What is Cognitive Behavioural Therapy (CBT)?

 figure 1: cbt model

figure 1: cbt model

Cognitive Behavioural Therapy (CBT) emphasizes the inter-relationships between our thoughts, behaviours, and feelings (both emotions and physical sensations).  More specifically, CBT assumes that our thoughts, behaviour, and feelings mutually influence each other.  CBT also assumes that how we interpret or evaluate situations in daily life can influence how we feel and behave.  For instance, if a student is faced with a math test next week and thinks, "I have no time to study, I'm going to fail," there is a good chance that he or she would feel anxious, and have a hard time focusing on studying or avoid it altogether.  Alternatively, if he or she thinks, "I have little time to study, how do I make the most of what little time I have?," she still might feel tense and nervous, but she will likely experience better concentration and better quality study time.  

The beauty of the CBT approach is that when we become aware of how our thoughts, actions and feelings fit together, we introduce opportunity: to either carry on as usual with our reactions or make a conscious choice and shift our reactions.  Once we decide to modify any one of these three components, we can create change in the other components. 

In a nutshell, CBT focuses on helping people identify and change unhelpful thoughts and behaviors, which can trigger and maintain anxiety, depression, insomnia, and stress, to improve quality of life.  It is also an evidence-based approach, meaning that there are numerous studies that support its effectiveness in the treatment of anxiety, depression, stress, insomnia, and health-related concerns (e.g., chronic pain).  

Some CBT Basics:

1.       CBT can provide a new or different way of understanding problems, as well as emotional or behavioural reactions.

2.       CBT can help clients develop new coping skills to address their problems.

3.       CBT homework exercises are an essential part of therapy.

4.       CBT relies on active collaboration between the client and therapist.

5.       CBT aims to help the client become his or her own therapist.

6.       CBT focuses on the present.

Strategies for Improving Sleep

 Image courtesy of  Feelart

Image courtesy of Feelart

In my previous post, insomnia and Cognitive Behavioural Therapy for Insomnia (CBT-I), a non-medication based therapy, for insomnia were discussed.  Drawing from the CBT-I approach, here are some behavioural strategies for improving sleep:

1. Establish a regular sleep routine and stick to it, even on the weekends and while on vacation.  Sleeping in on the weekends or during vacation can delay sleep onset on Sunday evening as it disrupts our circadian rhythm, a 24 hour biological cycle influenced by light and temperature, which regulates sleeping and eating patterns.

2. Reserve your bedroom for sleep and intimacy only.  Refrain from mind activating, and thus sleep incompatible activities in the bedroom such as working, studying, reading, or watching tv.

3. Learn a relaxation strategy or practice meditation to help calm your mind and body in preparation for sleep.

4. Have a wind-down period 1-2 hours before bedtime. This is the time to take a shower or bath, floss and brush your teeth, change into your bed clothes, dim the lights, and unwind from the day's activities.

5. Limit caffeine and have your last cup of coffee or tea by mid-day.

Many factors can set the stage for and maintain insomnia - the ideas above need to be practiced consistently to be of benefit. For more information, consult a health professional familiar with CBT-I.

Getting a Good Night's Sleep, Without Medication

coco sleeping.JPG

Most of us know the difference between a good night's sleep and a poor one. Having an occasional sleepless night is not necessarily cause for concern. However, sleep troubles (e.g., difficulty falling asleep or staying asleep) that persist and cause distress and/or impair daily functioning may indicate insomnia, a clinical sleep disorder.

Insomnia is a chronic condition in about 50% of sufferers and is a risk factor for physical and mental health conditions (1). According to a Canadian Study of 2000 adults published in 2011, insomnia is prevalent: about 40% have trouble falling asleep or early morning awakenings three or more nights per week in the previous month, about 20% were dissatisfied with their sleep, and 13.4% met full criteria for insomnia (one symptom of insomnia plus distress or disruption to daily function as a result of the insomnia) (2).  Females, older adults, and individuals with poorer physical and mental health were more likely to report insomnia. Regarding treatments, 10% had used prescription medication in the past year to manage their sleep, 9% used natural remedies, about 6% used over the counter products, and about 5% used alcohol (2).

Concerns about psychological dependency on sleep medication to fall asleep is an often cited reason for not wanting to start a sleep medication.  For individuals who are not keen on taking sleep medication to manage their insomnia, Cognitive Behavioural Therapy for Insomnia (CBT-I) is an excellent alternative.  CBT-I has been shown to be effective for improving sleep and it has been shown to reduce healthcare visits and costs (3).  In CBT-I, patients work with a trained therapist to build awareness of their sleep patterns and behaviours, learn to eliminate sleep disruptive behaviours and activities (e.g., watching tv in bed, not keeping a regular sleep schedule, worrying in bed), and implement sleep promoting behaviours (e.g., regular exercise, learning strategies to manage worries, re-establishing a regular sleep routine).

For further information about CBT-I, consult a trained health professional.  NPR also published a short health blog article last week on CBT-I:

http://www.npr.org/blogs/health/2014/02/14/276503025/working-with-a-therapist-can-help-when-sleeping-pills-dont