- OBSERVATION AND FANTASY (Revised 9-3-2017)
This is one of the suggestions for Step D1 Section 44 for falling asleep
Often it may seem that sleep is prevented by persistent thoughts of daily life, accompanied by strong emotions. Many behavioral treatments are predicated on the idea that a person first can’t sleep and then has thoughts associated with behavioral tension. Here we look at managing the thoughts and emotions directly.
Thoughts are typically about past or anticipated future events. Past events may be accompanied by strong feelings of anger, guilt, helplessness, shame, or self-criticism. Anticipated events may be accompanied by feelings of fear or anxiety, excitement, or dread. Either can lead to problem-solving ideas, which may or may not be effective, and typically can’t be carried out while lying awake in bed.
41a. Direct and Immediate Answers
FOR THOUGHTS ABUT UPCOMING EVENTS
It may help some people to postpone problem-solving with the awareness that they will be just as smart tomorrow, so there is no need trying to solve daytime problems in bed. Besides, nothing can be done in bed, so the project is hampered and likely to become a repetitive or obsessive exercise.
A person can keep a notepad next to the bed, and write down important or disruptive thoughts when they occur, with a plan to look at the notes the next day. This is also helpful for other thoughts in the night – great ideas, inventions, realizations, plans, names, solutions, etc.
It may be consoling to some people to realize that their brains are still working on major issues while they are asleep, so there is less loss than they might expect. A digital recorder serves the same function and may be easier to use. In fact, many of people’s best ideas occur at night. Perhaps a person can program his/her sleeping thoughts to work on the problem. The follow-up is for the person to awaken asking him/herself if anything new came up overnight.
DISTURBING BEDTIME FANTASIES OR THOUGHTS
The person can try re-writing the fantasy If the fantasy leads to strong emotions, like a fear of disaster, he/she can imagine that it turns out differently. All sorts of changes can be made – in the location, the characters, the action, etc. After all, it’s just a fantasy, and it’s the person’s own creation, so why not take charge of it?.
Glovinsky and Spielman (202-203) recommend a similar approach for dealing with disturbing dreams and nightmares. In an approach they call Image Rehearsal Therapy, which they credit to Krakow etal (1995). disturbing dreams are collected in a journal. Then they are re-written, and the revised stories are rehearsed, in the anticipation that future dreaming is likely to follow the revised path.
THOUGHTS THAT WON’T GO AWAY
To interfere with thinking, the person can try articulatory suppression (Espie and Ellis, p.303). Instructions are to lie in bed with the eyes closed, and think the word “the” twice per second for about 5 minutes. It shouldn’t be said out loud but the person can mouth it. Sleep may come because thinking is interrupted.
MODIFYING THE INTERNAL VOICE
In another exercise for managing a disturbing thought, McKenna, (95-97) has a patient first recall a thought from the time when he/she couldn’t get to sleep. Then he suggests paying attention to the tone, and modifying the tone and location of the voice to be progressively farther away and drowsy. Finally he suggests putting in some yawns and the idea of drifting away.
41b. Psychotherapy
Most of the above suggestions are directed to lay persons or behavior therapists. Those of us who are trained in psychodynamic therapies may see disturbing thoughts and dreams as points of access to unconscious fears and conflicts. As such, we want to learn more about them as a path to a patient’s greater self-awareness and a more effective and satisfying life. Freud called dreams the “royal road to the unconscious.’ Fantasies are also worthy of exploration. Much can be learned by focusing on them rather than modifying or suppressing them.
There are many ways to examine dreams and theoretical frameworks for interpreting them. For now, discussions of dream interpretation can be found in other resources.