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Psychotherapy and Insomnia

By: Jennie Kermode - Updated: 19 Aug 2012 | comments*Discuss
Psychotherapy Cognitive Behavioural

After decades of trying to manage insomnia with drugs, doctors are waking up to the possibility that psychotherapy may be a more effective option for many patients. Increasingly, research studies are showing that cognitive behavioural therapy (or CBT) can help insomniacs break away from problem sleep patterns and reset their body clocks.

Who Can Psychotherapy Help?

Psychotherapy is a potentially effective treatment for insomnia that has a primarily psychological cause. It can also help with insomnia caused by pain, as it can teach the body new ways of responding to pain and can break the link between pain and sleep disruption.

Unfortunately, you are unlikely to benefit from psychotherapy if your insomnia has a primarily physical cause, such as a brain injury, a hormone imbalance or a serious underlying health problem. In some cases, however, doctors recommend CBT as an add-on to drug based treatment, boosting its overall effect.

Psychotherapy doesn't work for everyone, but the statistics are good. A plus point is that it doesn't have the problematic side effects often associated with drug-based treatment.

How Does CBT Work?

The principle of CBT involves changing routine behaviour patterns to better cope with circumstances. Often we can become set in our ways, and this can happen just as easily with ways we don't much like. CBT for insomnia aims to change our sleep habits.

This treatment usually begins with the therapist encouraging the patient to develop positive feelings about sleep. Often insomnia is reinforced by a feedback mechanism - when we go to bed expecting to be frustrated and sleepless, we feel stressed, which stops sleep from happening. CBT helps to relieve these feelings of stress and restore calm.

Also important to CBT is restoring a healthy pattern of sleep. This can mean getting up at the same time each day regardless of how little sleep you may have had, and adjusting your use of your bedroom so that you're only in there when you're sleepy. This teaches your body to associate the bedroom with sleep and makes sure you'll be properly tired when you go to bed. Because the therapist provides the rules, you won't have the extra stress of self-discipline,

Other Forms of Psychotherapy

Several other forms of psychotherapy have shown some degree of success in treating insomnia:-

  • Progressive muscle relaxation - this approach to treating insomnia combines breathing exercises with a process of tensing and relaxing particular muscles, encouraging full physical relaxation in conjunction with a psychological association with sleep.
  • Guided imagery - related to meditation, this treatment teaches you to put yourself into a trance by focusing on a particular stimulus (which can be visual or auditory). It helps to drive away distracting thoughts and condition the body for sleep.
  • Hypnotherapy - this involves being placed in a state of extreme relaxation by a therapist who will then teach you to associate particular stimuli, such as the sight of your bed at night, with feeling sleepy.
How to Access Therapy

If you are a British citizen and suffer from severe or chronic insomnia, you will usually be eligible for psychotherapy on the NHS. Unfortunately, due to a shortage of practitioners, the waiting list can be several months long, so this is not the best option for everybody.

There are many privately operating therapists, some in specialist clinics, who offer treatment for insomnia. Not all of these people, however, are as well qualified as they may appear to be. The best way to make sure you get a good therapist is to ask your doctor for a recommendation. If a therapists says they are licensed, look up the licensing body to make sure it's one you approve of.

Most people who find psychotherapy helpful for treating their insomnia do not need more than a few weeks of treatment, but it's important to follow your therapist's recommendations and complete the course to be sure of lasting results.

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