Tell me about congitive behavioral therapy

I saw a sleep doctor for the first time today, and was diagnosed with childhood insomnia, meaning insomnia that I have pretty much always had. She said that it is an ailment that responds well to CBT. My first appointment is in November with the specialist.

What should I expect from CBT? I understand that it is the treatment of choice for some personality disorders, which I don’t have (although if I don’t get some sleep soon, I might develop a very grumpy and mean personality). The same principals can be applied to the mental part of insomnia. But what are these principals?

That sh*t will cause you to be able to control your thoughts, if done correctly. Basically, it is an analysis of your own thoughts in the moment, learning better awareness of thoughts that are counterproductive to mental health, then challenging and eventually eliminating those thoughts. You learn quite a few strategies to challenge and eliminate the “bad” or counterproductive thought patterns. It’s really beneficial for all kinds of anxiety, phobias, and compulsive behaviors like anorexia, OCD, and trichotillomania. Takes a lot of persistence, but after a lot of practice, one is generally a mentally healthier and more comfortable individual. YMMV. Best wishes… I have been insomniac most of my life and can very much sympathize. :slight_smile:

Basically, CBT posits that you have more control over your mind and thoughts than you might have thought, and that you can control or at least direct your mind. What you feel is a result of what you think and what you think is under your control.

That’s the gist.

I spontaneously used a form of CBT on myself when I was in my early 20s and decided I was no longer going to be shy. I didn’t know that I was reinventing the wheel, but it worked remarkably well. Good luck!

There have been a lot of good threads on Cognitive Behavioral Therapy. Here’s one from last year that will give you a general overview:

The Cognitive Behavioral Therapy Support Thread

Hmm. I’ve talked to a lot of therapists, counselors, and clergymen about this approach. The biggest obstacle is the ability to be honest about yourself, and then believing when the evidence is overwhelming.

For example, let’s say someone doesn’t like doctors. The underlying reason could be that their parents were constantly belittling them and the person doesn’t feel they’re worthy enough to waste the doctor’s time, even if they’re seriously ill. In CBT, you then change the way you think about the original underlying event and the fear of doctors will then magically disappear. In theory. The key point that all the people I talked to agree is that when presented with the underlying cause, can they accept the truth of it? Most people are unable to face the truth and prefer the illusion (“I don’t like doctors because they’re asses, not because my parents were jerks.”)

All the people I talked to agreed that a very small number of people can see past their ego and embrace the truth, even in the face of overwhelming evidence. One psychiatrist only knows of one person who ever was able to do it.

Also, some people think they’re accepting the truth, but deep down, they aren’t.

Superhal, I’m no expert, but that doesn’t sound like what I know of CBT. That sounds more like psychotherapy or something that’s supposed to be more about exploring the roots of feelings or fears.

CBT, and again I’m no expert, is more focused on the present. What are your current thoughts and how do they reflect reality? What distortions are creeping into your thoughts? Etc.
For example: When I de-shyed myself, I wasn’t trying to figure out what had made me shy. I was working with what thoughts I had (mostly about how people were looking at me, laughing at me, etc.) that I could identify as being irrational. Once I found those irrational thoughts, I learned how to short-circuit them and redirect them to ease my anxieties. Again, this was self-taught, so I can’t claim any sort of universal knowledge.

Cognitive behavioral therapy is emphatically not about underlying causes. Sometimes you do discuss the underlying causes to help in changing the direction of your thoughts, but in CBT, they are essentially irrelevant. In your example, the problem is that the person doesn’t feel worthy to waste the doctor’s time. CBT would help them to see that their health is important, that they are a worthy person, and that they deserve to see a doctor. What their parents thought, or whether doctors are asses has nothing to do with it.

This particular example struck a nerve with me, because it’s very close to an issue that I have dealt with using CBT.

On preview, I see that jsgoddess has made the same point.

Agree with jsgoddess and SpoilerVirgin. I have used CBT techniques to help deal with some of my social anxiety issues (among other things), and the source of the social anxiety is basically irrelevant. The important thing is identifying thought patterns and beliefs that have no basis in reality and replacing them with reality-based thoughts. That’s probably ultra-simplified, but that’s how I think about it.

This, a thousand times this. We live in universes made solely of are own perceptions. I can think of so many times my thinking, and emotions distorted my perceptions of things, and I was the worse for it.

To add to the above, not all of the CBT takes place in your head. You’re assigned what my therapist called “experiments” between sessions in order to test your beliefs. I too had social anxiety and one of these experiments was walking into a crowded coffee shop to see if my presence there would really be all that strange or offensive to the other people.

It sounds simplistic, but it does have a way of shutting up the nagging doubts that make it so hard to talk yourself into a healthier frame of mind. There’s also the desensitization factor: lots of practice facing your demons in manageable doses.

Congitive therapy eh? Well, it was a long time ago, but I remember a long line and lots of dancing…

This sounds interesting, but can somebody provide an example that may work with insomnia? It’s hard to wrap my head around this applies to “hyper-arousal”, even though it sounds like it makes a ton of sense for other mental processes.

Let’s say that I am trying to sleep but instead of gracefully nodding off, I can’t stop thinking about how cute puppies are (this is one of the things that keeps me awake, believe it or not). What processes could I go through to stop being excited about thinking about the puppies and get back to falling asleep?

It kinda sounds like CBT would teach you to realize that no matter how much you think about how cute puppies are, your thinking about it will change nothing about said cuteness. Therefore it is not worth thinking about at a time when you should be doing something else that does help you fall asleep.


CBT changed everything for me. There isn’t much about it that has been said here about general CBT that I couldn’t say better.

As a fellow sufferer of insomnia, though, I can tell you a bit about what the CBT application would look like. Honestly emphasis is more on ‘‘behavior’’ than ‘‘cognition’’ unless you have serious nighttime anxiety (which I did, but whatever.)

We summarize what we know about sleep research. Sleep is important. We used to think it was pretty important, but now we know that it’s extremely important. Regular sleep deprivation can pretty much knock years off of your life among other things. So, first step is accepting that sleep is important, and that really out of all your problems, sleeping is going to have the greatest positive impact.

There is also a lot of research through the Penn sleep lab indicating that you can’t really ‘‘make up’’ sleep the way we commonly believe. You get the best rest in total darkness (otherwise your pineal gland can’t do its thing), and it’s pretty important that you’re asleep by 11pm because that’s when really interesting things start happening like seratonin production. If you think sleeping 4am to 12pm is the same as sleeping 10pm to 6am, the latest research indicates you’d be wrong. Your brain can’t do what it needs to do unless there is darkness. I had to get a sleep mask which was my least favorite thing because I can’t be hypervigilant with a sleep mask, but YMMV.

Second: Technology keeps the brain awake. So, no more activating activities one hour before bed. You now have a sleep routine. You do the exact same thing every night before bed, whether that’s brushing teeth or taking a bath or having tea or whatever. You go to bed at the same time and get up at the same time every day.

Third: You can put yourself to sleep by gently bringing your mind away from whatever you’re thinking about and by counting backward from 50 as you breathe. You’ll probably be taught a breathing technique. The way my therapist explained it is you basically have to bore your brain into going to sleep. And counting is really boring.

Fourth: If you wake up, don’t get out of bed (this runs contrary to most advice on this matter, but this is what the sleep lab recommends.) Stay put, keep your eyes closed, and go right back to counting. This actually works.

It takes time for this stuff to stick. It took me about 30 days of patiently counting and wearing a sleep mask (the sleep mask took a long time to get used to) and everything before it became second nature. Ever since I started implementing these techniques I have been sleeping regularly and consistently and my anxiety issues have been significantly reduced (in part due to exposure, but it doesn’t sound like you have that issue. I wish to GOD my problem was a fixation on puppy cuteness. I spend most of my insomnia time thinking about being tortured to death with a very sharp knife.) I can now put myself to sleep in short order just by counting.

Anyway, that’s CBT (with emphasis on ‘‘B’’) and sleep.

Probaby the least desirable thing about CBT for a lot of clients is you’re actually expected do something about your problems, not just whine about them for an hour a week in therapy. For some people this is salvation, for others they really struggle to believe they have control of their own lives. My experience was that I struggled to believe at first, but once I began testing it out in the real world I realized I have way more control than I ever realized. Now there is nothing that doesn’t seem possible to fix. And that is why CBT is awesome.

Seeing you say this makes me giddier than a child on christmas morning. You have no idea the extent, but Mithril does

:smiley: :smiley: :smiley: :smiley: :smiley: :smiley:

And this is just icing on the cake.
All in all, your post was a big dose of ‘WOOHOO!’ for me :slight_smile:

Oh, Olives. You just validated my husband’s ideas, and I don’t like it one bit! :smiley:

Actually, I was hoping that you would chime in because you have mentioned CBT a lot. What you discuss is largely what I have heard under the umbrella of “Sleep Hygiene”. I’ve been using them all except for the counting on and off for years. The counting hasn’t worked for me at all.

I’ll try the sleep mask more. It has a history of being on my face at night but not in the morning, so I kind of gave up on it. I’m a squirmer, so it doesn’t stay put.

It’s surprising to hear that there is a school of thought that you should stay in bed if you wake up in the middle of the night, since I have always heard the opposite. My sleep doctor did tell me yesterday that I should cover up my clock after I set the alarm because I don’t *need *to know what time it is and it will only lead to stress. Maybe not knowing what time it is won’t give that little surge of thinking that seems to ruin my nights.

For now, I am on sleep restriction. Hopefully by the time that I start working on the CBT, the sleep restriction will have reset my sleep cycles enough that those activities will work.

I still say ‘ur doin it rong’. Try it for multiple days in a row - not just one night for a brief period of time until you’re bored of it (which is the whole point) and decide ‘nah, that didn’t instantly put me to sleep, so it didn’t work’.

I agree 100% with Olives - counting is excruciatingly boring, and I rarely get to 25 before I’m out, or have dulled my brain enough that I’ve lost count (at which point I have to start over).

You mine as well start trying it on a regular basis to get used to it - because they’ll make you do it!

I’m on the path to righteousness! Woot! :smiley:

Oh, I know all about stupid advice that works. I’m married to a CBT therapist. After the standard, ‘‘Oh, honey, I’m sorry you feel that way…’’ he hands me a negative thought record and a pencil and refuses to leave until I record and refute my irrational congitions! And then I feel better. Which is, of course, the worst part. :stuck_out_tongue:

Yeah, sleep hygiene is sort of the skeleton. At some point your therapist probably will work with any thought patterns that are holding you back, but those are totally dependent on your specific situation. For instance, I had a deathly fear of someone breaking into the house and murdering me. I am particularly sensitive to sounds at night which cause me to bolt upright in terror just as I am drifting off.

During the day, my therapist had me write down my biggest fears and night terrors and investigate whether those were rational claims. So, I started by finding out the murder rate in my neighborhood (it’s 0.) Then she had me listen to the sounds in the house during the day, to get used to what are ‘‘normal’’ house sounds. I began to recognize sounds at night that I usually hear during the day. She also pointed out that the vast majority of break-ins are to steal and that the last thing the thief wants is to run into someone. She said if someone did break in they would probably run away in terror upon realizing someone was in the house. Then she told me a story of a thief breaking into her house who dove head-first through a second-story window to get away from her.

The sleep mask was a hard sell for me. I’m a squirmer too, I didn’t like it, and I especially didn’t like it because I couldn’t just open my eyes and check on the noises I heard. This eventually became an advantage, because checking on the noises was a safety behavior that reinforced my anxiety. After two or three nights laying blindfolded in utter terror it was SO HARD not to look!), I realized the noises don’t mean danger and I’m very rarely anxious at night anymore.

All I can say about the sleep mask is, you get used to it. It used to fall off my face but lately I’ve been tucking the strap underneath my hair and above my ears and I find it stays put. Now I feel like I can’t sleep without it.

I know the counting sucks. But after 30 days of sticking to it your brain should take it as an immediate signal that it’s time to sleep. I do it automatically now, half the time I’m not even aware I’m doing it.

Insomnia well and truly sucks. I’m lucky I haven’t had any major problems this summer, it really seems like the sleep hygiene works for me (though I find I don’t need the ‘‘routine’’ as much as the mask and the counting. But no internet before bedtime is a hard and fast rule.) I find my insomnia is worse during major transitional periods. I have already decided to be super vigilant in the weeks leading up to school, as those anticipatory times are the worst for me. I will follow an uber-strict routine and may take sleep meds the few days leading up to that specifically so that the insomnia cycle never gets started.

Slight hijack related to insomnia. I used to have trouble sleeping and would inevitably wake up in the middle of the night, and it would take me at least an hour to fall back to sleep. Then for a completely unrelated reason I got a bite guard. Not one of the soft munchy ones like athletes wear, but the kind that the dentist makes for you specially. Instantly, I stopped waking up in the middle of the night. Just totally stopped. The second morning, I said something to Prince Charming, and he’d noticed it as well. It was a completely unexpected side benefit. I wish I’d done it much sooner.

My point? If you have insomnia, teeth grinding might be something else to check.

Good advice on the CBT here so far (I used it on very effectively on my anxiety disorder). I’ll also put in my usual plug for mindful meditation for sleep problems. Like the counting Olives has mentioned, I’ll take a couple of mindful breaths (doing nothing but paying attention to my breathing - no thinking allowed!), and I’ll be back asleep, after a lifetime of the form of insomnia where you sleep for a couple of hours then wake up and toss and turn the rest of the night. Like the CBT, it is also very useful for getting control of your wayward mind.