Insomnia and Fatigue after Traumatic Brain Injury: A CBT Approach to Assessment and Treatment

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Insomnia and Fatigue After Traumatic Brain Injury: A CBT Approach to Assessment
and Treatment
Copyright
Contents
Preface
	References
Part I: Essential Background
1 Insomnia and Fatigue Following Traumatic Brain Injury: Prevalence, Correlates Evolution, and Treatment Options
	Traumatic Brain Injury: A Brief Overview
		Definition and Epidemiology of Traumatic Brain Injury
		Care Trajectories and Prognosis and After Traumatic Brain Injury
			Mild Traumatic Brain Injury
			Moderate–Severe Traumatic Brain Injury
		Common Sequelae Following Traumatic Brain Injury
			Physical Issues
			Cognitive Impairments
			Behavioral and Personality Changes
			Social Network and Relationship Strain
			Psychopathology
			Impacts on Daily Activities, Quality of Life, and Social Participation
			Impacts on Caregivers
			Sleep–Wake Disturbances and Fatigue
	Post–TBI Insomnia
		Nature and Prevalence of Insomnia After Traumatic Brain Injury
		Etiology of Post–TBI Insomnia
			Pathophysiology
			Medication
			Pain
			Psychopathology and Stress
			Sleep-Related Habits
			Traumatic Brain Injury Severity
		Evolution of Insomnia
		Potential Impacts of Post–TBI Insomnia
		Treatment Options for Post–TBI Insomnia
			Pharmacological Interventions
			Cognitive–Behavioral Therapy
			Other Nonpharmacological Interventions for Post–TBI Insomnia
	Post–TBI Fatigue
		Nature, Prevalence, and Impacts of Post–TBI Fatigue
		Etiology and Correlates of Post–TBI Fatigue
			Pathophysiology
			Coping Hypothesis
			Activity Levels and Rest
			Cooccuring Issues: Mood, Disability, Pain, and Sleep Disturbance
			Differentiating Fatigue From Sleepiness
		Evolution of Post–TBI Fatigue and Its Relation to Traumatic Brain Injury Severity
		The Phenomenology of Post–TBI Fatigue
		Treatment Options for Fatigue
			Pharmacological Treatment
			Exercise
			Education About Health-Related Habits and the Environment
			Light Therapy
			Cognitive and Behavioral Strategies
	Interaction Between Insomnia and Fatigue
	References
2 Assessment of Insomnia and Fatigue Following Traumatic Brain Injury
	Assessment: A Dynamic Process
	What to Assess
		History, Nature, and Manifestations of Insomnia and Fatigue Symptoms Since the Injury
		Impact of Insomnia and Fatigue Symptoms on Evolution of Brain Injury Condition/Adaptation
		Habitual Sleep–Wake Schedule
		Medications and Treatments
		Lifestyle and Environmental Factors
		Screening for Other Sleep Disorders
		Screening for Psychopathology
	Types of Assessment
		Clinical Interviews
			Post–Traumatic Brain Injury Insomnia Interview
			Post–Traumatic Brain Injury Fatigue Interview
		Diaries
			Sleep Diary
			Energy/Activity Diary
		Questionnaires
		Objective Measures
			Nighttime Polysomnography
			Daytime Polysomnography
			Actigraphy
	Assessing the Patients’ Readiness for Intervention
		Assessment Tools Suggested in This Manual
	References
3 CBT Interventions for Insomnia and Fatigue in the Context of TBI: Rationale, Adaptations, and Clinical Challenges
	General Cognitive–Behavioral Therapy Treatment Components
		Fostering a Self-Management Approach
			Rationale
			Implementation
				Fostering Commitment and Effort
				Keeping Realistic Goals
				Adopting a Scientific Attitude
		Establishing Effective Self-Monitoring
			Rationale
			Implementation
				Sleep Diary
				Energy/Activity Diary
	Cognitive–Behavioral Therapy Components Specifically for Post–TBI Insomnia
		Psychoeducation About Normal Sleep, Sleep After Traumatic Brain Injury, and Insomnia
			Rationale
			Implementation
		Sleep Hygiene Education
			Rationale
			Implementation
		Restriction of Time in Bed: Limiting Time Spent in Bed to Actual Sleeping Time
			Rationale
			Implementation
		Stimulus Control: Recreating a Time and Space for Sleep
			Rationale
			Implementation
		Brief Cognitive Therapy for Insomnia: Working on Unhelpful Thoughts, Beliefs, and Attitudes About Sleep and Insomnia
			Rationale
			Implementation
	Cognitive–Behavioral Therapy Components Specific to Post–TBI Fatigue
		Psychoeducation About Fatigue After Traumatic Brain Injury, and Health Habits Influencing Energy Levels
			Rationale
			Implementation
		Increasing Self-Awareness of Energy Levels and Signs of Fatigue
			Rationale
			Implementation
		Activity Management or “Pacing” for Fatigue
			Rationale
			Implementation
		Working on Attitudes About Fatigue
			Rationale
			Implementation
	Additional Components
		Encouraging Graded Physical Exercise
			Rationale
			Implementation
		Stress and Worry Management
			Rationale
			Implementation
		Involving a Family Member
			Rationale
			Implementation
	Clinical Challenges in the Context of Traumatic Brain Injury
		Cognitive Impairment
		Behavioral Particularities
		Physical Impairment
		Polypharmacy and Sleep Medication
		Symptoms of Anxiety and Depression
		Issues With Adherence and Motivation
	References
Part II: Practical Tools
4 Assessment Tools for Post-TBI Insomnia
	Overview
	DSM-5 Diagnostic Criteria for an Insomnia Disorder
	Clinical Interview on Insomnia Following Traumatic Brain Injury—Full Version
	Clinical Interview on Insomnia Following Traumatic Brain Injury—Short Version
	Sleep Diary
	Sleep Diary (Full Version)—Example and Instructions
	Sleep Diary—Short Version
	Sleep Diary—Analysis
	How to Compute Sleep Efficiency
	Insomnia Severity Index (ISI)
	Insomnia Severity Index (ISI)—Scoring and Interpretation
	Dysfunctional Beliefs and Attitudes about Sleep (DBAS)
	Dysfunctional Beliefs and Attitudes about Sleep (DBAS)—Scoring and Interpretation
	Case Conceptualization Summary for Post-TBI Insomnia
5 Assessment Tools for Post-TBI Fatigue
	Overview
	Clinician guide ?Proposed Diagnostic Criteria for TBI-Related Fatigue
	Clinical Interview on Fatigue Following Traumatic Brain Injury
	Energy/Activity Diary
	Energy/Activity Diary—Example and Instructions
	Energy/Activity Diary—Analysis
	Multidimensional Fatigue Inventory (MFI)
	Multidimensional Fatigue Inventory (MFI)—Scoring and Interpretation
	Fatigue Severity Scale (FSS)
	Fatigue Severity Scale (FSS)—Scoring and Interpretation
	Fatigue Numerical Rating Scale
	Fatigue Barometer
	Case Conceptualization Summary for Post-TBI Fatigue
6 Intervention Tools for Post-TBI Insomnia
	Overview
	Overview of Intervention Strategies for Post-TBI Insomnia
	Self-Management of Insomnia
	Helping a Family Member or Friend Manage Insomnia
	Establishing Effective Self-Monitoring With the Sleep Diary
	An Essential Tool: The Sleep Diary
	Sleep Diary (Full Version)—Example and Instructions
	Presenting Basic Information on Insomnia
	Sleep Following a Traumatic Brain Injury
	What is Chronic Insomnia and How Common Is It?
	What Causes Insomnia?
	Factors Which Perpetuate Insomnia
	Presenting Basic Information on Sleep
	How Sleep is Produced
	Stages of Sleep and Sleep Cycles
	Presenting Basic Information on Sleep Hygiene
	Sleep Hygiene: Maintaining Lifestyle Habits That Promote Good Sleep
	Stimulus Control: Recreating a Time and Place for Sleep
	Recreating a Time and Place for Sleep
	Restriction of Time in Bed: Limiting the Time Spent in Bed to Actual Sleeping Time
	Limiting the Time Spent in Bed to Actual Sleeping Time
	Brief Cognitive Therapy: Promoting Beliefs and Attitudes That are Conducive to Sleep
	My Motivating Activities
	Beliefs and Attitudes That Promote Good Sleep
	Strategies for Better Management of Worries When Going to Bed or During Nighttime Awakenings
	Motivational Strategies When Encountering Resistance
	Clinical Challenges and Solutions to Adapt CBT for Insomnia to the Context of TBI
7 Intervention Tools for Post-TBI Fatigue
	OVERVIEW
	Overview of Intervention Strategies for Post-TBI Fatigue
	Self-Management of Energy
	Helping a Family Member or Friend Manage Fatigue
	Establishing Effective Self-Monitoring With the Energy/Activity Diary
	An Essential Tool: The Energy/Activity Diary
	Presenting Basic Facts About Fatigue and Understanding the Vicious Circle of Fatigue and the Benefits of B...
	Fatigue Following a TBI
	The Vicious Circle of Fatigue
	The Positive Cycle of Effective Energy Management
	Understanding the Connection Between Lifestyle Habits and Fatigue
	Healthy Habits to Optimize Energy
	Improving Self-Perception of Signs of Fatigue
	Recognizing the Signs of Fatigue
	Understanding Energy Fluctuations and the Activity–Fatigue Connection
	Understanding the Activity–Fatigue Connection (Example)
	Understanding the Activity–Fatigue Connection
	Identifying Sources of Energy and Fatigue
	Countering Inactivity by Gradually Increasing Activity Level and Planning Rest Periods
	Different Ways to Rest
	Recommendations Concerning Naps and Rest Periods
	Strategies to Adapt Activities in Order to Manage Energy Levels Effectively
	Adapting Activities to Minimize Fatigue
	Identifying High-Risk Situations
	Promoting Attitudes and Expectations for Good Energy Management
	Maintaining a Balance Between Different Types of Activities
	Maintaining Realistic Expectations About My Energy Levels
	Reintegrating Avoided Activities and Integrating New Activities
	Gradually Increasing Physical Exercise
	Increasing Physical Activity to Fight Fatigue
8 Detailed Treatment Plan
	Overview
Index
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