Cognitive Behavior Therapy for Insomnia in Those with Depression: A Guide for Clinicians 1st

190 Appendix B 11a. How many times did you nap or doze? A nap is a time you decided to sleep during the day, whether in bed or not in bed. ‘Dozing’ is a time you may have nodded off for a few minutes, without meaning to, such as while watching TV. Count all the times you napped or dozed at any time from when you first got out of bed in the morning until you got into bed again at night. 11b. In total, how long did you nap or doze? Estimate the total amount of time you spent napping or dozing, in hours and minutes. For instance, if you napped twice, once for 30 minutes and once for 60 minutes, and dozed for 10 minutes, you would answer ‘1 hour 40 minutes.’ If you did not nap or doze, write ‘N/A’ (not applicable). 12a. How many drinks containing alcohol did you have? Enter the number of alcoholic drinks you had where one drink is defined as one 12 oz. beer (can), 5 oz. wine, or 1.5 oz. liquor (one shot). 12b. What time was your last drink? If you had an alcoholic drink yesterday, enter the time of day in hours and minutes of your last drink. If you did not have a drink, write ‘N/A’ (not applicable). 13a. How many caffeinated drinks (coffee, tea, soda, energy drinks) did you have? Enter the number of caffeinated drinks (coffee, tea, soda, energy drinks) you had where for coffee and tea, one drink = 6-8 oz.; while for caffeinated soda one drink = 12 oz. 13b. What time was your last caffeinated drink? If you had a caffeinated drink, enter the time of day in hours and minutes of your last drink. If you did not have a caffeinated drink, write ‘N/A’ (not applicable). 14. Did you take any over-the-counter or prescription medication(s) to help you sleep? If so, list medication(s), dose, and time taken: List the medication name, how much and when you took EACH different medication you took tonight to help you sleep. Include medication available over the counter, prescription medications, and herbals (example: Sleepwell 50 mg 11 PM). If every night is the same, write “same” after the first day. 15. Comments: If you have anything that you would like to say that is relevant to your sleep feel free to write it here.

Consensus Sleep Diary-M (Please Complete Upon Awakening) ID/NAME: ______________________________ Sample Today’s Date 4/5/11 1. What time did you get into bed? 10:15 PM 2. What time did you try to go to sleep? 11:30 PM 3. How long did it take you to fall asleep? 55 min. 4. How many times did you wake up, not counting your final awakening? 6 times 5. In total, how long did these awakenings last? 2 hours 5 min. 6a. What time was your final awakening? 6:35 AM 6b. After your final awakening, how long did you spend in bed trying to sleep? 45 min. 6c. Did you wake up earlier than you planned? ✓ Yes  No  Yes  No  Yes  No  Yes  No  Yes  No  Yes  No  Yes  No  Yes  No 6d. If yes, how much earlier? 1 hour

7. What time did you get out of bed for the day? 7:20 AM 8. In total, how long did you sleep? 4 hours 10 min. 9. How would you rate the quality of your sleep? Very poor ✓Poor Fair Good Very good Very poor Poor Fair Good Very good Very poor Poor Fair Good Very good Very poor Poor Fair Good Very good Very poor Poor Fair Good Very good Very poor Poor Fair Good Very good Very poor Poor Fair Good Very good Very poor Poor Fair Good Very good 10. How rested or refreshed did you feel when you woke-up for the day? Not at all rested ✓Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested Not at all rested Slightly rested Some - what rested Wellrested Very wellrested

Consensus Sleep Diary-M (Please Complete Upon Awakening) ID/NAME: ______________________________ Sample Today’s Date 4/5/11 11a. How many times did you nap or doze? 2 times 11b. In total, how long did you nap or doze? 1 hour 10 min. 12a. How many drinks containing alcohol did you have? 3 drinks 12b. What time was your last drink? 9:20 PM 13a. How many caffeinated drinks (coffee, tea, soda, energy drinks) did you have? 2 drinks 13b. What time was your last drink? 3 :00 PM 14. Did you take any over-the-counter or prescription medication(s) to help you sleep? If so, list medication(s), dose, and time taken ✓Yes  No Medica - tion(s): RelaxoHerb Dose: 50 mg Time(s) taken: 11 PM  Yes  No Medica - tion(s): Dose: Time(s) taken:  Yes  No Medica - tion(s): Dose: Time(s) taken:  Yes  No Medica - tion(s): Dose: Time(s) taken:  Yes  No Medica - tion(s): Dose: Time(s) taken:  Yes  No Medica - tion(s): Dose: Time(s) taken:  Yes  No Medica - tion(s): Dose: Time(s) taken:  Yes  No Medica - tion(s): Dose: Time(s) taken: 15. Comments (if applicable) I have a cold © Consensus Sleep Diary 2011

Appendix C: Daytime Insomnia Symptom Response Scale People think and do many different things when they feel tired. Please read each of the items below and indicate whether you almost never, sometimes, often, or almost always think or do each one when you feel tired. Please select only one answer. Please indicate what you generally do, not what you think you should do. 1 = Almost Never 2 = Sometimes 3 = Often 4 = Almost Always 1 2 3 4 1. Think, “I won’t be able to do work because I feel so bad” 1 2 3 4 2. Think about your feelings of fatigue 1 2 3 4 3. Think about how hard it is to concentrate 1 2 3 4 4. Think about how unmotivated you feel 1 2 3 4 5. Think about how your thoughts are cloudy or muddled 1 2 3 4 6. Think about how everything requires more effort than usual 1 2 3 4 7. Think, “Why can’t I get going?” 1 2 3 4 8. Think about how sad you feel 1 2 3 4 9. Think about how you don’t feel up to doing anything 1 2 3 4 10. Think about your feelings of achiness 1 2 3 4 11. Think about how bad you feel 1 2 3 4 12. Think about how hard it is to keep your mind on task 1 2 3 4 13. Think about how tired you feel 1 2 3 4 14. Think, “I can’t shake this feeling off” 1 2 3 4 15. Think about how irritable you feel 1 2 3 4 16. Think about how sleepy you feel 1 2 3 4 17. Think, “I can’t seem to pay attention” 1 2 3 4 18. Think, “I’m so forgetful” 1 2 3 4 19. Think, “I can’t be around people when I’m feeling this way” 1 2 3 4 20. Think about how you don’t have the energy to get through the day

Appendix D: TRAP or TRAC Worksheet TRIGGER RESPONSE AVOIDANCE PATTERN OUTCOME TRIGGER RESPONSE ALTERNATIVE COPING OUTCOME TRAP TRAC

Appendix E: Daily Activity Monitoring Form Time Monday Tuesday Wednesday Thursday Friday Saturday Sunday 6–7 AM 7–8 AM 8–9 AM 9–10 AM 10–11 AM 11–12 AM 12–1 PM 1–2 PM 2–3 PM 3–4 PM 4–5 PM 5–6 PM 6–7 PM 7–8 PM 8–9 PM 9–10 PM 10–11 PM 11–12 AM 12–1 AM 1–2 AM 2–3 AM 3–4 AM 4–5 AM 5–6 AM

Appendix F: Goal Tracking Form Name: ________________________ Session Week # ____ GOAL TRACKING FORM Activity Set GOAL Record of Goal Attempts Frequency Duration M T W T F Sa Su

Appendix G: Blank Pro-Depression and Anti-Depressant Worksheet Pro-Depression Behaviors Anti-Depressant Behaviors

Appendix H: Blank Pro-Sleep versus Pro-Insomnia Worksheet Pro-Insomnia Behaviors Pro-Sleep Behaviors

Appendix I: Blank Pro-Energy versus Pro-Fatigue Worksheet Pro-Fatigue Behaviors Pro-Energy Behaviors

Appendix J: BABIT Continuum Exercise Establishing Insomnia and Depression on a Continuum of Symptoms No depression No insomnia Insomnia diagnosis Severe insomnia Depression diagnosis Severe depression

Appendix K: Behavioral Experiment Monitoring Belief to test: Week One Experiment: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Week Two Experiment: Monday Tuesday Wednesday Thursday Friday Saturday Sunday

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abbreviated behavioral and cognitive therapy (ABCT) 29 actigraph 34, 48, 114 American Academy of Sleep Medicine: guidelines for treating insomnia 14–15 arousal system: dysregulation 8 assessment of sleepiness 49–50 behavioral activation (BA) 49, 90–91, 105, 108, 122, 125, 133, 135, 136–154 Behavioral Activation with Behavioral Insomnia Therapy (BABIT) 67, 136–156 behavioral experiments (BE) 89–93, 99, 105, 108, 120, 122, 171, 177 bibliotherapy for CBT-I 34 brief behavioral insomnia therapy (BBIT) 29 Buysse, D. J 1–2, 10, 14–15, 26, 29, 41, 48, 115 chronotype 6 Circadian Psychoeducation script 7–8 Circadian Rhythm Disorders 54–56 circadian system dysregulation 5–8 Cognitive Behavior Therapy for Insomnia (CBT-I) 15, 24, 26–36 Cognitive Model of insomnia 81 Cognitive Therapy 32, 60, 83 conditioned arousal 9, 63, 66, 163 Consensus Sleep Diary 41, 185–193 contraindications for CBT-I 27, 36 Coping Cards 93–94 counter arousal strategies 32, 60, 75–77, 78, 161 Diphenhydramine (off-label use) 22 Doxepin 21–22 early morning awakenings (EMAs) 9, 100–101, 119 Electroconvulsive therapy (ECT) 19–20 Espie, C. 9, 12, 13, 18, 24, 26, 28–29, 39, 75–76, 81–82, 107 etiology of insomnia 2–3 etiology of insomnia in MDD 12–13 excessive daytime sleepiness 49–50 Group Therapy CBT-I 32–3 Harvey, A. 9, 12, 18, 24, 48, 76, 81–83, 86, 93, 95, 107, 116–117, 120 Homeostatic Psychoeducation script 3–5 Homeostatic System dysregulation 3–5 hypnotic medication discontinuation 30–32 hypnotic medications 20–1 internet-delivered CBT-I 35 Kupfer, D. 1, 10, 41, 111 Manber, R. 2, 13, 26, 28–29, 34–35, 62–63, 96, 113, 126, 131, 134–136 melatonin supplements 23 metacognition 122–125 Mindfulness Based Treatment for Insomnia 122, 123, 131 Morin, C. 1, 15, 24, 26, 28, 30–32, 40–41, 49, 58, 60, 63, 68, 73, 76, 81, 83, 95, 107, 136, 154 narcolepsy 53 obstructive sleep apnea (OSA) 50–52 Index

Pennebaker technique 76 periodic limb movement disorder 53 polysomnography (PSG) 34, 47, 114, 132 positive airway pressure (PAP) device 20, 27, 51 rapid eye movement sleep markers in depression 9–11 relaxation therapies 76 resources for those with insomnia and depression 35 restless leg syndrome (RLS) 17, 52 Riemann, D. 10–11, 14, 16, 28 rumination 12, 18, 48, 80, 82, 120–122 sleep diaries 41, 61, 114 sleep disordered breathing 50–51, 118 sleep effort 12, 58, 67, 82 sleep hygiene 60, 72–75 sleep inertia 98–99 sleep restriction 60, 68-72 sleep state misperception 115 slow wave activity marker in depression 9 smart phone applications 33 Socratic questioning 86–89 Spielman’s 3P Model 2 Stimulus Control 60, 63–67 St. John’s Wort 19 Thase, M. 2, 136 Thought Records 84–86, 87 Transcranial magnetic stimulation 20 trazodone 16–17 troubleshooting avoidance 105–106 troubleshooting cognitive difficulties 112 troubleshooting eveningness/night owl problems 99–100 troubleshooting problems with anhedonia 104–105 troubleshooting problems with fatigue 106–109 troubleshooting problems with mobility 109–110 Vagus nerve stimulation 20 5-Hydroxytryptophan (5-HTP) 24 226 Index