A More Creative Version of Counting Sheep to Get to Sleep

For many patients at Ramey Nutrition, anxiety can get so high, that sleep can become almost impossible. This article comes from PubMed and was found helpful! Read on!

For insomniacs, focusing on personally engaging but nonarousing thoughts instead of ruminations seems to be more effective than standardized sleep hygiene.

Sleep-onset insomnia continues to be a widespread problem. Cognitive-behavioral approaches such as stimulus control therapy and more recently developed treatments (JW Psychiatry Feb 6 2012 [Free full-text Sleep article online | PubMed® abstract]) are quite effective, although used less often than medications. This small study introduces a very practical one-session intervention, cognitive refocusing therapy (CRT), to eliminate bedtime ruminations that many poor sleepers identify as the major stumbling block to getting to sleep.

Sixty-two college students were randomized to CRT plus standard sleep hygiene (SH; similar to stimulus control therapy) or SH alone. CRT participants were taught to identify personally engaging but nonarousing thoughts (e.g., song lyrics, TV program plots, recipes) that they would focus on when preparing for sleep or if they awoke later. Data on 51 students were analyzed.

After 1 month, both interventions were associated with large reductions in insomnia from baseline (within-subject effect size: CRT, 1.57; SH, 0.81), yielding a moderate improvement for CRT compared with SH after controlling for anxiety and depression (effect size, 0.60). The CRT group also showed a trend toward reduced nighttime arousal.

Comment: Insomnia is a complex problem with multiple causes, but this intervention is simple, brief, logical to the lay person, and effective. Clinicians, especially those in primary care, could offer this technique to their patients as a first-line intervention before prescribing hypnotic medications. The intervention seems to be a creative variant of the old "counting sheep" method, but is more likely to be effective because it employs personalized cognitive scripts that are more appealing and easier to focus on. The use of college students limits generalizability, although they are likely to have disturbed sleep and chaotic routines that make sleep more difficult.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry September 17, 2012

CITATION:

Gellis LA et al. Cognitive refocusing treatment for insomnia: A randomized controlled trial in university students. Behav Ther 2012 Jul 27; [e-pub ahead of print]. [Link to Behav Ther article abstract]

Copyright © 2012. Massachusetts Medical Society. All rights reserved.