Combining Stimulus Control Therapy & Sleep Restriction Therapy
In the last section, we discussed two behavioral interventions for insomnia. The two behavioral interventions for insomnia that we discussed were stimulus control therapy and sleep restriction therapy.
In this section, we will discuss combined stimulus control therapy and sleep restriction therapy, as well as two additional behavioral interventions for insomnia. The two additional behavioral interventions for insomnia are relaxation therapies and cognitive therapy. As you listen to this track, you might consider if it is appropriate for use with a client who has insomnia.
Combined Stimulus Control Therapy & Sleep Restriction Therapy
First, let’s discuss combined stimulus control therapy and sleep restriction therapy. If you recall the two behavioral interventions for insomnia from the last track, you already know how similar the two methods are. You may also already know that it can be productive to combine stimulus control therapy and sleep restriction therapy if, after four to six weeks, your client’s progress hasn’t reached an optimal level. I have found that each intervention is generally effective on its own, but that a combination can be useful in the following situations.
2 Situations that Combined Therapies can be Useful:
If your client begins stimulus control therapy, but finds themselves repeatedly getting out of bed, he or she may be allowing too much time in bed. Would you agree that this would be an appropriate time to apply sleep restriction principles? You might consider suggesting to your client that he or she reduce the average total nightly time he or she spends in bed to maximize the results from stimulus control therapy.
Another situation in which combined stimulus control therapy and sleep restriction therapy can prove beneficial is if your client begins with sleep restriction and finds themselves awakening frequently during the sleep period. Stimulus control methods can then be used to restrict waking periods in bed to ten or fifteen minutes.
Think of your client. Could he or she benefit from combined stimulus control therapy and sleep restriction therapy?
4 Behavioral Interventions for Insomnia (#3 & #4)
Intervention #3: Relaxation Therapies
Next, let’s examine relaxation therapies. What types of relaxation therapies do you use with your clients? I have found that everything from meditation, yoga, and tai chi to Stroebel’s Quieting Response, deep breathing, muscle relaxation, and guided imagery can work. How do you decide which relaxation therapy to use with your clients?
I have found that it can be difficult to predict which relaxation therapy might work best due to varying individual responses among clients. Perhaps you can start with a simple technique, like deep breathing, and progress if necessary to a more complex relaxation therapy. I prefer to discuss various techniques with clients and allow them to choose.
Intervention #4: Cognitive Therapy
Third, in addition to combined stimulus control therapy and sleep restriction therapy and relaxation therapies, let’s discuss cognitive therapy. As you already know, cognitive therapy works by replacing maladaptive cognitions with more positive and realistic thoughts. For example, Jeff, age 52, sought treatment due to a progression in sleeplessness which was later diagnosed as insomnia. In one of our sessions, Jeff stated, "I think maybe it’s getting harder to sleep because I’m getting older."
What do you think Jeff’s underlying belief was regarding this statement? Clearly Jeff was making a connection between his sleep problems and aging. Jeff’s conclusion was that insomnia, like growing old, was unavoidable. How would you have worded a response to Jeff to implement cognitive therapy? I stated, "Jeff, aging can change your sleep. However, aging does not make it impossible to sleep well. Insomnia is not an inevitable effect of aging."
Think of your Jeff. What maladaptive cognitions does your client have? What would be a good adaptive and realistic thought for your client?
In this section, we have discussed combined stimulus control therapy and sleep restriction therapy, as well as relaxation therapies and cognitive therapy.
In the next section, we will discuss circadian rhythms. In addition to how circadian rhythms work, we will also discuss realigning circadian rhythms and altering circadian rhythms with light.
Peer-Reviewed Journal Article References:
Ashworth, D. K., Sletten, T. L., Junge, M., Simpson, K., Clarke, D., Cunnington, D., & Rajaratnam, S. M. W. (2015). A randomized controlled trial of cognitive behavioral therapy for insomnia: An effective treatment for comorbid insomnia and depression. Journal of Counseling Psychology, 62(2), 115–123.
Colvonen, P. J., Drummond, S. P. A., Angkaw, A. C., & Norman, S. B. (2019). Piloting cognitive–behavioral therapy for insomnia integrated with prolonged exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 107–113.
What are two additional interventions for insomnia?
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