Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94301-5597, USA.
J Clin Sleep Med. 2012 Apr 15;8(2):209-18. doi: 10.5664/jcsm.1786.
Strong evidence supports the efficacy of cognitive behavioral therapy for insomnia (CBTI). A significant barrier to wide dissemination of CBTI is the lack of qualified practitioners. We describe challenges and decisions made when developing a CBTI dissemination program in the Veterans Health Administration (VHA). The program targets mental health clinicians from different disciplines (psychiatry, psychology, social work, and nursing) with varying familiarity and experience with general principles of cognitive behavioral therapies (CBT). We explain the scope of training (how much to teach about the science of sleep, comorbid sleep disorders, other medical and mental health comorbidities, and hypnotic-dependent insomnia), discuss adaptation of CBTI to address the unique challenges posed by comorbid insomnia, and describe decisions made about the strategy of training (principles, structure and materials developed/recommended). Among these decisions is the question of how to balance the structure and flexibility of the treatment protocol. We developed a case conceptualization-driven approach and provide a general session-by-session outline. Training licensed therapists who already have many professional obligations required that the training be completed in a relatively short time with minimal disruptions to training participants' routine work responsibilities. These "real-life" constraints shaped the development of this competency-based, yet pragmatic training program. We conclude with a description of preliminary lessons learned from the initial wave of training and propose future directions for research and dissemination.
强有力的证据支持认知行为疗法治疗失眠症（CBTI）的疗效。CBTI 广泛传播的一个主要障碍是缺乏合格的从业者。我们描述了在退伍军人健康管理局（VHA）开发 CBTI 传播计划时遇到的挑战和做出的决策。该计划针对来自不同学科（精神病学、心理学、社会工作和护理）的心理健康临床医生，他们对认知行为疗法（CBT）的一般原则的熟悉程度和经验各不相同。我们解释了培训的范围（要教授多少关于睡眠科学、共病睡眠障碍、其他医疗和心理健康共病以及催眠药依赖型失眠的知识），讨论了针对共病失眠症提出的独特挑战对 CBTI 的适应性调整，并描述了培训策略的决策（培训原则、结构和材料的开发/推荐）。在这些决策中，有一个问题是如何平衡治疗方案的结构和灵活性。我们开发了一种基于案例概念化的方法，并提供了一个一般性的逐节大纲。培训已经有许多专业义务的持照治疗师，要求在相对较短的时间内完成培训，尽量减少培训参与者日常工作责任的中断。这些“现实生活”的限制塑造了这个基于能力但实用的培训计划的发展。我们最后描述了从最初培训浪潮中获得的初步经验教训，并提出了未来的研究和传播方向。
