Meet an SBSM Founder - Michael Smith, PhD

Dear SBSM Members,

As one of the founding past presidents, I was asked to share my memory of the early years of the Society.  I hope this does not mean I am perceived as either rapidly dementing or about to die. 

It will be a decade ago this June 2018 at the Baltimore APSS (SLEEP) meeting, over beer and muscles at “Berthas” that a small group of us decided to launch the Society of Behavioral Sleep Medicine. It grew out of a passion to take destiny by the reigns. The field was discovering great things; our interventions were standing up to double-blinded placebo controlled designs, head-to-head challenges, meta-analyses, outcomes were lasting for two years, as long as we could measure them; but people had no access. Much of the medical profession, even within sleep and I was sorry later find out Psychology equated BSM with sleep hygiene education. It was and sometimes still is a frustrating state of affairs.

We needed an organized voice to advocate for our discipline. We needed legitimacy to realize our full impact on health.  Were we a growing interdisciplinary field with unique skills sets, burgeoning subspecialties within our field, and our own scientific methods? or were we the “insomnia section” of the American Academy of Sleep Medicine. As Sleep Medicine was working to formally recognize itself as medical subspecialty, we seemed to be losing, not gaining ground.

So…. we planned a consensus conference for the field with financial backing from Johns Hopkins Department of Psychiatry and in many ways blind faith that we would not lose money (and we did not, I am happy to say!)  After much debate, we left the conference with enough support, though it was tenuous, at times, to forge ahead. We further solidified support by surveying the field. We negotiated with the American Academy, made our case and ultimately with perseverance, the American Academy of Sleep Medicine agreed. They helped us write our bylaws, became our management company and we were off.  Dr. Michael Perlis was our first president. We formed our Board with many senior leaders stepping up, including Drs. : Kenny Lichstein, Daniel Buysse, Michael Vitiello, Judy Owens.

Running the Society in the early days was hard on us all. With little money, we were always under threat, we worked hard to put things in place: a website; holding our first meeting in Boston; and a subsequent meeting in Baltimore.  Through Kenny Lichstein’s Leadership, we negotiated with Taylor Francis Publishing and adopted the Journal of Behavioral Sleep Medicine as our Society’s Journal. 

We grappled with how best to develop a board exam. Should there be one exam for all practitioners? Should we have multiple exams based on each discipline’s clinical profession? Should there be different levels of certification based on degrees?  The majority, but certainly not all of the membership were psychologists.  The American Psychological Association (APA) offered structural pathways to clearly define the psychology subset of the BSM field. The closely aligned, but separate American Board of Professional Psychology (ABPP) had a process for board certification that might help define and preserve a role for doctoral level clinical psychologists to practice Sleep Psychology.  So with major tension between embracing our diversity of professions and seeking to first define a legitimate pathway for the majority of members, we pursued developing Sleep Psychology as a formally recognized “specialty” of psychology.  This was a required step to approach the ABPP to create a new Board of Sleep Psycholology that would permit us to develop an ABPP exam for psychologists.  These decisions were difficult to make. The idea, whether it will prove true or not, was that with changes in the health care system under “Obamacare,” there was ample precedent that certifications and the reimbursements tied to them were being defined by licenses and degrees, not broad interdisciplinary certification organizations.  The vision was, that for the Society to be vibrant and strong it needed to be interdisciplinary, but certification procedures would need to be developed within each profession. Psychology, because of its critical mass, would go first. Further down this road, other professions that comprise the field, such as nursing and social work, etc. with the Society’s support, would create certifications processes based on the scopes of practices within each clinical license.

We spent many months toiling on the application to recognize Sleep Psychology as a professional specialty. This required us to define all of the proficiencies, skill sets, training standards, etc. needed to practice sleep psychology. To be a specialty and not a proficiency, the field needed to be both broad, but also with enough true depth and scientific foundation that it would meet criteria.  We had to demonstrate that we in fact were a legitimate specialty that cut across more the one disorder, that we had a critical mass of providers and training programs across the country. We had to demonstrate that we did not overlap with other specialties within psychology that could call us a subspecialty. It was quite rigorous and simply put, we met those criteria.  The APA’s commission for the Recognition of Specialties and Proficiencies in Professional Psychology granted specialty recognition for Sleep Psychology in 2013 under Dr. Christina McCrae’s stewardship. We are up for renewal in 2020. As part of this process, we realized that we needed to continue to develop, maintain and expand BSM core competency areas for our field to thrive. This was the impetus behind our decision to create and publish the SBSM Guide to Actigraphy Monitoring, which we published as a special edition of Behavioral Sleep Medicine. I became the Society’s first delegate, so to speak, joining the Board of the Council of Specialties in Professional Psychology.  With these accomplishments under our belt, we applied to develop a board exam in Sleep Psychology.

Much to our surprise, ABPP rejected our application, encouraging us instead to apply as a subspecialty within one of the already established boards. Things were quite political and complicated, but it is fair to say ABPP was expressly seeking to expand and promote a newly developed subspecialty program.  The argument was in fact that sleep medicine itself is subspecialty in medicine and so Sleep Psychology should be too. Needless to say, many of us were disappointed, especially since we appeared to meet all of the criteria and had already achieved independent recognition as a Specialty from APA. We appealed to no avail.  ABPP reiterated the subspecialty pathway, but this itself was vaguely defined and would require members to first become certified in one of the existing ABPP specialties, such as Health Psychology, Clinical Psychology, Cognitive and Behavioral, etc.  We would have to petition these Boards and work with them to develop a subspecialty exam. It was going to be even more costly to become board certified in Sleep Psychology. We were getting a big dose of psychology politics.  I think at this point many of us began to feel that we needed to get back to grass roots BSM. We ultimately decided it did not make sense for us to pursue a subspecialty ABPP exam. 

My hope is that this will become an important inflection point in our continued professional development.  I think it can be a point where we buck the trend and lead the way toward developing a truly interdisciplinary field where we work out some of the professional trade issues over time, but ultimately come to embrace our larger BSM field as our most important identity.

Within this context, we broke away from the Academy of Sleep Medicine. We needed to be more free to pursue our self-interests. It has been quite a journey in 10 years and looking back, a lot was accomplished. It is time for another run. With the American College of Physician’s recommending CBT-I as the first line treatment for Insomnia disorder, we are well positioned to aggressively pursue growth on our field.  We have a strong foundation. We need to focus on expanding our membership base; dramatically. We need to increase our public profile in the media and we need develop a serious philanthropy campaign. We need to forge strong working relationships with primary care and family medicine organizations.  They want to work with us now more than ever.  We need to translate our new science into practice faster.  I think this is where we can really shine. We are a nimble enough community that we need to make sure we a learning new treatments as they come out.

For those of us developing new BSM approaches, we need to ensure that we are training our field to implement them. I look forward seeing what we can all accomplish in the next 10 years.

Sincerely, 
Michael T. Smith