Introduction to Cognitive Behavioral
Therapy
Cognitive-behavioral therapy (CBT) tries to reduce a person's misconceptions about sleep,
as well as teach more positive sleep behaviors. The therapy consists of talking with a therapist (alone or with a
group) to address your beliefs, assumptions and behaviors regarding sleep, and is often used in conjunction with
stimulus control, sleep restriction and good sleep hygiene. Several studies have shown that CBT is an effective way
of treating insomnia and that the therapy can reduce the number of long term medical issues associated with
insomnia.
Cognitive behavioral therapy addresses a person’s beliefs about sleep and helps replace negative or unhelpful
behaviors with positive ones. The significance of one’s thinking about sleep is often underestimated. Sleep
problems which start as isolated incidents can become chronic because of mental hang-ups.
How we think about sleep can play an important role in how we deal with sleep difficulties.
For this reason, an essential part of your sleep treatment involves identifying your thoughts about sleep that tend
to make sleeping more difficult and replacing these thoughts with more helpful thinking.
One technique for examining your thinking is to treat your thoughts as scientific hypotheses or ideas. You may have
had certain beliefs about your sleep for a long time. At this time you are being asked to consider alternative
beliefs and determine which of these beliefs is best supported by the information available to you.
As you pay attention to your thinking about sleep and consider alternatives, you will probably notice two issues to
address:
1. The more important it is to get a good night's sleep, the less you sleep. Believing that a poor night's sleep is
a disaster only generates more anxiety and worry about your sleep. Challenge this thinking and consider alternative
thoughts that reduce the importance of sleeping on the rest of your life (i.e. "It's no big deal", "I'll be a
little tired and cranky tomorrow but nothing I can't handle.").
2. The more you try to control your sleep, the less you sleep. Sleep is a natural body response. Telling yourself
that you must sleep and trying to force yourself to sleep only puts pressure on you and makes your sleep worse.
Focusing on what you can control (sleep habits, schedule, when you are in or out of bed) and letting go of what you
can not control will allow falling asleep and staying asleep to happen naturally.
Now that you've become aware of the thoughts that make your sleep worse and have considered alternative ways
of thinking, the next step is to practice these new thoughts. This challenging of new thoughts replacing old
thoughts will take some effort because our thoughts are typically automatic and we are not accustomed to
deliberately noticing them.
Scheduling a time each day to examine the ways you think about your sleeping will be helpful in getting you to
notice and challenge any maladaptive thought patterns. It is important to do this on a regular basis, as it can be
easy to fall into old thought habits if you are not actively monitoring your thoughts.
Like any new skill, it is important to practice it. Keep a diary of your sleep-related thoughts and your ideas on
how to think differently. Once you have become accustomed to examining your thoughts, you will find that this is an
excellent skill that will prove useful for helping you to approach your sleeping difficulties differently as well
as for learning a healthier approach to other life problems as well.
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