Featured Member -Donn Posner, PhD, DBSM
HOW DID YOU DECIDE TO SPECIALIZE IN BEHAVIORAL SLEEP MEDICINE (WHAT GOT YOU STARTED, WHO DID YOU DECIDE TO WORK WITH ALONG THE WAY)?
It is always felt to me that few people in our field seek out this career from the beginning. It seems to me that is more the case that whatever discipline you are in, at some point in your career you brush against sleep medicine, fall in love, and get hooked. So it was with me. I was in the process of establishing my career as a psychologist focused on treatment of anxiety disorders. One of my first jobs was at the medical school for the University of Illinois in Peoria.
When I first arrived, I was made aware that there was a sleep center in town that had sent a letter out to all the members of the psychiatry community. They described having numerous patients who, after sleep study, did not turn out to have an occult sleep disorder but nevertheless had difficulty sleeping. They were asking whether any psychiatrist in town would welcome these referrals and a ready source of clientele. Interestingly, not one psychiatrist in the community answered the call. The medical school asked if I had any experience with this, which at the time I did not. However, once I started looking at the literature it became abundantly clear to me that is evidence based behavioral therapy and was something that could be in my wheelhouse. I decided to consult with the sleep center and started seeing patients. I fell in love, got hooked, and the rest is history.
WHO GOES ON YOUR BSM MOUNT RUSHMORE?
This is hard to say because there are so many pioneers in our field worthy of the honor. Are we looking for the traditional 4 faces? Then let’s call it the Mount Rushmore of CBT-I. For me, I would have to start with Dick Bootzin, Art Spielman, and Peter Hauri who gave us stimulus control, sleep restriction, and sleep hygiene. Clearly three of the major building blocks for CBT I. There are so many others that can go up there but I guess I would round off with Charles Morin, as it was some of his early work researching nonpharmacological treatment for insomnia that first inspired me.
WHAT IS THE NEXT STEP THAT YOU PLAN ON TAKING EITHER IN YOUR RESEARCH PROGRAM OR CLINICAL PRATICE?
Having just moved back to the East Coast I am looking to the next evolution in my career. It is clear to me that we have a nearly epidemic problem with insomnia and, in CBT-I, a therapy that works. The problem, of course, is that we do not have enough well-trained clinicians to meet the need. It has always been my passion to teach and mentor others in this field. Therefore, one of my missions going forward is to assist with getting “more boots on the ground”. This means giving workshops and consulting to get others well-trained and up to speed. I also think that the need is great enough that we will need to utilize tele-health and online delivery of these services. Accordingly, part of my work has also been to promote these forms of service delivery.
This said, I think we need to be careful about how this is implemented. Clearly the upside is greater availability of treatment to those in need. However, I worry that too many of those using online treatments (without any follow-up) run the risk of not getting the full benefit of treatment, due to any one of a number of factors including improper assessment, interference from comorbidities, lack of consistent engagement, poor adherence, etc. My concern is that such failure experiences will inoculate patients from seeking further assistance. Therefore, my strong preference is that online services should be something that are utilized within larger healthcare systems where there is a clinician prescribing the online therapy, following up with the patients to see how they have done, and then refer those who have not gotten a full benefit into hire, more targeted levels of care, such as therapist assisted online treatment, group therapy, and specialized
WHERE WOULD YOU LIKE TO SEE THE FIELD IN 10 YEARS?
As I’ve said, I’d like to see more well trained practitioners of CBT-I who can eventually become diplomates in the field. Eventually, with enough practitioners I think the case should be made that every accredited sleep center should have diplomate in behavioral sleep medicine either on staff or somehow associated with the center. I’d also love to see more standardization of practice. We now have a consensus sleep diary we can all work with. I think it would be important for us to eventually standardize how therapies like stimulus control and sleep restriction are delivered.
WHAT IS YOUR ADVICE TO EARLY CAREER INDIVIDUALS, OR THOSE RE-SPECIALIZING INTO BEHAVIORAL SLEEP MEDICINE?
My advice would be to get good training. Hopefully we will begin to see the proliferation of more training programs in sleep medicine for all disciplines. As for re-specializing, research from dissemination implementation science is informing us that for clinicians not only to learn but to adopt and utilize a new treatment, probably requires more than one day of workshop. I think this is especially true for CBT-I because to truly practice well you have to become immersed in the field of sleep medicine which is a background that most practitioners from most disciplines currently do not have as part of their education. In addition to the workshops-three words. Consultation! Consultation! Consultation!
WHAT IS YOUR FAVORITY SLEEP RESOURCE THAT YOU WOULD LIKE OTHER TO BE AWARE OF?
Well I would have to say Cognitive Behavioral Treatment for Insomnia: A session by session guide, by Perlis, Jungquist, Smith, and Posner of course! I admit it’s older but I do think it holds up well and we are working on a 2nd edition as we speak. Also for insomnia, I would recommend Treatment Plans and Interventions for Insomnia: A Case Formulation Approach by Rachel Manber and Colleen Carney. For those interested in a broader selection of BSM techniques and therapies, I would recommend Behavioral Treatments for Sleep Disorders: A Comprehensive Primer of Behavioral Sleep Medicine Interventions which is edited by Perlis, Aloia and Kuhn. Finally, anyone who is working in the field of BSM needs to have access to the Principles of Practice of Sleep Medicine by Kryger, Roth, and Dement.
WHAT ARE OUR FAVORITY THINGS TO DO AWAY FROM THE OFFICE?
I started out my schooling as a film major and I have never lost my love for movies and music. If I add going for long walks will that sound too much like a personal ad? Finally, I like to sleep…naturally!
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