Afhto Cbti Presentation July 2021
Afhto Cbti Presentation July 2021
Afhto Cbti Presentation July 2021
Erin Desmarais, MSW, RSW; Clinical Social Worker, Queen's Family Health Team
Cynthia Leung RPh, Pharmacist, Department of Family Medicine, Queen's University
Faculty: Erin Desmarais, MSW, RSW; Clinical Social Worker, Queen's Family Health
Team
Faculty: Cynthia Leung, RPh, Pharmacist, Department of Family Medicine, Queen's University
Covid-19 pandemic can cause insomnia for many Insomnia Severity Index Scoring
individuals as well as exacerbate insomnia in those
who already have it. We hope to share our experience 0-7 No clinically significant insomnia
in transforming our face-to-face CBTi-based sleep
8-14 Subthreshold insomnia
program to a virtual CBTi program.
15-21 Clinical Insomnia (moderate severe)
Patient Recruitment & Assessment
22-28 Clinical Insomnia (severe)
Patient Eligibility:
• A physician referral The program was delivered via Zoom.
• A valid email address & internet connection • Share screen feature was used to present program
• A device with webcam, microphone & speaker material, useful websites and smartphone apps.
• A printer (optional for printing program material) • Breakout room features were used to allow smaller
Recruitment & Assessment: group discussion with individual facilitators.
• Patient recruitment was initiated via telephone. • Chat feature was used to facilitate Q&A and encourage
Interested candidates were invited to complete an interactions with participants.
online survey (via email) which include the following • Poll feature was not used, could be explored to
components: encourage interactions or assessment of knowledge
• Program Material & Consent base. Pearls to share:
• Davidson Sleep Questionnaire • We completed ~ 12 patient assessments and enrolled 6 patients. Reasons for
• Insomnia Severity Index non-enrollment include lack of interest, timing, contraindications.
Patient Satisfaction & Improvement in Sleep • Of the 6 enrolled patients, 1 patient dropped out.
• Epsworth Sleepiness Scale
• HADS & PhQ9 20% Moderate improvement On Line. Warm & • Patients who are prescribed sleep medications may be more reluctant to
• A follow up phone call was conducted to discuss 60% Much improved friendly. Super well participate in the sleep program
result and confirm enrollment. Also explored (if 20% No trouble at all organized. • Our first virtual sleep program suggests this platform is effective in delivering
relevant) if the patient was receptive to medication cognitive behaviour therapy for insomnia with high patient satisfaction.
deprescribing and discussed program goals. Patients Although, I had never used Zoom for learning However, we are limited to recruiting less complex cases.
were also asked to complete weekly sleep diaries. purposes, I found the mode of communication more • Further validation is needed with more experience with larger group.
than adequate and very handy
CBT-I
Cognitive Relaxation
Restructuring Techniques
• Learned associations
• Deep Breathing- Set aside time 2 times daily for 1-2 minutes to
practice
Self-care
Self-guided books, apps, and online resources and services
Benefits of Group Programs
Patient Assessment Book appointment for 45 minutes Review assessment forms completed online
Patient to be allotted 20 minutes to Schedule phone appointment to discuss
complete assessment forms assessment results
If deemed appropriate, will enroll patient If deemed appropriate, will enroll patient into
into program program.
How to set up a CBT-I Group Program
Program Outline
*The description is a general Session 1 Introduction to Sleep
guide. Each program may vary
according to the patients’ Session 2 Reconnecting your Bed with Sleep
needs.
Relaxing Breathing
Adapted from Cognitive Behaviour Therapy Skills training workbook
(https://www.hpft.nhs.uk/media/1655/wellbeing-team-cbt-workshop-booklet-2016.pdf)
Week #4: Relaxing your Mind and Body
Facilitator Tips
• Encourage patients to
continue to follow sleep
schedule and brainstorm
any challenges they are
encountering.
• Sleep improvement should
be noted by this time.
• “Clear Your Head Time”
introduced as a means of
managing worries.
Clear your head time
Instructions
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14
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Summer 2020 Fall 2020 Winter 2021 Spring 2021
Before ISI (after)
How to improve accessibility of Virtual Programs?
Self-care
Self-guided books, apps, and online resources and services
QUESTIONS?