Clinicians

A few words about Insomnia

I remember my mom coming home from a sleep disorders center in our hometown in disbelief: "They don't treat insomnia!" We were baffled at what appeared to us to be a paradox. (We didn't know there were sleep disorders other than insomnia.) At the time I wanted to be a writer when I grew up. But this incident with my mother was foreshadowing as I am now a clinical psychologist and behavioral sleep medicine specialist. Now, in 2009, many sleep disorders centers have behavioral sleep medicine specialists on staff who treat insomnia. And, these types of specialists can be found in other settings as well (like RICBT!).  The take-home message is that sleeping pills are not the only treatment for insomnia. Here is a bit more information about CBT versus medication for insomnia:

Rarely should sleep medication be the first or only line of defense for treating chronic insomnia. Most sleep medications are primarily intended for short-term use, and chronic use can lead to hypnotic-dependent insomnia (Nau, McCrae, Cook, & Lichstein, 2005) Hypnotic-dependent insomnia is characterized by increased bouts of sleep problems during periods of high tolerance to sleep medication. Withdrawing sleep medication (in hopes of at least restoring sleep patterns to baseline levels) is usually problematic because of psychological or physiological dependence or both. Fortunately, cognitive-behavior therapy for insomnia (CBTI) – combined with gradual sleep medication withdrawal or used alone – is generally effective in treating hypnotic-dependent insomnia (Nau et al., 2005). Despite their flaws, sleep medications usually improve sleep relatively quickly and are readily available. Sleep medication is the most common intervention for sleep problems across ages (Nau, McCrae, Cook, & Lichstein, 2005). Furthermore, there is evidence that, short-term, there seems to be no incremental effectiveness of combining psychological and pharmacological treatments; they are equally effective either alone or in combination. However, for a sustained treatment effect, CBTI or a combination of CBTI and medication may be more effective than medication alone. ~Stone, Booth, & Lichstein, 2008

Now is the Time

That which we are, we are,

and if we are ever to be any better,

now is the time to begin.

~Alfred Lord Tennyson

Why come to therapy? Come to therapy because you want to change. Through my work I have been amazed at the capacity of the human being to change. It is incredible. I have learned that the walls closing in on us are not permanent and inescapable. Changing is hard. Changing is possible. . . And changing is empowering.

One type of cognitive-behavioral therapy that takes complete advantage of this human capacity to change is called ACT (Acceptance and Commitment Therapy). ACT encourages us to stop using our thoughts and feelings and to start using our values as the guide for how to act. Some of the most powerful and observable examples of this change process occurs with couples. . . with people who are committed to the relationship. When they begin the work, they are at the point of wondering if the relationship is "meant to be." Through the change process, they begin to understand how their values are aligned, how important their value to be together is to them, AND HOW THEY CAN CHANGE ANY BEHAVIOR INTO ONE THAT WILL HELP THE RELATIONSHIP. Anything. And the walls that had seemed so permanent shift.