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 Therapeutic Approach |
(This page contains details on the treatment methods used by Northern Colorado Sleep Consultants. In somewhat technical language, it provides an overview of our treatment approach.) Northern Colorado Sleep Consultants use cognitive-behavioral therapies for the treatment of insomnia and nightmares, CBT-I and CBT-N respectively. Additionally they may use other non-drug treatments to reset the phase of the circadian clock when there is a problem with the setting of this body clock. Recently, there has been a convergence of evidence indicating that these sets of non-drug treatments produce reliable and durable improvements in sleep and significant reduction of the severity and frequency of nightmares. These effective treatments aim at making specific changes in behaviors and cognitions related to sleep and nightmares. As such, they are a specialized subclass of the more general cognitive-behavioral therapy frequently used in psychology. They have been shown to be more effective than general psychotherapy for treatment of insomnia and nightmares (Backhaus, Hohagen, Voderholzer, & Riemann, 2001; Krakow, Kellner, Pathak, & Lambert, 1995). They are generally well tolerated and acceptable to many insomnia and nightmare patients.. Many are considered standard practice by the There are four domains to CBT-I:
The target thoughts and behaviors for change in CBT-I are those that are incompatible with sleep. These include thoughts and behaviors that increase physiologic and cognitive arousal and behaviors that disrupt the sleep-wake rhythm. In an attempt to control sleep, many people engage in behaviors that tend to perpetuate, rather than solve, the problem. These behaviors often increase frustration and arousal and may weaken the homeostatic and circadian sleep rhythm, thus perpetuating a vicious cycle of insomnia. CBT-I aims at reversing this. Additional advanced but compatible methods are employed. Hypnosis coupled with instructions on self-hypnosis can be effective and is used when appropriate if the person is comfortable with it. People who are dependent of sleeping pills may be given a taper schedule specially designed to gradually but effectively reduce then eliminate the need for sleeping pills. Newer techniques and approaches developed by Barry Krakow, M.D ( (For information about how Northern Colorado Sleep Consultants can use this approach to help with your insomnia click here.) CBT-N has two domains:
People can be taught to take control of their nightmares and disturbing dreams by changing them into new, less threatening scenarios. This is done by repeated rehearsal when awake plus positive thinking about what they can do with their disturbing dreams and nightmares as they go to sleep. Also, people vary in their attitudes toward their disturbing dreams and nightmares. Some people are indifferent to their nightmares while others, with nearly identical nightmare intensity, are extremely disturbed by them. It has been shown that people can change their attitudes toward their nightmares, which is also therapeutic. The approach to treating nightmares in children depends on the child’s age and the severity of the nightmares and the degree of distress caused by them. Nightmares in younger children that are not very frequent, intense, and distressing are typically not treated and allowed to remit mby themselves. With older children and teenagers with more severe nightmares, techniques similar to those used with adults can be used with age-appropriate modifications. Younger children with severe nightmare problems often require different, simpler techniques. Concluding Comment Such behavioral and cognitive changes are often not easy, especially when attempted without professional guidance. Written instructions for behavioral changes do not usually produce the desired results. Instead, individualized firm support, close monitoring, frequent follow-ups, and continued direct discussion of compliance problems are important for success. To increase compliance, it is important to address the individual's worries and to explore potential obstacles to the implementation of the requisite behavioral changes. Also, deciding which components are appropriate for each individual client and in what order are critical. To obtain free, additional information about insomnia click here. References: Backhaus, J., Hohagen, F., Voderholzer, U., & Riemann, D. (2001). Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia. European Archives of Psychiatry and Clinical Neurosciences, 251, 35-41. Morgenthaler T; Kramer M; Alessi C et al. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American To find out more about Northern Colorado Sleep Consultants click here. Answers to frequently asked questions can be found by clicking here. (For information about how Northern Colorado Sleep Consultants can use this approach to help with your nightmares click here.) |
