![]() At the outset, a cancer diagnosis itself is a traumatic event that completely alters the course of the patient’s life and can precipitate insomnia. Patients with cancer are exposed to a myriad of precipitating factors for insomnia along the cancer trajectory ( Table 1). The 3-P model is helpful not only to understand the etiology and maintenance of insomnia, but can also help to identify appropriate targets for proper treatment. Some examples of perpetuating factors include maladaptive sleep behaviors, dysfunctional beliefs and thoughts, or excessive worries. Once insomnia disorder has developed, it can develop into chronic insomnia through maintenance by perpetuating factors, even though the factors that initially precipitated the sleep disruptions have diminished or disappeared. Precipitating factors are the various triggering factors for acute insomnia, including an environmental or psychological stressor, acute illness, or medication side effects. Predisposing factors are biological or psychological factors that make an individual more likely to develop insomnia, such as female gender, or a family history of insomnia. The model describes the predisposing, precipitating, and perpetuating factors for insomnia. 10.1093/’s 3-P model is widely accepted for explaining the etiology and maintenance processes of chronic insomnia. Insomnia in young men and subsequent depression: the Johns Hopkins Precursors Study. Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD). Epidemiology of insomnia: what we know and what we still need to learn. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. ![]() The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Our future directions include examining how long-term behavior changes as a result of this training.īehavioral Medicine CBT-i Case-Based Learning Cognitive Behavioral Therapy Insomnia Internal Medicine Nonpharmacologic Treatment Preventive Medicine Primary Care Psychiatry. Our results showed that participants increased their intent to incorporate CBT in their primary care practice and increased their comfort with the various components of CBT. Our results showed immediate positive outcomes as a result of participating in the workshop. Sixteen internal medicine residents participated in the workshop and completed the pre/post survey. ![]() Participants were asked how often they incorporated (presurvey) and intended to incorporate (postsurvey) CBT as part of treatment of insomnia in their clinical practices. ![]() To evaluate the workshop, we used a pre/post survey that was administered at the beginning of the workshop and at its end. This pairing provided complementary perspectives to allow for learner engagement. Two facilitators, a general internist and a clinical psychologist with content expertise in CBT, delivered the workshop to 16 internal medicine residents. We developed a 90-minute workshop that included a didactic component to deliver content, role-playing to practice skills, and discussion to reflect and solidify learning. Although psychopharmacological interventions have traditionally been taught as first-line treatment in medical education, cognitive behavioral therapy (CBT) for insomnia has emerged as the recommended treatment to address the multimodal precipitants and reinforcing factors of insomnia symptoms. Insomnia is a common complaint among primary care patients that can have significant consequences for physiological and mental health. ![]()
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