Table 4.

Sessions and activities structuring CBT among patients with narcolepsy.

Sessions	Activities
Treatment session 1	An overview of the treatment program is presented during the first therapy session. Each therapy component is discussed briefly, but specific procedures are not described.
The agenda of subsequent sessions is reviewed. At the end of the session, the objectives form is jointly completed by the patient and his or her clinician, and the therapeutic approach is determined.
Treatment session 2	The behavioral component of therapy (systematic desensitization, nap training, stimulus satiation, or some combination thereof) is introduced during the second session.
The methods are described with their theoretical foundations. Patient resistance and obstacles with regard to implementing the procedures are briefly discussed; however, the patient is encouraged to experiment with these techniques first and realize the problems during the next session.
Treatment session 3	This session is primarily dedicated to solving the difficulties found during the first week of practice at home.
Each procedure is reviewed, and the patient is asked whether he or she has met the requirements. Specific methods are reviewed to facilitate treatment acceptance.
Treatment session 4	The cognitive therapy component is introduced during this session. The basic principles, objectives, and foundation of cognitive restructuring are discussed. The importance of this conceptual framework for understanding narcolepsy and its effect on the patient׳s life is emphasized.
Furthermore, imagery rehearsal therapy is introduced in the event that hypnagogic hallucinations occur.
Treatment session 5	After the issues related to the implementation of behavioral procedures have been reviewed, this session continues with cognitive therapy.
Patient-reported cognitions during the preceding week are reviewed; if they are considered dysfunctional, then they are replaced by others that are more appropriate. During this treatment phase, the progress made toward the proposed objectives is discussed with the patient, and the summary data sheet is reviewed.
Treatment session 6	This session is dedicated to the sleep hygiene education that is similar to what is recommended among patients with insomnia; however, little evidence supports its use among patients with narcolepsy. This education prescribes improved sleep habits and constant sleep patterns among patients with narcolepsy, thereby increasing their quality of sleep. The stimulus satiation, nap training, and systematic desensitization techniques are checked.
Treatment session 7	The clinician comprehensively reviews therapy components. Patient progress is reviewed and discussed with the patient, highlighting the areas that need more attention. The therapeutic relationship, process, and intervention outcomes are discussed.