New @ NYCCT: COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA

Noah Clyman, LCSW-R of NYC Cognitive Therapy has completed CBT-I training and demonstrated proficiency in the CBT-I program that was developed by Dr. Greg D. Jacobs and tested at Harvard Medical School. 

COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA

Over 50% of adults now complain of difficulty sleeping, half of these chronically. We now know that sleeping pills are not the solution to insomnia and that it is possible to successfully treat insomnia using cognitive-behavioral therapy (CBT). CBT has been endorsed by the National Institutes of Health as an effective and preferred method for treating insomnia.

Research on CBT shows the following:

* 75% of insomnia patients experience significantly improved sleep

* The majority become normal sleepers

* 85- 90% reduce or eliminate sleeping pills

* CBT is more effective than sleeping pills

Did you know? Sleeping pills fail to treat the causes of insomnia, which are thoughts and behaviors. By treating only insomnia’s symptoms, any improvement in sleep can only be temporary, thereby perpetuating the cycle of insomnia and sleeping pills. This cycle can become a trap that can lead to dependency. Many patients are aware of the drawbacks of sleeping pills and prefer non-drug approaches to managing insomnia but don’t know how to escape their reliance on sleeping pills. Even if the ideal sleeping pill were developed-one that had no side effects and that produced natural sleep-it would still reinforce the belief that the cure for insomnia comes from something external; and, it wouldn’t treat the causes of insomnia, which are thoughts and behaviors. So sleep may improve while taking a sleeping pill, but as the pill is stopped insomnia usually returns.

Did you know? The success of CBT is based on a central theme: insomnia can only be treated by addressing all of the underlying causes. In most instances, the causes of insomnia are thoughts (cognitions) and behaviors (habits) which are learned and can be unlearned. Some examples include:

*negative, distorted thoughts and beliefs about insomnia,

*feeling of loss of control over sleep,

*inadequate exercise or exposure to sunlight,

*going to bed too early or sleeping too late,

*trying to control sleep rather than letting it happen,

*lying awake in bed, frustrated and tense.

5 Sleep Behavioral Skills to DRAMATICALLY Improve Sleep

1. Establish a regular arising time: To promote a regular arising time, pair it with a pleasurable activity: walk the dog, read the newspaper, exercise or take a morning walk, etc. By establishing a consistent arising time, you will fall asleep and stay asleep more easily, and sleep more deeply. This will improve sleep efficiency and make the bed a stronger cue for sleep.
2. Establish a relaxing wind-down routine during the hour before bed (reading, “neutral” television, or a hobby as opposed to problem solving, computer work, finances, work-related activities, phone calls, “negative” tv). However, don’t become so sedentary during the wind-down period that drowsiness occurs. Use physical activity and light to ward off fatigue and drowsiness and don’t be a “couch potato.” Avoid computers the hour before bed and during the night since the light exposure may promote wakefulness.
3. Break habits that make the bed a cue for wakefulness. Poor sleepers have often lain awake for so many nights that the bed and bedroom have become strong cues for sleeplessness! As a result, just getting into bed triggers a learned arousal response and wakefulness. In fact, it is not uncommon for insomniacs to find themselves falling asleep in front of the television in the living room, yet when they get into their bed to go to sleep, they become wide awake because the bed has become such a strong cue for wakefulness.
4. Develop habits to associate the bed with drowsiness: Practice identifying the internal cues for drowsiness (eyelids dropping, head nodding, yawning, reading the same line in a book several times) rather than relying on external cues such as the clock, a bed partner’s bedtime or the end of the evening news.
5. Follow the half hour-half hour rule. If patients don’t fall asleep within 20 or 30 minutes, or if they awaken during the night and don’t fall back asleep within 20-30 minutes, they should not lie in bed tossing and turning (since focusing on the clock only heightens anxiety about falling asleep, the 20-30 minute limit should be estimated). Instead, they can go into another room and engage in a quiet, relaxing activity such as watching television, reading a book, magazine, or catalog until drowsy, then attempt to go to sleep again.

7 Lifestyle Considerations to DRAMATICALLY Improve Sleep

1. Alcohol: suppresses deep sleep and dream sleep and exacerbates snoring. Alcohol in the evening should be limited to two drinks and not after 7 pm.
2. Caffeine: disrupts sleep because it produces stimulant effects (faster brain waves, heart rate, etc.) that can persist for up to eight hours in sensitive people. Caffeine should not be consumed after 3:00 pm; total daytime use should be limited to two cups.
3. The Food-Sleep Connection: Those who desire to fall asleep more easily should eat a high carbohydrate snack and avoid high protein foods the hour or two before bedtime. Those who desire to minimize nighttime awakenings should eat a carbohydrate snack immediately before bedtime, which will increase serotonin levels during the night and help one stay asleep. Having a light carbohydrate snack before bedtime will also ensure that sleep isn’t disturbed due to hunger.
4. Role of exercise: Moderate physical activity (lawn work, taking stairs instead of elevators, walking) and vigorous aerobic activity improve sleep by promoting greater rise and fall in body temperature that persists for up to five hours. This greater rise and fall in temperature can make it easier to fall asleep and stay asleep. The beneficial effect of exercise is greatest when exercise occurs within three to six hours of bedtime. Try to engage in 20-30 minutes of physical activity at least every other day to improve sleep.
5. Room temperature: A cooler room will improve sleep by producing a drop in body temperature. In constrast, a warm room will inhibit the drop in body temperature and impair sleep. (Have a spouse or bed partner use an extra blanket if they prefer a warmer room).
6. Baths: A hot bath before bed will improve sleep. Must be kept hot for 25 minutes and should be taken about two hours before bedtime. (A great way to relax and a good substitute on days when you can’t exercise).
7. Noise: White noise (the sound of a fan, air conditioner, or commercial white noise machine) masks noise, is relaxing to the brain, and can make it easier to fall and stay asleep.

CBT COMPONENTS

Techniques taught in CBT include:

* changing sleep thoughts and behaviors

* lifestyle habits that improve sleep

* relaxation techniques

WHO WOULD BENEFIT

* individuals with problems falling asleep or waking during the night

* individuals who wish to reduce or eliminate sleep medications

To Get Started Using Powerful CBT Methods to Conquer Your Insomnia, Call us at 347-470-8870, email info@nyccognitivetherapy.com, or visit our website, NYC Cognitive Therapy. 

Free training: Using Cognitive Behavioral Therapy for Recidivism with Court-Involved Youth

CBT and Mindfulness for addictions group – now forming

aod-flyer

Cognitive Behavioral Therapy (CBT) has been proven across many clinical studies to be effective in helping people treat issues related to substance use. CBT addresses unhelpful thought patterns and maladaptive behaviors, while the group format provides an opportunity for secure human connection, all of which are part of the underlying causes of addiction. Mindfulness is an evidence-based approach for reducing distress, coping with difficult emotions, and overcoming wounds of the past. If you are struggling with addiction and recovery, this group can give you both concrete tools for dealing with addiction and a confidential place to discuss your difficulties.

New articles about CBT: Relationship to Buddhism; Effectiveness versus Medications

Hello friends,

Follow this link to the “About CBT” tab on our website. When you scroll to the bottom of the page you will see three new articles about Cognitive Behavioral Therapy to enjoy.

• Buddhism and Cognitive Therapy
• Cognitive Therapy for Depression May Be More Effective
• Research Shows CT Superior for Social Phobia

Post on the forum with your comments and questions. What did you learn? Also, are there articles you would like to share for the NYC Cognitive Therapy library?

Best, Noah

NYTimes: The Year of Conquering Negative Thinking

Enjoy!

http://www.nytimes.com/2017/01/03/well/mind/the-year-of-conquering-negative-thinking.html?smid=nytcore-iphone-share&smprod=nytcore-iphone

Constant negativity can get in the way of happiness, but with practice, you can learn to disrupt and tame negative cycles.

—

3 Simple Steps to Outsmart Anxiety

Step 1: Label your anxiety as a false alarm

Fear and fight-flight-freeze response are basically good. They were designed to keep you alive. We run into problems when the fight-flight-freeze response misfires. Think of it as being similar to a car alarm: you want the alarm to sound when someone tries to break into your car, but you don’t want the alarm to go off when a strong wind blows or a bird lands on the car’s roof. When your car alarm goes off too easily, it is too sensitive. Yes, it will let you know when someone is trying to steal your car, but it will also go off at the wrong times. So even though in reality there is only a strong wind, the alarm reacts as if someone is breaking into your car.

People who have excessive fears have an internal alarm system–the fight-flight-freeze response that is too sensitive. The object of your fear–whether it is flying, public speaking, dirt, the dark, or something else–is like the strong wind, and your internal alarm system reacts as if it were really threatening. When your car alarm acts this way, it needs to be fixed or recalibrate. Similarly, when your internal alarm–your fight-flight-freeze response–is overly sensitive, you have to retrain it. The first step is noticing it and labeling it as a false alarm.

Step 2: Catch your anxious thoughts

Father of Cognitive Behavioral Therapy (CBT), psychiatrist Aaron T. Beck, pointed out that people become anxious not merely because of the feared object or situation, but also because of the particular thoughts or beliefs they have about the object or situation. For example, instead of saying, “This airplane flight scares me,” it would be more accurate, according to Beck’s theory, to say, “I feel scared because I am telling myself that this airplane is going to crash.” It is my thought process, not the airplane itself that scares me.

When are beliefs are completely rational and proportional to real danger, the system works just fine. Unfortunately, the cognitive system can sometimes misfire in which case our threat-related thoughts or beliefs tell us than an object or situation is more dangerous than it actually is. When thought processes go wrong, they tend to do so in predictable ways, and fearful people make the same mental errors (which Beck termed cognitive distortions) over and over again. 

Step 3: Recognize your tendency to probability overestimate a bad outcome

One common cognitive distortion is probability overestimation: believing a bad outcome or event to be more likely to occur than it actually is. For example, if you had asked me, in the middle of a turbulent flight, what the probability of a plane crashing is, I might have said that there was a 25 percent chance of a crash. Of course, now that I’m off the plane and can think about it a bit more rationally, I realize how illogical my thoughts were: if there was a 25 percent chance of a plane crashing, that would mean one out of every four planes crashes. There would be planes falling out of the sky all over the place! In reality, the odds of being in a plane crash are about 1 in 11 million. So my belief about the likelihood of a plane crash was extremely exaggerated. In fact, if my thought process had been based on actual probabilities, I should have been much more afraid of the drive to the airport than the flight, because the odds of dying in a car crash are a thousand times greater than those of dying in a plane crash. Come to think of it, because the leading causes of death (by a huge margin) are heart disease, stroke, and cancer, maybe I should be most afraid of the burger and fries I had at the airport while waiting for my plane!

Take-home message: When anxious, ask yourself (and write down):

(1) Catch it: what upsetting thought or image am I having right now?

(2) Check it using helpful questions: am I engaging in the cognitive distortion of probability overestimation? what is the evidence that I am magnifying the likelihood of a bad outcome? what good things might happen?

(3) Change your thought: Record the actual probability of your feared scenario, 0-100%? And summarize what you learned.

New CBT workshops in NYC for clinicians – Register now

TBCT Workshops Flier

Trial-Based Cognitive Therapy (TBCT) is a three-level, three-phase, case formulation approach developed by Dr. Irismar Reis De Oliveira at the Federal University of Bahia, Brazil in 2011. TBCT’s foundation is in Cognitive Therapy.  

Like CBT, TBCT is an active approach to treatment that helps clients to recognize situationally based thoughts and unhelpful beliefs that exacerbate emotional distress. One of the main goals of both approaches is to help clients modify the so-called core beliefs (CBs) which are those global, rigid, and over-generalized perceptions about themselves, and accepted as absolutely true to the point that they do not question them. However, TBCT has a unique approach to conceptualization and techniques that make it a distinct intervention in modifying clients’ CBs.

• One of the main techniques used in TBCT is the Trial-Based Thought Record (TBTR or Trial I), a structured strategy that is presented as an analogy with Law, in which the therapist engages the client in a simulation of the judicial process. Inspiration for this technique came from the surreal novel by Franz Kafka, The Trial; in the book, the character Joseph K., for reasons never revealed, is arrested and ultimately convicted without even knowing the crime of which he was accused. The TBCT therapist uses a creative and stimulating process to make clients aware of their core beliefs about themselves (self-accusations) and, differently from Joseph K’s process, engages them in a constructive trial to develop more positive and functional beliefs.