Not Sleeping? - CBT-I with Kasryn Kapp

For this week’s blog, I will be sharing about my interview with Kasryn Kapp, the owner of BodyMind Alliance Counseling and Consulting. We discussed so many things but we mainly talked about getting a good night’s rest.

Kasryn is from my area and I met her in my hometown. Now, though, she is based in Philadelphia and is helping so many individuals find empowerment, deepen their relationships, and offer mental health therapy for those who underwent a hearing loss journey as well as gender exploration. 

Kasryn’s Introduction

So like you said, I am in the therapy space, mental health therapy. I'm a licensed professional counselor in the state of Pennsylvania, so I can see folks all across Pennsylvania on Telehealth. One of the cool things about mental health therapy is that it's a low touch field, so it has paired really well with virtual Telehealth.

I have a couple of different specialties. I work with insomnia, trouble sleeping, waking up too early, waking up in the night, that kind of thing. I also work with the LGBTQ and folks either with disabilities or chronic illness or some sort of body mind difference, so maybe low vision, hearing loss, that kind of thing.

I also do sign language with my clients if they need it. I'm conversational in American sign language. So I would refer out if anybody is absolutely fluent native sign language user, but a lot of folks grew up using it a little bit and also speaking and listening.

Our Thoughts On Getting Certified To Counsel People

Kate: I think a lot of times with, I know for myself, since I'm not in the therapist space, you know, people think of counselors and therapists and we kind of get muddied with like what your credentials are. But as I was reading through your bio, you have a long list of summa cum laude graduations from, you know, you have your masters, you have your bachelor's, and all of those things. So I know there are bunches of different certifications that people can have to counsel people. So do you want to give like a brief, like what your venue is and how you got certified with different things?

Kasryn: Yeah, that's a great question. And you are so right. It does get confusing and sometimes people use the word therapist when they're not a therapist. Like particularly in the finance space, I see people saying like, I'm a financial therapist, but they're not.

So it's licensed at the state level. In Pennsylvania, you're a licensed professional counselor, a clinical social worker, or a marriage and family therapist. You could also be a psychologist. So that's a whole different thing. The other folks can use the word therapist and in order to do that in Pennsylvania, you have to complete an undergraduate degree in Psychology, Social Work, Marriage and Family Therapy, and then a master's degree as well as 3,000 hours of supervised experience. So it's quite a lot of supervised experience and then you can be licensed in the state of Pennsylvania. So all of that coursework has to be related to counseling and social work.

I've taken Statistics, Counseling Strategies, really all of this kind of stuff. And then every year we have to do 30 hours of continuing education. So we need to be staying up on the latest information.

That’s the background of being a therapist and all of that you need to do. And you can always ask folks if you're interested in starting work with someone, you can ask them what are your credentials, and they're really required to bring that up as well. So you should be able to see on the website or on some other part of their office, their credentials.

Kate: Because I feel like in today's day and age, with social media and everything, you see lots of people who put their credentials out there and say that they're a therapist, but I don't think that they're by any means a licensed by the state kind of therapist, with all of the schooling behind it.

I think people just put a word before, like sex therapist or food therapist or, you know what I mean? I think it devalues the word when you put so many 3,000 extra hours past your masters into it.

Kasryn: Right, right. There's a lot of coaching, like life coaching. I think that I see that more and more and it's really important to be careful because you can get into big trouble for putting therapists next to your name if you don't have that qualification. There's other therapists too, like physical therapy, massage therapy, but if we're talking about mental health therapists, I want to make sure you have that, but I see that too.

Kasryn’s Work With Insomnia

Kate: Well, the first thing that Kasryn and I had touched on was her work with insomnia. And for myself and my patients, that really piqued my interest because from the physical aspect of people's health, I can't get people fully healed if they're not getting adequate sleep. That's when we rest. That's when we restore. That's when we have our growth hormone works. That's all these different physiological things happen when we're sleeping to make you heal.

And if you're not getting it, it's going to be a huge stumbling walk. And I'm not good at getting people better sleep. If they're not sleeping because of pain, that can be helpful. But a lot of times, with pain, they've had it chronically, then it becomes like a mental barrier too because it becomes a totally all-consuming thing of their day and it gives them anxiety, it gives them depression, all sorts of things.

Kasryn: You're so right. It has such a huge impact on our life, the quality and quantity of our sleep. And treating sleep can impact so many areas. If you can improve your sleep, it can help with depression, there's a lot of research on that. It can help with all of the healing work that you're talking about. It can really unblock a lot of issues and let them heal on their own.

I love CBT-I because it's evidence based. Even if you just Google C like the letter C B T I, it shows up with a ton of research that shows how effective it is. So that's what gets me excited about it because I love to see results. I've run a group before for it and just, it was amazing seeing folks sleep better for the first time in a long time.

And I'm running a group again. I'm excited about that. But one of the things that can come up is usually there's a precipitating event – having a kid, having surgery, having some kind of chronic pain, maybe a shift work, we have to work overnight. And then there's the perpetuating factors. So we try to catch up on employees, go to bed earlier. All these sorts of things work in the short-term, but in the long-term, they can create insomnia. So a lot of what CBT-I does is kind of undoing the perpetuating factors. And I can talk about some quick tips, but if you have had insomnia for a couple of months, it might take more than just a few quick tips.

Kate: Definitely. And I feel like most of my patients have struggled with it for years. And, you know, I always ask people if they're hurt, getting good sleep, because it's really important for what I do. But a lot of times, they just blow me off and say, “Oh, I'm just a bad sleeper. I've been a bad sleeper for years.” And they just kind of have accepted it. I don't think PCPs are equipped to deal with it either. And they tell they're PCP, but really they only have the resource of medication to help with it.

Kasryn: Right. Yeah. It can become, it can take on a life of its own. If you find you're having insomnia, it falls into a pattern. So I try to go to bed like two hours to go to sleep. So I go to bed two hours ahead of when I think I'll fall asleep. And then I wake up about 1:00 AM and I'm having a glass of water, and then about two hours later I have to go to the bathroom. If it has a pattern like that, that's a really good sign that it's treatable because it's falling into this pattern where our brains are used to this sleep pattern and you can do something called sleep restriction and stimulus control to push the sleep back into a quality ,efficient sleep. And then increase the quantity once you improve. So what's happening is your brain's used to this routine of, “Okay, I'm going to go to bed and I'm going to lie awake and think about what I have to do tomorrow and what I forgot to do today and all these scenarios, and then I go to sleep and then it's time to wake up for water.” We get into these routines.

Another way to think about it, we just had the time change, the daylight savings time and a lot of people, it'll mess us up because, not because the clock's on, because a lot of our smartphone and all that update automatically, but because our internal clock doesn't just change like that. We get onto a routine. And so what CBT-I does is it helps you reset your clock, to oversimplify it. It helps you reset your clock depending what works for you, where you're getting quality sleep at the quantity you need.

That was a lot, but hopefully that makes sense.

Kate: That makes sense. And that kind of, I got into Vedic meditation a year ago and that's kind of how they see the meditation is it's a condensed period of really quality deep rest that is better than just, you know, non-quality, longer periods of resting, like with white noise and all the other stuff going on around you.

Kasryn: Yeah. I love that. And one of the things that people I think worry about when we talk about treating sleep maybe a barrier is if the time that you're lying in bed awake is your me time, if it's the time that you're on your phone, if it's the time that you read, it can be really difficult to give that up. Or if you're choosing time in the morning is your me time, I wouldn't want to give that up.

I'd say this is how it is and this is how I sleep. But what I like to emphasize is, we're not taking anything away. It's great to rest in the morning. It's great to rest at night. So we're not taking anything away, but that can be a barrier sometimes.

CBT versus CBT-I

Kasryn: So CBT, Cognitive Behavioral Therapy is a modality of therapy. And that's also very evidence-based. So if there's a big umbrella of Cognitive Behavior Therapy, CBT-I is under it. But we're talking about sleep science and CBT, we're talking about sleep prescription, similar control. We're talking about really focusing on the sleep. And then a little bit of thought cognitive restructuring or changing your thoughts. The broader CBT is your thoughts, feelings and behaviors, looking at how they interact and how you can change your thoughts to change your feelings and your behaviors.

A quick, easy example is if you're in the grocery store and you see somebody that you know and you wave to them and they have a weird look on their face and keep walking, there's a couple different thoughts you could have to that. One is, they hate my guts and I'm actually terrible. And something I said six months ago must have made them that. You could think, “Okay, they must not have seen me at all. They must be in their own head thinking about their grocery list. And they remembered something which was the facial expression”

So the first thought they hate me, you're going to see it all like a lot of negative uncomfortable feelings and probably maybe avoid the person, maybe confront them. It's going to affect your behavior versus, “Okay, they must have not seen me or had something on their mind.” You could probably feel a little bit lighter. They probably won't be wanting to confront them or anything like that. So that's CBT. Thinking about things in a different way.

And some folks have had a bad experience with CBT, where they feel it can be kind of invalidating. Let’s say you're victimized by somebody and it's real, but you're trying to think about it in a different way. But there's still this, I don't know what to call it, victimization going on. There's still harassing you. CBT would not be a helpful intervention there, but some people have had experience with it in that way.

So I like to clarify with CBT-I, we're talking about sleep science. We do a little bit of changing our thoughts. So what that looks like for sleep is I go to sleep right now, I'll get exactly four hours of sleep, and if I stay up one minute later, then that's one more minute more exhausted I'll be tomorrow. That sort of thinking is less helpful. We’re humans and we sometimes get horrible in our sleep and we survive it and you know, I'm working on improving my sleep and it's going to take a little bit of time. That thought is going to be more helpful. So that's the CBT of sleep, but it's not a hundred percent that, I'd say maybe 5-10% CBT of CBTI. That's confusing because they share a name.

Kate: That makes sense. And this isn't on the sleep end of things but some of my patients who have tried therapy, I get the common response that they say it's not for them. And I say it's probably like chiropractic, you probably just haven't found the right type or the right provider for you. There are tons of different techniques and therapies out there for chiropractors and PTs to use and that one type of treatment might simply not have worked for you or you just didn't mesh well with your provider. That doesn't mean the whole professionalism entirety has failed you.

Kasryn: I'm so glad you brought that up. I had done a little bit with chiropractor. There's different modalities, different treatments, different styles and there's a lot of different types of mental health therapy.

I know it can be intimidating to start with a new therapist and you don't know what really went wrong with the last one or what to look for. Starting with somebody new can be really intimidating. So something that might be helpful in that case is to learn about therapy modality. So some examples of some stuff you could look up and see if it feels like a good fit, you could take a look at Internal Family System, IFS, ENDR or Eye Movement Desensitization and Reprocessing. You could look at CBT, you could look at DED. Just take a look at them and see if one really clicks. It might feel like a better modality. So you could try with a different therapist with that.

Group CBT-I versus Individual CBT-I

Kate: Now I saw that you have the, the group CBT-I, but then also the individual. I'm guessing when you do the group, it's like we're talking about only sleep here. And then when you do the individual, do you draw in some other therapy type things into their visits?

Kasryn: That's a great question. So if somebody's coming in and they're only presenting concern with sleep, that's it, no depression, no anxiety, no family tension, I would do pure CBT-I, but I would say that's really rare. Most of the time we have something else going on. A little bit of depression, anxiety, family stress, existential dread. Most of the time there's something else going on.

So in that case, in the individual, we can weave it in and use other modalities in order to get the holistic picture. With the group, you're right, we are talking a hundred percent about sleep. And with that you can have an individual therapist who's either somebody else or me to work on the other stuff or for the folks who just have sleep and that's it. You can just do the group by itself.

Kate: That's so that's interesting. So your group program would also be relevant for people who already have a therapist that they like and they could do this as well at the same time?

Kasryn: That's right. Yeah. And when I ran a group of four, my colleagues who referred their clients to the group said, “Wow, we finally had that breakthrough with the depression” or, “Finally things are starting to move forward because the sleep issue is addressed.”

So it's a six- to eight-week program CBT-I, and unlikely that a therapist who's working with depression is going to focus a hundred percent on sleep for two months because there's other things to look at, but you can have that breakthrough elsewhere.

Kate: How long are your sessions each week?

Kasryn: So it's 60 minutes weekly and I run it for eight weeks. I like to give a little bit of more time. You can do it in six, but I like to have a little more time to work things out. And it's an hour and then you're doing a little bit of homework. Of course you're going to track your sleep every night, what time you got into bed, what time you tried to go to sleep, how long it took you to go to sleep, you do that one. So we can track your sleep efficiency.

And it's really cool to see because it tends to, for the first two weeks, it's really frustrating. We're basically getting a baseline how things are now, but then over the next several weeks it's really great to see the progress improve on the sleep diary.

The other thing with CBT-I is that it tends to last a really long time. So you're going to learn a lot of skills that you can keep forever with sleep medication. A lot of times it wears off or you build a tolerance to it, it doesn't work as well. Whereas the CBT-I is really getting to the root of the problem. And so you're likely to see long lasting effects. So it's not like you're going to have to do the CBT-I group every couple years or you know, every however often. It tends to be really effective and last a long time.

The Prices Of The Program

Kasryn: So it's $53 per group. So the group session. And then the individual is just my regular individual rate, which is on the website.

Kate: Nice. And then people can use their health savings accounts for that. Yeah?

Kasryn: Yeah. You can use your FSA, HSA. I don't take insurance. Some insurance companies allow out of network benefits, so you'd have to ask if that's something they do. But I'm not in network with any insurance companies.

Kate: Do you provide like the CPT and ICD 10 codes for people to submit a claim to their insurance company if they wanted to?

Kasryn: Yeah, I can provide bills with that information on it.

Working With People Specifically In Pennsylvania

Kate: With your licensure, you work specifically with people in Pennsylvania?

Kasryn: Yeah, it is by state. So they're actually looking at doing a reciprocity agreement with other states. Psychologists are able to do this now where there's 26 states who need an agreement that if you're licensed in one of these 26 states, then you can see clients anywhere. Because again, we are a little touch field. We talk to you, we do assessments, we do all sorts of things to test where you're at, but none of it requires touching your person. So we're very, well I guess virtual. But for licensed professional counselors, so me, I'm just in Pennsylvania, so anyone in Pennsylvania would be able to work with you.

If you're listening to this and you're outside of Pennsylvania, you can find a CBT-I provider. If you just Google CBT-I directory, there's a list of people who do CBT-I if you're interested in it.

What Made Kasryn Get The CBT- I Training

Kasryn: Yeah, that's a great question. So I was in college and I had the worst sleep ever. I did not sleep and then I would sleep during the day, which is a problem because I am trying to take classes and it was kind of hilarious. I was drinking coffee at like 9:30 at night, terrible sleep.

So I went to the counseling center at my school and that was part of the issue I came in with. I was like, “God, I can't sleep. It's stressing me out.” And my therapist at the school counseling center told me about CBT-I and we did some CBT-I stuff. Next thing you know, I'm sleeping through the night. It was like a miracle. It changed my life. And ever since then, it really does last a long time.

Sometimes I’m on my phone at night, I slip up a little bit, but as soon as I implement the strategies again, I sleep well. So yeah, it came from a really personal place. I'm naturally not a good sleeper, but CBT-I helped me a lot.

Techniques That Kasryn Uses In Her Individual Sessions

Kate: Now in your individual sessions, like when, if you're not dealing, if you're just doing your work with your regular clients patients, what techniques do you use with them?

Kasryn: I tend to take a person-centered approach. And I do get a little bit of CBT when it's a good fit for it. But, what it looks like is we are so social, we're so connected to other people, but in our society and our culture today, it's so easy to be very disconnecting and to not really understand how to have a deep connection with other people. So I'll do a lot of boundary work.

I think boundaries are a way of showing someone you care about them. That might sound radical, but if you're taking the time to communicate your needs to someone that's really powerful. So boundary work, relationships, it's kind of difficult to describe in a quick way like this, but basically, how you feel about yourself, how you feel about and connect with other people, and how you feel about and connect with your environment. We're going to look at all those pieces in sort of a holistic way.

Kate: That sounds kind of like how I practice with the body in my practice too.

Kasryn: The holistic, right? Yeah, it's difficult to describe it because it's so individual for each person, the work that you do, I would imagine is really tailor to the person.

Kate: Definitely. And you know, it's good to have different tools in your toolbox because not every patient is so different and you know, if you try something and like with those patients that go one time to therapy and they're like, It's not for me. Well your therapist might have many other tools in their toolbox that you need to try out because maybe that might work for you better, you know,? So like, yeah. Making that clear, I guess, while they're in it so that they're not like writing it off immediately for sure.

Better Serving An All-Inclusive Community

Kate: And then the last thing I saw on your website and we had talked about earlier was that you work with different healing specialists to work on being better serving an all-inclusive community. I thought that was very interesting because it just helps us get a better idea of how to make everyone feel comfortable in our offices.

Kasryn: Yeah, definitely. So I love talking about inclusivity and accessibility specifically with LGBTQ and folks with disabilities. So those are my two other specialty areas.

So a couple of tips for providers, how to help clients, LGBTQ, and clients with disabilities feel more included. For LGBTQ, there's a couple of main highlights. One is, not assuming that somebody is straight. So if you see somebody come in and say, “Oh, how's your husband?” That is going be a signal. Like, “Okay, this person's assuming I'm straight. Am I the first if I come out to them, is it going be a whole thing?” So just you could ask open-ended questions like, “Oh, are you seeing anybody right now?” Or just not assuming.

And then pronouns is another big one. I see a lot of talks about this. So if you don't know what a pronoun is, if I'm not in the room, you would say, “Oh, she talked about this.” It's the way that you speak about somebody else and you don't use the name. So asking pronouns can be a helpful way to be inclusive because we never know what somebody, what their gender is, you can't really tell by looking at someone.

For folks with disabilities, having an accessible office is kind of the one that most people think of. Wheelchair accessible. But also asking before if you're doing something with movement or touch, asking someone if they can do something before they do it. For example, if they need to sit on the floor, asking them, is that something that you have a lot of pain doing? Is that something you're comfortable doing? That can be helpful as well.

And I work a lot with the virtual space, digital accessibility. I did a blog about it, but for virtual accessibility, making sure that things have captions and that the screen reader can read them. So somebody who's blind, they would use a device that reads it for them. And that can kind of all feel overwhelming. I get that feedback a lot that, “Oh my gosh, I don't what to do. So stressful.” But just taking it one thing at a time and just little by little improving over time can be helpful.

Kate: I think that there has been a lot of, as I gone through, I started doing more online stuff and the exercises online, that kind of thing, when the pandemic hit, because I don't sit still very well and I had a month off and I've noticed that there are a ton of free apps. Like I use the captions app and it will transcribe things for me up for free, up for up until three minutes. So that works well with those shorter things that I do, whether it be on YouTube or TikTok, those kind of things. And so that's really nice that they've come out with is really affordable options and you can edit yourself and that kind of thing because it can be pretty labor intensive to do on your own.

So I have seen some things, it's the longer stuff that is harder to get in there because transcription back in the day when I started, to have someone transcribe your stuff was expensive. But

Kasryn: Yeah. I think there's some platforms that allow you to do it. We're getting really advanced with speech to text and text to speech. The technology is rocket shipping, that's not a word. It's advancing. So there's a lot of ways to do that that are just coming out now.

Kate: Yeah. And I had used one when I first started that I paid for that did do longer ones. I just remembered this after we had talked. It is called Zub titles, and it will do longer ones for you, but you have to like sign up for so many transcriptions per whatever monthly period.

Kasryn: Yeah. That's great. One other thing too that can be helpful is to ask if folks need accommodations. Is there anything you need just setting the norm for that. And it can be really hard as a solo practitioner and private practice, but even setting aside a really small amount of the budget for accommodations that can be helpful to you as well. It doesn't have to be a lot and most accommodations don't cost anything. Just an adjustment.

Kate: Well actually, this isn't an accommodation, but we just switched software. It's like our note taking software and it just populated itself and has a space for what your pronouns are.

Kasryn: Yeah. That's perfect. That's so great. A lot of folks really benefit from that. The impact of using someone's correct pronouns on their mental health is phenomenal and the impact of misgendering someone is devastating. So yeah, it makes a huge difference and if somebody just uses the pronouns that you would assume, then you just have those pronouns in there. It doesn't hurt anything.

Kate: And a lot of times in the software we had before, it wasn't very customizable. You just get what you get it, you know, it sends it out, you can't edit things. And so for this new software, I see that they're making changes. It's a newer company. You can make, you can edit things if you want to. It puts stuff like that in there automatically.

Kasryn: The technology more and more is moving in that direction to make it sort of seamless, including pronouns. Telehealth platforms are including captions more and more often. It's really moving in that direction, which is great.

Conclusion

Kate: Well I will put Ryn's website info below in the description and if you have any questions or if you'd like to reach out to her to work with her, I'm going to make her info available at the office because I think that getting more sleep is going to benefit my patients and everybody.

And if you feel like the group setting seems less scary since one-on-one seems to be a little more frightening to people at first. So usually, sometimes have people start with the group setting and be like, okay, maybe I have some other things that I need to address and then go on and do other kind of therapy after.

Kasryn: In the CBT-I group, it sort of feels like you're taking a sleep class. If it's helpful to think about it, if it feels a little less scary that way, like I'm taking a sleep class and there's homework and everything, so yeah. And I adapt it to all levels. So if a lot of the terms I use are really confusing, don't worry. We break it all down. I won't overwhelm me with technical jargon, but you will leave much more knowledgeable about sleep and how to get a better night's rest.

Kate: Awesome. Alrighty! Well thank you so much and let me know if anyone has any questions for Ryn.

Kasryn: Awesome. Thank you so much for having me!

You can contact Kasryn here: Contact — BodyMind Alliance Counseling and Consulting (bodymindalliancecc.com). You can also visit her website here if you want to know more about her: BodyMind Alliance Counseling and Consulting (bodymindalliancecc.com)

If you have any questions, you can drop it in the comment section or you can send me a message through Facebook or Instagram. I’d be happy to do another blog about your questions. Also, if you want me to talk about something specific, let me know!

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