THE 3 STAGES

CBT-I can be broken down into three parts: cognitive interventions, behavioural interventions and psycho-educational interventions. Working with a trained CBT therapist, you will explore the connection between your thoughts, behaviours and how you sleep. Here’s what these approaches involve...

1 COGNITIVE INTERVENTIONS

‘The cognitive part of CBT-I helps us let go of the unhelpful thoughts that can trigger stress and sleep anxiety and keep us awake,’ explains Dr Gillihan. The main technique is cognitive restructuring, which is a simple three-step process:

1. Notice your distressing thought.

2. Evaluate whether it’s accurate.

3. Consider alternative thoughts. For example:

1. ‘I’m never going to fall asleep.’

2. ‘Actually, I always fall asleep at some point.’

3. ‘I may be up for a long time but at some point I’ll get some sleep.’ ‘This process helps us stop the common catastrophic thinking when we’re not able to sleep, because we’re prone to seeing the worst in the sleepless hours of the morning,’ explains Dr Gillihan.

‘We can also challenge common thoughts like, “I won’t be able to function tomorrow,” (I may be sleepy at times but will get through the day), “I should be asleep by now” (I’d like to be asleep, but nothing says I should be) or, “I have to make myself fall asleep” (more effort just leads to worse sleep).’

2 BEHAVIOURAL INTERVENTIONS

This involves creating new, healthy sleeping habits, which include: >>

allowed. This is critical for lowering night-time awakenings, and helping them sleep through the night.’

3

PSYCHO-EDUCATION

Simply put, this is when your therapist educates you about the importance of good sleep hygiene and is a core component of CBT-I, according to Beverley Blackman, psychotherapist, counsellor and member of Counselling Directory.

‘Good sleep hygiene involves increasing practices that encourage and support sleep, while decreasing or eliminating those that discourage sleep,’ says Beverley. This may include: ✢ Avoiding caffeine after lunchtime ✢ Keeping your bedroom quiet, cool and dark ✢ Not using alcohol to help you fall asleep ✢ Creating a wind-down routine.

Linked with the cognitive and behavioural interventions, you should gradually start to change your bedtime routine, which will eventually become a habit.

‘Once both mind and body come to understand what to expect from a wind-down routine, and you have new levels of control over [intrusive thoughts], a client can start to relax and fall asleep more quickly and naturally,’ says Beverley. But as with all CBT-I, it requires commitment, focus and repetition to be effective.