44: CHOICE AMONG FOCUS TECHNIQUES (Revised 9-17-2017)
This section follows Section 17 of Step D1 to deal with the choice among ways to focus one’s attention and get away from obsessive thinking about daily life
A person may be able to put emotional issues aside during the day, but they come back to disrupt the ability to sleep. The person may be about to fall asleep and think of something that leads him/her to be worried, frightened, guilty, angry, etc. This can happen over and over, with different thoughts or memories.
It may be due to particular events or experiences, or it may be a function of the person’s daytime defenses, which prevent the working-through of experiences and emotions. It could also be a consequence of medical issues that get expressed when the person is winding down for sleep (Reite, Weissberg and Ruddy, 202).
44a. Some Possible Choices
If the person is anxious, guilty, angry or depressed, the treatment most likely to be effective in the long run is psychotherapy for cognitive distortions, underlying conflicts or interpersonal difficulties. In the meantime, some relief can be obtained from
- Limit use of the bedroom (Section 20)
- Develop Bedtime rituals (Section 37)
- Try Yoga (Section 39)
- Try passive observation (Section 41)
- Have a buffer period before bed (Section 18)
- Use relaxation techniques (Section 24)
- Consider temporary medication (Section 36)
44b. Making the Choice
We can divide the possible treatments according to when the person implements them.
THROUGHOUT THE DAY
There are programmatic changes that apply throughout the day and affect the way the person thinks about the bed and bedroom. They may not fit directly for people who are away during the day, but they still apply in principle, in the evening, and on days the person is home.
Limiting the use of the bed to sleeping and sex (Section 20). This may train a person to think of a bed as a limited-function resource rather than a place to continue the thoughts of the day or to get stimulated by activities such as reading or watching television.
AFTERNOON AND EVENING
The way a person winds down after the work day leads to approaches to make the process more sleep-friendly (see Section 17b).
When, how and what the person eats can have a major effect on the ability to sleep. Eating late in the evening, in a noisy or contentious environment, can be disruptive.
BEFORE BED
Next consider things that a person can do in immediate preparation for sleep. The idea of each of them is to approach bedtime with attitudes and expectations that make falling asleep more likely.
Engaging in distracting or calming activities, such as reading and television, that the person knows will take him/her away from the strongly emotional issues of the day.
Instituting a buffer period (Section 18), or bedtime rituals (Section 37) to distract the person and change his/her pattern of thinking as bedtime approaches.
It is also possible that increasing the person’s sleepiness could interfere with obsessive thinking, so sleep restriction (Section 29) and other techniques discussed in Section 46 could be helpful.
IN BED
Once the person is in bed, there are things that can be done to allow the person to relax and let sleep happen.
Limiting time awake in bed (Section 34). This approach may interrupt obsessive thinking in bed while allowing it elsewhere. A general approach is to have the person who can’t fall asleep get up and do something distracting.
Yoga (Section 39) or systematic relaxation (Section 24) to direct thinking to the process of bodily self-control.
Once in bed, it can be helpful for some people to deal with their fantasies and emotions more actively (Section 41).