PS380 Unit 8 Evidence-Based Practice Paper Example

Sleep Medicine or Sleep Therapy After a Brother's Death: A PS380 Unit 8 Evidence-Based Practice Paper

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Purdue University Global

PS380: Clinical Psychology

Unit 8 Evidence-Based Practice Paper

[Instructor Name]

[Date]

The client, the clinic and the treatment details are composite; the policy, guideline and meta-analysis cited are real.

The Decision

Darlene is a 52-year-old Ojibwe woman whose younger brother died without warning five months ago; her physician sent her to us because she could not sleep. Most nights an hour or more passes before sleep comes, wakes around three and cannot get back to sleep, and estimates she sleeps four to five hours. The problem occurs at least five nights a week. She is exhausted at work. Her physician offered a prescription sleep medication, which she declined, and referred her to us.

Dr. Lund, our psychologist, had to decide how to begin. The options were cognitive behavioral therapy for insomnia, a return to her physician to reconsider medication, or grief-focused therapy on the theory that the insomnia would resolve as her grief did. This paper uses the definition of evidence-based practice in psychology to work through that decision.

What Evidence-Based Practice Means

A 2006 APA task force described evidence-based practice in psychology as bringing together three things: the strongest research available, what the practitioner knows from training and experience, and who the patient is, including culture and preferences (American Psychological Association Presidential Task Force on Evidence-Based Practice, 2006). The definition was written partly in response to the idea that clinicians should simply follow lists of empirically supported treatments. The task force argued that research is essential but that it must be combined with the clinician's judgment and with what the client brings.

Evidence-based practice is not a list of approved treatments; it is a way of deciding that gives research a vote but not the only vote.

Each of the three parts is examined below for Darlene's case.

The Research

Trauer et al. (2015) conducted a meta-analysis of twenty randomized trials of cognitive behavioral therapy for chronic insomnia, involving more than a thousand adults. Compared with control conditions, the therapy shortened the time it took to fall asleep by about nineteen minutes, reduced time awake after first falling asleep by about twenty-six minutes and raised the percentage of time in bed actually spent sleeping by about ten points. The effects were clinically meaningful and lasted at later follow-up points.

The American College of Physicians reviewed the evidence on treatments for chronic insomnia and recommended the therapy as the first treatment for every adult with chronic insomnia, reserving medication for shared decisions when the therapy alone is not enough (Qaseem et al., 2016). The recommendation reflected both the therapy's benefits and the limited long-term evidence and side effects of sleep medications.

The research therefore points toward the therapy rather than medication. It says less about grief, and that gap matters for this client more than any other detail in the trials. Most trials excluded people with recent major losses or did not report on them, so the research does not directly answer whether the therapy should be offered during acute grief or whether grief work should come first.

Clinical Expertise

This is where clinical expertise matters. Dr. Lund has used cognitive behavioral therapy for insomnia for several years, and she knows its components: sleep education, keeping a regular wake time, limiting time in bed to the time actually spent asleep, leaving the bed after a long stretch awake, reducing worry at bedtime and addressing unhelpful beliefs about sleep.

Her experience suggested two adjustments. First, Darlene's insomnia had lasted five months, which meets the duration for chronic insomnia, and it had developed patterns of its own, such as lying in bed for hours, which grief work alone would probably not change. Second, the sleep restriction component, which can cause temporary daytime sleepiness, should be introduced gently for a grieving client who is already exhausted, with a less strict schedule than usual. Dr. Lund also judged that the nighttime worry in Darlene's case was mainly grief, and planned to give it a protected place in sessions so it would not be pushed into the night.

Client Characteristics, Culture and Preferences

Darlene's preferences shaped the plan in several ways. She had already declined medication, and the guideline supports starting without it. She said she wanted practical help with sleep and did not want treatment to focus on her culture, which fit an approach centered on sleep habits.

Her family's customs also mattered. After her brother's death, relatives had stayed in her home for weeks, and her family gathered often in the evenings. A rigid bedtime routine that required her to leave family gatherings early would conflict with how her family grieves together. Dr. Lund and Darlene agreed on a fixed wake time, which the therapy treats as most important, while letting bedtime vary on evenings with family. They also agreed that Darlene could get up and sit quietly in another room when she could not sleep, rather than being asked to do anything that would feel disrespectful in a full house.

Darlene also raised a concern Dr. Lund had not anticipated. She worried that sleeping well again might feel like forgetting her brother. Dr. Lund did not argue with the worry. She asked what her brother would have wanted for her, and Darlene laughed and said he would have told her to get some sleep. That exchange did more for her willingness to try the plan than any summary of the research could have, and it is a reminder that preferences include meanings as well as practical choices.

The Decision and How It Will Be Evaluated

Dr. Lund and Darlene chose to begin cognitive behavioral therapy for insomnia over six sessions, with time in each session for grief. Darlene will keep a sleep diary, and Dr. Lund will use the Insomnia Severity Index at the first, third and sixth sessions. If her sleep has not improved by the sixth session, they will discuss returning to her physician about medication, consistent with the guideline, or shifting the focus to grief therapy.

Conclusion

Darlene's case shows the three parts of evidence-based practice working together. Research favored cognitive behavioral therapy for insomnia over medication. Clinical expertise adapted it for a grieving client where research was silent. Darlene's preferences and family customs shaped how it was delivered. The result is a plan that is evidence-based not because it follows a list, but because it combines the best evidence with the person it is meant to help.

References

American Psychological Association Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285. https://doi.org/10.1037/0003-066X.61.4.271

Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-133. https://doi.org/10.7326/M15-2175

Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191-204. https://doi.org/10.7326/M14-2841