interstate telehealth practice requires compliance with the licensing laws of the state where the client is located, not just where the practitioner is based.

When obtaining informed consent for CBT-I, which element is most critical to include?

Answer: The temporary worsening of sleepiness that may occur during sleep restriction

Clients must be warned about the initial increase in daytime sleepiness from sleep restriction so they can make an informed decision and take necessary safety precautions.