Addressing Insomnia with Team CBT

Today we feature Marina Dyck, a TEAM-Certified Clinical Counselor in private practices in Swift Current, Saskatchewan, Canada. She works with individuals and families struggling with trauma, anxiety, depression, and relationship issues. She combines the latest research in neuroscience, powered by TEAM-CBT, and what she calls the "whole person" approach.

Marina describes her innovative TEAM-CBT treatment for patients with trouble sleeping. Many of them toss and turn at night, unable to turn off their anxious and agitated brains, so they ruminate over and over about problems that are bugging them. Sound familiar?

Here’s David’s quick, step by step overview of Marina's treatment approach, which is based on the steps of TEAM and the Daily Mood Log.

Step 1. Let’s imagine you’re the patient (or the shrink), so you start with a brief description of the Upsetting Event at the top of the Daily Mood Log. It could be something as simple as ”Lying in bed for several hours, unable to get to sleep because I keep ruminating about a report I have not finished for work,” or some other problem.

Step 2. Identify your negative feelings and estimate how intense each one is on a scale from 0 (not at all) to 100 (the worst.) For example, you may be feeling:

1. Sad, down: 80%
2. Anxious, panicky: 95%
3. Guilty, ashamed: 70%
4. Inadequate, incompetent, inferior: 90%
5. Alone: 100%
6. Discouraged: 80%
7. Frustrated: 95%
8. Angry, annoyed: 100%

Step 3: Record your negative thoughts and how strongly you believe each one from 0% to 100%. For example, you may be telling yourself:

1. I have to get to sleep! 100%
2. If I don’t get to sleep, I’ll never be able to function tomorrow. 90%
3. I should have completed my report for my boss today. 100%
4. I should get out of bed and work on it. 90%
5. There must be something wrong with me. 100%
6. etc. etc.

Step 4. Identify the distortions in these thoughts, like All-or-Nothing Thinking, Fortune-Telling, Should Statements, Emotional Reasoning, Magnification, and more.

Now, if you’re a shrink, after you’ve empathized, do the A = Paradoxical Agenda Setting or Assessment of Resistance. If you’re a general citizen, you can do Positive Reframing. In other words, instead of trying to make your negative thoughts and feeling disappear entirely by pushing the Magic Button, you can ask two questions about each negative thought (NT) or feeling:

1. How might this NT or feeling be helping me?
2. What does this NT or feeling show about me and my core values that’s positive and awesome?

Example. In the current example you are 95% anxious and panicky about your report for work as well as the fact that you can’t relax and fall asleep. Could there be some positives in your anxiety and panic? For example, these feelings might show

1. Your intense commitment to your work.
2. They may be a reflection of your high standards.
3. Your anxiety, while uncomfortable, has probably motivated you to work hard and achieve a great deal.
4. Your anxiety may protect you from danger and keep you focused on what you have to do to succeed and survive.
5. Your anxiety could be an expression of your respect for your boss and for the company you’re working for.
6. Your desire to do a good job is probably a reflection of one of your core values as a human being.

You could make similar lists for other feelings as well, like feeling down, guilty, discouraged, angry, and so forth.

At that point, you can set your goals for every negative feeling.

For example, you might decide that 15% or 20% might be enough anxiety and panic, and that 15% shame would be enough, and so forth. You can record your goals for each negative feeling in the goal column of your Daily Mood Log.

This is much easier than if you try to reduce them all to zero by pressing the Magic Button. And even if you could, then all of the positives you listed would go down the drain, right along with your negative thoughts and feelings.

Instead, you can aim to reduce them to some lower level that would allow you to relax while still maintaining your core personal values.

Now we’re ready for the M = Methods portion of the TEAM session.

You will enjoy this portion of the podcast. Marina led Rhonda in three classic TEAM methods: The Paradoxical Double Standard Technique, the Externalization of Voices, and something Marina calls Distraction Training, which is actually a mix of Image Substitution, self-hypnosis, and relaxation training. Essentially, you focus on something positive and relaxing, as opposed to ruminating about all you have to do.

This approach will come to life when you listen to the podcast, and I think you will agree that it IS innovative and significantly different and from 99% of what is currently sold as “insomnia treatment!”

Marina emphasizes that you, the client, will have to agree to spend 15 to 20 minutes per day doing written work with the Daily Mood Log, or all bets are off.

In addition, I would like to add that you and your shrink (or you and your patient) will have to find effective ways to combat each patient’s ruminations and negative thoughts, because we’re all quite different and our problems will usually be unique. In fact, that’s why I (David) have created way more than 100 methods for challenging distorted thoughts.

But here’s the basic idea: When you learn to CHANGE the way you THINK, you can CHANGE the way you FEEL as well as the way you SLEEP!

Thanks so much for listening today, and happy dreams!

Marina, Rhonda and David