CBT-I Ethical Standards & Professional Practice 3 — Questions and Answers
Question 1: A CBT-I client who is a nurse asks the practitioner detailed questions about hypnotic medication dosing for her patients. The practitioner should:
- Answer fully because the client is a licensed professional
- Clarify that medication guidance is outside the CBT-I scope and suggest appropriate clinical resources (Correct answer)
- Refuse to engage and document the request as a red flag
- Provide general information from publicly available pharmacology references
Correct answer: Clarify that medication guidance is outside the CBT-I scope and suggest appropriate clinical resources
Scope of practice boundaries require practitioners to redirect questions that fall outside their competency, even when the client has professional credentials.
Question 2: When obtaining informed consent for CBT-I, which element is most critical to include?
- A guarantee that sleep will improve within four weeks
- The temporary worsening of sleepiness that may occur during sleep restriction (Correct answer)
- The practitioner's personal sleep history to build rapport
- A list of all competing therapies the practitioner does not endorse
Correct 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.
Question 3: A practitioner trained in CBT-I is asked to supervise a trainee who will deliver the intervention. Ethical supervisory practice requires:
- Allowing the trainee full autonomy to develop their own style without interference
- Ensuring the trainee is competent and that client welfare is monitored throughout supervision (Correct answer)
- Limiting supervision to administrative and billing matters only
- Delegating all supervisory responsibility to the trainee's academic institution
Correct answer: Ensuring the trainee is competent and that client welfare is monitored throughout supervision
Supervisors bear ethical and often legal responsibility for supervisee conduct and must actively monitor client welfare, not merely observe administrative compliance.
Question 4: A CBT-I practitioner who experiences personal burnout and chronic fatigue notices it is affecting session quality. The ethical course of action is to:
- Power through and maintain all client commitments to avoid disruption
- Seek consultation or personal therapy and consider reducing caseload to protect client welfare (Correct answer)
- Inform clients that session quality may vary due to personal circumstances
- Refer all current clients to colleagues immediately and take an indefinite leave
Correct answer: Seek consultation or personal therapy and consider reducing caseload to protect client welfare
Ethical codes require practitioners to monitor their own health and take corrective action when impairment may compromise client care.
Question 5: Which statement best describes the ethical use of outcome measures in CBT-I?
- Outcome measures are optional if the practitioner's clinical impression is positive
- Standardized measures like the ISI should be used to track progress and inform treatment decisions (Correct answer)
- Outcome data should be shared with third-party payers without client consent to justify treatment
- Measures should only be administered at intake to avoid burdening the client
Correct answer: Standardized measures like the ISI should be used to track progress and inform treatment decisions
Regular use of validated instruments such as the Insomnia Severity Index supports evidence-based, client-centered care and transparent documentation.
Question 6: A client objects to completing sleep diaries, citing privacy concerns. The practitioner's ethical response is to:
- Discharge the client for non-compliance with the treatment protocol
- Explore the concerns, offer alternative methods, and document the discussion and outcome (Correct answer)
- Override the objection because sleep diaries are clinically essential
- Agree to proceed without any self-monitoring and adjust outcome expectations accordingly
Correct 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.
Question 7: In CBT-I research, participant deception is generally:
- Acceptable whenever it increases study validity
- Permissible only when IRB-approved, scientifically necessary, and followed by full debriefing (Correct answer)
- Never permissible under any circumstances in behavioral health research
- Required for placebo-controlled sleep intervention trials
Correct answer: Permissible only when IRB-approved, scientifically necessary, and followed by full debriefing
Research ethics allow limited deception only under strict conditions: IRB approval, no reasonable alternative, minimal risk, and complete debriefing afterward.
CBT-I Ethical Standards & Professional Practice 3
A CBT-I client who is a nurse asks the practitioner detailed questions about hypnotic medication dosing for her patients.
The practitioner should: