Over the years as a cognitive behavioral therapist, I’ve worked with numerous clients who are struggling with sleep. At first they start the conversation with, “I’m really upset about an argument with my spouse,” or “I’m here because I want to stop being so anxious.” Sleep is not the first thing on their mind when they walk into my office, but it probably is by the time they leave.
Insomnia is an epidemic that receives far too little attention. It is estimated that 60 million Americans struggle with insomnia at any given time. That equates to about one of every five adults, and that number tends to rise with age.
Sometime during 2013, a colleague handed me a book called Cognitive Behavioral Treatment of Insomnia. I was hooked. It amazed me how straight-forward the treatment of insomnia could be, and how effective the method is. Word got out, and before I knew what was happening, I was inundated with clients who wanted to see me exclusively for sleep problems. The waiting list was upwards of three months long. It was time to expand on this untapped need.
On May 1st, 2018, the Behavioral Sleep Solutions program will launch. The ultimate goal of this program is to be able to provide effective evidence-based treatment of insomnia to the greatest number of clients in need. Accomplishing this will take a combination of individual sessions, groups, and the assistance of well-educated and supervised student interns.
With a treatment protocol that is as rigorously tested and effective as CBT for insomnia, there is no reason anyone should continue to suffer through sleepless nights. For more information about the Behavioral Sleep Solutions program, please see the Behavioral Sleep Solutions page.
Written by: Erin Shadle, LCSW
One of the main components of cognitive behavioral therapy (CBT) is learning to recognize flaws in our thinking, or cognitive distortions. If you’ve ever looked at yourself in a funhouse mirror, you may already know more about cognitive distortions than you realize. When you see yourself in that mirror, is that really you? Are those your eyes? Is that your nose? Are those your feet? Yes, of course! The problem is that it is not an accurate reflection of you. It is a distortion of reality.
Our thoughts have a way of playing tricks on us and causing us to see problems that may not actually be there. Most of us have made assumptions about what another person may be thinking, or predictions that a future event will go horribly wrong. These thoughts often cause great distress in the form of anxiety, fear, or sadness. It becomes hard to feel good if we truly believe a person dislikes us based on the tone of their voice, or if we expect to fail at an important task.
Once we have been hurt by a situation once, the mind has a way of predicting that we will get hurt again in similar situations. This tends to lead to the development of patterns of negative, or distorted thinking. For example, if I once lost a job after being called into an unscheduled meeting with my supervisor, I may feel a sense of dread or anxiety any time in the future I am called into a meeting. This dread may persist despite only one of numerous meetings leading to termination of my job. My mind has created expectations based on one bad past experience.
In general, the mind seeks to protect us from harm, hence the development of these expectations. If I was hurt once in the past after being called into a meeting, my mind wants to protect me from getting hurt again, and thus triggers a sense of fear or anxiety in similar future situations. When the mind senses danger, it causes us to feel anxious or afraid, and asks us to take action to ensure our safety. If we do not feel those emotions, we may not recognize that we are at risk. Unfortunately, this warning system can often be misleading and cause us to perceive threat where there is none.
It can be very helpful to catch ourselves in distorted thinking. For some, the act of acknowledging that a thought could be inaccurate is enough to ease distress. We can accomplish this by noticing the thoughts that cause distress in the first place, then asking “How do I know that’s true?” In the example of having a meeting with a supervisor, I realize that I simply do not know why my supervisor requested a meeting, therefore there is no guarantee that I have done something wrong. That warning system may still be activated, but I may no longer feel it as intensely.
The next step in handling cognitive distortions is to find a way to test them. In this case, going to the meeting and finding out what the supervisor wanted to discuss. Once I know I am not in trouble, I can relax. For some, challenging cognitive distortions is a process that requires repetition and practice over time. In future entries, we will explore in more detail different types of distorted thinking and how to reframe them in ways that are closer to accurate reflections of reality.
For more information, contact us at 828-350-1177.
Cognitive behavioral therapy (CBT) differs from the the stereotype of talk therapy. Unlike many traditional talk therapies, CBT is designed to be a short-term process focused on learning skills to practice and apply. It combines awareness of unhelpful or inaccurate thinking with individually tailored practice work. Though everyone is different and some will take longer than others, many people notice improvements in how they think and feel within two to three months of consistent CBT.
CBT is used in the treatment of a variety of problems, the most common of which are anxiety and depression. Though this is not an exhaustive list, other applications include bipolar disorder, obsessive compulsive disorder, life stress, relationship struggles, problems with body image, addictions, and even sleep disorders.
The word “cognitive” refers to your thoughts. CBT often begins with the therapist assisting you in identifying which thoughts you are having that are causing you emotional pain or distress. Once you learn how to catch yourself when you think those thoughts, you then have the opportunity to second guess or outright change them. For some, this awareness alone is enough to drastically improve their wellbeing.
Imagine you see a friend walking down the street in your direction. You wave to him, but he passes by without stopping to acknowledge you. What might you think about what just happened? Some people may think, “he must be really angry with me.” Believing someone is angry with you could lead to distress. A CBT therapist might explore this thought further by asking what it would mean to you if that person truly was angry. For someone experiencing depression or anxiety, you might say “if someone is angry with me, I must be a bad person.” This could certainly be an upsetting thought.
Cognitive behavioral therapy teaches how to take a second look at those thoughts. Where is the flaw in the thinking that the friend is angry because he did not wave back? What else could have been going on that you may not know about? Ultimately what we find is that we do not know what a person is thinking unless they specifically tells us. Recognizing this and other similar common flaws is a central component of CBT. We often refer to these flaws as cognitive distortions.
The next step brings you to the behavioral component of CBT. Once you begin catching yourself when you experience cognitive distortions, you have a choice: Do I react to this thought as if it were true, or do I find a way to challenge the thought? If the thought were true, you might avoid the friend; however, CBT would suggest finding a way to verify what that friend was truly thinking. Perhaps a phone call to ask how his day was going could offer some important information. That friend could have received bad news and was distracted, or was late to an appointment and failed to notice you.
Challenging our thoughts helps us transition from “head knowledge” to “heart knowledge.” We can know in our thoughts that we do not know what a person is thinking, but until we hear it straight from them, we may still feel worried or upset. Experience is often the most powerful and effective way to learn.