CBT

#Insomnia #CBT #PTSD

Post-Traumatic Stress Disorder(PTSD) is characterized by a chronically heightened state of arousal after a traumatic event. PTSD often gets worse over time or develops insidiously, so that people may not realize they have it until many months after the traumatic event. The disease is more common in women, though it can happen to anybody. An estimated seven people out of 100 will experience PTSD during their lifetime.

PTSD and sleep have a complex relationship. Though sleep problems accompany many mental health conditions, sleep problems in PTSD are actually considered part of the disorder. Among the symptoms used to diagnose PTSD, two are directly related to sleep: hyperarousal and intrusion, which can manifest as insomnia and nightmares. Researchers are still trying to understand whether sleep problems precede PTSD or whether PTSD causes sleep problems.

Individuals with PTSD frequently have trouble falling asleep and awaken easily, often waking up many times throughout the night. Many people with PTSD also have nightmares. These issues result in disrupted, non-refreshing sleep.

Those with chronic pain, substance abuse, traumatic brain injury, depression or other medical problems face an additional barrier to getting quality sleep. Certain sleep medications also interfere with REM sleep, which is the sleep stage during which we dream and an important sleep stage for dealing with traumatic memories.

You can refer to this:

resiliens.com/resilify/program/cognitive-behavioral-therapy-...

Kind of an inflammatory headline in my opinion 😅

As it could be read as: 'stop taking #antidepressants immediately as they don't help chronic pain AT ALL'.

When rather the review is suggesting:

A) Antidepressants have been prescribed for chronic pain for years and STILL there seems to be no clear or concrete understanding into how they help the pain of chronic pain sufferers.

B) Confusion into whether antidepressants do help the pain aspect of chronic pain.

C) As many suffers have [very unstandably] mental health issues they could be helping that. Making pain management easier 🤔

C) Which antidepressants is concretely better for chronic pain.

Article found here:
'Shocking' lack of evidence on antidepressants for chronic pain

Another wonderful day for chronic pain sufferers🙃

I joke.

It is better to have this awareness and recognition that ultimately MORE RESEARCH, DONE MUCH LONGER is urgently needed.

However, I do feel like articles like this arm those who are very anti-antidepressants. The NHS is definitely trying to move away from prescribing medication in general for chronic pain sufferers.

(In my opinion) though I believe this is more a money saving move than a research influenced change of course. As soon as I see CBT as an alternative I feel vindicated 😆

For those who aren't aware the NHS (largely to save money) prescribes CBT for literally EVERYTHING nowadays 🥲😔

#ChronicPain #Fibromyalgia #ChronicFatigue #Depression #Anxiety #MentalHealth #IrritableBowelSyndromeIBS #CBT #Agoraphobia #AgoraphobiaWithoutHistoryOfPanicDisorder #FunctionalNeurologicalDisorder #BackPain #Jointpain #AuditoryProcessingDisorder #BladderIncontinence #InterstitialCystitis #Insomnia #Asthma #Prediabetic #HearingLoss #hippain #dissociation #NHS #Nice

#Insomnia #CBT #SleepDisorders

Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.

Stay active. Regular activity helps promote a good night's sleep. Schedule exercise at least a few hours before bedtime and avoid stimulating activities before bedtime.

Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also check the labels of OTC products to see if they contain caffeine or other stimulants, such as pseudoephedrine.

Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can't get by without one, try to limit a nap to no more than 30 minutes and don't nap after 3 p.m.

Avoid or limit caffeine and alcohol and don't use nicotine. All of these can make it harder to sleep, and effects can last for several hours.

Don't put up with pain. If a painful condition bothers you, talk to your doctor about options for pain relievers that are effective enough to control pain while you're sleeping.

Avoid large meals and beverages before bed. A light snack is fine and may help avoid heartburn. Drink less liquid before bedtime so that you won't have to urinate as often.

At bedtime:

Make your bedroom comfortable for sleep. Only use your bedroom for sex or sleep. Keep it dark and quiet, at a comfortable temperature. Hide all clocks in your bedroom, including your wristwatch and cellphone, so you don't worry about what time it is.

Find ways to relax. Try to put your worries and planning aside when you get into bed. A warm bath or a massage before bedtime can help prepare you for sleep. Create a relaxing bedtime ritual, such as taking a hot bath, reading, soft music, breathing exercises, yoga or prayer.

Avoid trying too hard to sleep. The harder you try, the more awake you'll become. Read in another room until you become very drowsy, then go to bed to sleep. Don't go to bed too early, before you're sleepy.

Get out of bed when you're not sleeping. Sleep as much as you need to feel rested, and then get out of bed. Don't stay in bed if you're not sleeping.

You can refer to this:

resiliens.com/resilify/program/cognitive-behavioral-therapy-...

#Insomnia #CBT

Situation

Nighttime silence in the pre-sleep period can facilitate CAAP of internal (body sensation or thoughts) and external (environmental sounds, light, and heat) stimuli. Bootzin and Rider (1997) noted that “bedtime may often be the first quiet time during the day available to think about the day’s events and to worry and plan for the next day.” Therefore, bed and bedtime tend to be cues for arousal rather than for sleep.

Attention Bias

Consciously attended internal and external stimuli develop an individual’s predictions and expectations from the pre-sleep situation. One of the commonly used paradigms for experimental assessment of attentional bias is the Dot-Probe task. In this, a pair of stimuli (e.g., words or pictures) are presented simultaneously at different locations (up/down or top/bottom) on the screen.

The stimuli pair disappear after a fixed time window and a probe appears in the location of emotional (congruent presentations) or neutral (incongruent presentations) stimuli. Subjects are asked to detect and respond to the location of the probe as fast as possible, and the attentional bias is measured through their reaction time in responding to the probe location.

Most of these studies have endorsed the notion that poor sleepers display attentional bias to sleep-related cues compared with controls. Jansson-Fröjmark et al. (2012) used a dot-probe task to demonstrate that individuals with primary insomnia had a considerably prolonged reaction-time when shifting attention away from insomnia-associated pictures paired with neutral pictures, in comparison to neutral-neutral paired picture presentations as control.

Emotional Value

The emotional value gets shaped through the evaluative conditional learning (ECL) mechanism which plays a crucial role in liking and disliking stimuli (Ghodratitoostani et al., 2016a, b). Based on ECL, neutral stimuli (CS) can obtain either positive or negative valence after being repeatedly paired with emotion-laden stimuli (US) (De Houwer et al., 2001). Valence represents emotional states varying along a spectrum, ranging from positive to negative feelings with a neutral center-point (Bradley and Lang, 1994). Based on the CCF, CAAP of both CS and US, and their contingencies are required at the time of EC-learning formation.

Additionally, evaluative conditioning is an accumulative procedure through which different valenced USs can add to CS valence after being repeatedly paired (Stahl and Unkelbach, 2009). Therefore, EC-learning is resistant to extinction so that neither individual CS/US presence alone, nor pairing CS with different USs would cause the extinction of previously shaped evaluative conditioning (De Houwer et al., 2001).

Cognitive Value

The cognitive value related to internal and external stimuli is built through an appraisal process. This process initiates when the meaning of an object or event is evaluated in a particular situation according to pre-existing beliefs, desires, and intentions (Scherer et al., 2001). However, not all information but that relevant to individuals’ concerns (Frijda, 1987), can trigger a cognitively aroused state followed by the appraisal.

Accordingly, attention bias to sleep-preventing cues (as concern-relevant stimuli) can trigger a cognitively aroused state with subsequent appraisals about insomnia, “I am never going to get to sleep,” “I am not coping with the amount of sleep I get,” and “I am going to lose my job” (Harvey, 2002). Negative thoughts through this appraisal mechanism further fuel the negative sleep-related cognitive value, leading to annoyance or distress reaction.

Annoyance-Distress Reaction

Consistent with many cognitive-behavioral studies, the CCF suggests that negative appraisals of insomnia trigger the annoyance-distress reactions. According to the cognitive model of insomnia, excessively negative thinking in the pre-sleep time provokes autonomic arousal, and emotional distress (Harvey, 2002). Tang and Harvey (2004a) have reported that the manipulation of psychological and physiological arousal produces adverse effects on the perception of sleep quality.

For illustrative purposes, Baglioni et al. (2010) presented five blocks showing neutral, negative, positive, sleep-related negative and sleep-related positive pictures to evaluate the psychophysiological reactivity to emotional stimuli, both related and unrelated to sleep, in people with primary insomnia and normal sleepers. facial electromyography, heart rate, and cardiac vagal tone were recorded during the picture presentation.

Distorted Perception

According to the CCF, valence and cognitive-arousal as two components of emotion can affect patients’ judgment about sleep quality perception. The following findings lend support to this proposal.

Yoo and Lee (2015) explored the effect of modulating arousal and valence on time-perception in subjects with social anxiety, comparing the time duration of the presented stimuli with the standard duration in training sessions. The perceived duration of negative-stimuli against positive-stimuli was longer with high arousal, but shorter with low arousal levels, suggesting that modifications in the type and magnitude of both valence and arousal modulate time-perception (Yoo and Lee, 2015). This may also be analogous to the distortion in sleep quality-perception in insomniacs.

You can refer to this:

resiliens.com/resilify/program/cognitive-behavioral-therapy-...

#Insomnia #CBT

‘Sleep hygiene’ refers to healthy habits, behaviours and environmental factors that can be adjusted to help you have a good night’s sleep. Some sleeping problems are often caused by bad sleep habits reinforced over years or even decades. In many cases, you can improve your sleep quality by making a few adjustments to lifestyle and attitude.

Some people resort to medications or ‘social drugs’ in the mistaken belief that sleep will be more likely.

Common pitfalls include:

Cigarettes – many smokers claim that cigarettes help them relax, yet nicotine is a stimulant. The side effects, including accelerated heart rate and increased blood pressure, are likely to keep you awake for longer. Ideally, cigarettes should be avoided altogether, and certainly in the 2-hours before you go to bed.

Alcohol – alcohol is a depressant drug, which means it slows the workings of the nervous system. Drinking before bed may help you doze off but, since alcohol disturbs the rhythm of sleep patterns, you won’t feel refreshed in the morning. Other drawbacks include waking frequently to go to the toilet.

Sleeping pills – drawbacks include daytime sleepiness, failure to address the underlying causes of sleeping problems, and the ‘rebound’ effect – after a stint of using sleeping pills, falling asleep without them tends to be even harder. These drugs should only be used as a temporary last resort and under strict medical advice.

You can refer to this:

resiliens.com/resilify/program/cognitive-behavioral-therapy-...

#Depression #CBT

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (such as thoughts, beliefs, and attitudes) and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems.

Though it was originally designed to treat depression, its uses have been expanded to include the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

CBT is a common form of talk therapy based on the combination of the basic principles from behavioral and cognitive psychology. It is different from historical approaches to psychotherapy, such as the psychoanalytic approach where the therapist looks for the unconscious meaning behind the behaviors, and then formulates a diagnosis.

Instead, CBT is a "problem-focused" and "action-oriented" form of therapy, meaning it is used to treat specific problems related to a diagnosed mental disorder. The therapist's role is to assist the client in finding and practicing effective strategies to address the identified goals and to alleviate symptoms of the disorder.

You can refer to this:

resiliens.com/resilify/program/cbt-for-depression

#Insomnia #CBT

The path to better sleep starts with small changes to lifestyle habits. Establishing routines, getting regular exercise, creating a healthy sleep environment, and changing dietary habits, can positively impact the quality of your sleep. Here are some tips to practice healthy sleep hygiene.

Follow a Consistent Sleep Schedule

Sticking to a consistent sleep schedule by going to sleep and waking at the same time each day not only helps with routine but it also leads to better sleep. The amount of shut-eye you get each night also contributes to a consistent sleep schedule.

Establish a Nightly Routine

Establishing a nightly routine that includes something you enjoy can help you relax and get ready for bed. Whether it’s reading a book, taking a bath, meditating, practicing restorative yoga, stretching, listening to soothing music, or journaling, activities that help calm your body and mind allow you to transition from wakefulness to sleep.

Create a Good Sleep Environment

An optimal sleep environment can help you fall asleep easier. Ideally, this environment should be free of electronics, kept at a comfortable temperature, and dark enough to fall asleep.

Aim to turn off all electronics including phones, TV, tablets, and laptops at least 60 minutes before bed. Turn off or dim all lights in your room, and check that the thermostat is set between 60 to 67 degrees, which is the suggested bedroom temperature.

Incorporate Physical Activity Into Your Daily Routine

Engaging in regular physical activity can improve sleep quantity and quality.8 And if you are an evening exerciser, there’s no need to shift your activity to the morning hours. Research indicates that moderate-intensity exercise performed within 60 to 90 minutes of your bedtime should not affect your ability to sleep.

However, you might notice sleep disturbances if you engage in vigorous activity ending 60 or more minutes before bed. So, save the hardcore workouts for earlier in the day and stick to moderate-intensity activities like yoga, walking, and low-impact swimming before bed.

Pay Attention to Food and Drink Before Bed

Optimal sleep begins with a stomach that is not too full or too empty. Ideally, avoid large meals before bed, especially ones that are high in fat since they have been associated with sleep disorders.

Limit Caffeine Intake

Consuming this stimulant too close to when you want to drift off to sleep can really make it hard to fall asleep. If you regularly drink caffeinated beverages like coffee, tea, or soda, aim to finish them earlier in the day rather than during the evening hours. Caffeine consumed six hours before bedtime can disrupt sleep.

You can refer to this:

resiliens.com/resilify/program/cognitive-behavioral-therapy-...

#Insomnia #CBT

Do:

1. Go to bed at the same time each day.

2. Get up from bed at the same time each day.

3. Get regular exercise each day, preferably in the morning. There is a good evidence that regular exercise

improves restful sleep.

4. Get regular exposure to outdoor or bright lights, especially in the late afternoon and winter.

5. Keep the temperature in your bedroom comfortable.

6. Keep the bedroom dark enough to facilitate sleep.

7. Keep the bedroom quiet and peaceful when sleeping.

8. Use your bed only for sleep.

9. Keep T.V.s, cell phones, and tablets out of the bedroom so they cannot be easily accessed at night.

10. Take medications as directed. It is often helpful to take prescribed sleeping medication 30-60 minutes before

bedtime so they are causing drowsiness by the time you lie down.

11. Use a relaxation exercise just before going to sleep (relaxation recordings can be used for this purpose).

12. Keep your feet and hands warm; it’s okay to wear socks and/or mittens to bed if needed.

13. Eat a small amount before bedtime so that you are not woken by hunger during the night. A small turkey

sandwich or a glass of warm milk is a good choice.

14. Get up out of bed and read or listen to soothing music for a few minutes if you cannot get to sleep after 30

minutes.

Don’t:

1. Exercise within an hour of going to bed.

2. Engage in stimulating activity (e.g. playing a competitive game, watching an exciting program on a screen,

listening to exciting music) within an hour of going to bed.

3. Try to fall asleep while watching T.V., tablet, or phone.

4. Eat or drink items containing caffeine (coffee, soda, chocolate, non-herbal teas).

5. Drink alcohol to help you sleep.

6. Take another person’s sleeping medication.

7. Go to bed too hungry or too full.

8. Take over-the-counter sleeping medications without your doctor’s knowledge. Some of these can be habit

forming or interact with other medications.

9. Take naps during the day or sleep too late into the morning.

10. Try to force yourself to go to sleep. This tends to make your mind more alert and your body more restless.

You can refer to this:

resiliens.com/resilify/program/cognitive-behavioral-therapy-...