ABSTRACT
Topics addressed this week:
Activity 21: A Review of Skills We Have Been Learning
Activity 22: The Clock Watching Experiment
Activity 23: How the Mind Affects Sleep (1): Low Mood and Anxiety
Activity 24: How the Mind Affects Sleep (2): Intrusive Thoughts that Go Endlessly Round and Round
Activity 25: How the Mind Affects Sleep (3): Voices, Visions, or other Unusual Sensations
Activity 26: Linking Thoughts and Feelings
Activity 27: Another Example of the Link between Thoughts and Feelings
Activity 28: Becoming Aware of Negative Thoughts
Activity 29: Managing Negative Thoughts
Activity 30: Negative Thoughts Record (Catch It)
Activity 31: Managing Unhelpful Thoughts Worksheet (Check It and Change It)
Activity 32: Managing a Busy Mind at Night
Activity 33: Relaxation Exercises
Activity 34: The Main Things I Learned Today
Activity 35: My Action Plan for the Week
<target id="page_233" target-type="page">233</target>Managing Worries and a Busy Mind and Introducing Relaxation Topics Addressed this Week https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781315643793/a121ca36-09ef-4fc3-9a96-2287eed9222a/content/fig18_1.tif"/> <target id="page_234" target-type="page">234</target>A Review of Skills We Have Been LearningLast week we learned about:
maximising daytime energy;
establishing helpful beliefs and attitudes about sleep;
managing nightmares.
The other sleep skills we have also been learning are:
sleep hygiene (everyday habits to help us sleep better at night);
winding down before bed (to help fall asleep);
getting out of bed if you can’t sleep (Goobics);
having a regular wake-up time (not oversleeping and limiting naps) and winding up into the day.
What went well?
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What was challenging?
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Let’s brainstorm ways to get around these challenges:
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<target id="page_235" target-type="page">235</target>The Clock Watching ExperimentWhen we are anxious about falling asleep, we naturally tend to check the time to see how long we have been awake for, and how much sleep we are likely to get. This can lead to predictions and worries about what the following day will be like.
The Cycle of Clock Watching at Night https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781315643793/a121ca36-09ef-4fc3-9a96-2287eed9222a/content/fig18_2.tif"/> The Clock Watching ExperimentIf you watch the clock at all overnight, try this experiment to test whether clock watching is helpful or unhelpful:
One night, watch the clock as normal.
The next night, put the clock/phone under your bed or cover it somehow so that you won’t be able to look at it (but can still hear the alarm).
In the morning, note down whether you looked at the clock or not, and how you slept.
Most people find that it is not helpful to look at the clock over the night!
Whether it is 11 p.m., 2 a.m., or 4 a.m., we want you to do the same thing. Knowing the time should not change your strategy. Relax and let sleep happen.
<target id="page_236" target-type="page">236</target>How the Mind Affects Sleep (1): Low Mood and AnxietySometimes, people may find it hard to sleep because of many sad thoughts and memories, or they are feeling very anxious in bed (e.g. feeling of dry mouth, heart racing, and feeling panicky). Sometimes, people have thoughts that make them feel paranoid or scared to go to sleep at night.
It is important to recognise when this is happening, so that you can find ways of managing low mood or anxiety before it ruins your sleep.
Here are some tips for how to help lighten your mood at night, so that you can get into bed feeling more relaxed and peaceful (tick those you may like to use):
Don’t be too hard on yourself. Everyone has bad days.
Give yourself permission to write this off as one bad day and look to have a better day tomorrow. What might you be able to put in place to help make tomorrow better?
Speak to people who make you feel positive. This could be family, friends, a helpline, or online forum members.
Make a list of the things you’re grateful for.
Concentrate on the here and now (what can you see, hear, touch, smell?) and just breathe.
Do something that comforts and relaxes the body and the mind. This can be cooking a favourite meal, taking a warm bath, lighting a candle, cuddling a soft toy, wearing your favourite pyjamas, gently stretching, listening to music, or reading a book.
Organise your problems. Spend a few minutes problem-solving and then make a point of putting the problems aside for today and coming back to them tomorrow. Give yourself permission to let them go.
Try and take your mind off things by doing an activity you don’t do often— rearrange your furniture, get some flowers in the house, change the bedsheets, or visit a neighbour.
Compile a ‘happy box’ of different possessions and trinkets that make you feel relaxed and happy or bring positive memories—for example, a favourite DVD, nail polish, magazine, photo album, scented candles, relaxation CD, or puzzle book.
Do a fun activity (see Appendix 12).
What else can you do when you start feeling down and depressed or anxious at night?
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<target id="page_237" target-type="page">237</target>How the Mind Affects Sleep (2): Intrusive Thoughts that Go Endlessly Round and RoundMany people also experience negative, intrusive, or recurrent thoughts at night that are hard to switch off. These thoughts can make it hard to get to sleep.
Here are some tips for dealing with intrusive thoughts (tick those you may like to use):
Label the thoughts as ‘intrusive thoughts’. For example, say to yourself, ‘I’m having an intrusive thought’.
Remind yourself that you can practise choosing not to engage with the thought (e.g. ‘I don’t have to change, argue with, or get rid of this thought’).
Remind yourself that everyone has intrusive thoughts from time to time. It is OK for the thought to be there, even if you don’t like it. You can choose not to become tangled up in the thought.
Use relaxation and meditation exercises.
Take a few slow, deep breaths.
Repeat a phrase or ‘mantra’—for example, words such as ‘calm and relaxed’, over and over.
Recite a soothing poem or prayer.
Have a poster or a note by your bed with reassuring messages written on it to read when you are woken up (e.g. ‘This experience is temporary and will pass’).
Try using a ‘worry box’—write down your worries and place them into a box to deal with in the morning.
What else can you do about negative and intrusive thoughts at night?
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Once you have carried out one or two of the above strategies, return your attention to whatever you were doing before the thought bothered you. As best you can, fully engage in the activity and pay full attention to it.
Keep trying. This work takes practice and patience.
<target id="page_238" target-type="page">238</target>How the Mind Affects Sleep (3): Voices, Visions, or Other Unusual SensationsIt is common for people with voices, visions, and other experiences to report that their voices are worse at night, and that they are unable to use their usual coping strategies at night-time, such as going for a walk. Some people may even find that voices, visions, or other feelings wake them up in the middle of the night.
Here are a few tips from the Hearing Voices Network on what to do about voices, visions, and other experiences that disturb sleep (tick those you may like to use):
Converse with the voice, explaining that now is not the time to be talking, but that you can talk again tomorrow.
Listen to and focus on the calming voice of an audiobook.
Listen to the radio or watch TV on low volume.
Listen to ‘white noise’ (e.g. the sound of a fan).
Wear earplugs.
Sing a song or read out loud.
Get up, go to another room, and start an activity.
Try sleeping with a dim light, using a night light or glow-in-the-dark stars.
Wear eye shades (e.g. sunglasses, night mask) if visions are disturbing you at night.
Use visualisation techniques (e.g. imagining a protective force field to fend off unwanted visions or voices).
For bodily sensations (e.g. feeling insects crawling, pain, feeling your limbs change shape), try switching the light on so that you can see the affected area or try massaging the affected area gently.
Note: It might also be useful to get a time switch on TVs, radios, and other digital devices, so that they will turn themselves off after a set time. This helps to save electricity and prevents them from disturbing your sleep later in the night.
What else can you do about hearing voices or seeing visions when they keep you awake at night?
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<target id="page_239" target-type="page">239</target>Linking Thoughts and FeelingsMost people assume that the events in their everyday lives directly cause their feelings. For example:
If we’re running late for an appointment, we may feel anxious or annoyed.
If someone gives us a compliment, we may feel happy.
An important part that we usually miss is the interpretation of what an event means to us (i.e. what thoughts we had about the event). Our thoughts help us to understand our emotional reaction.
Events or situations by themselves do not create emotions. In other words: https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781315643793/a121ca36-09ef-4fc3-9a96-2287eed9222a/content/fig18_3.tif"/>
To see how this process happens, look at the following example:
Event/Situation
Thought: What Are the Thoughts that Might Make You Feel. . .
Feelings
Imagine you are at a party and wave at a friend across the room.
. . . ____________________
Angry?
They don’t respond to you.
. . . ____________________
Embarrassed or sad.
. . . ____________________
Calm?
In the example in the table, there are many different ways of reacting, because the situation is unclear. It is the person’s thoughts about the situation that determine how they feel. Therefore:
Thoughts are a clue to understanding emotions.
You can understand your moods better by looking at the thoughts you have had whenever your mood has changed.
It is helpful to learn to manage unhelpful thoughts during the day and the night to improve sleep and daytime tiredness.
<target id="page_240" target-type="page">240</target>Another Example of the Link between Thoughts and FeelingsWe’ve just been learning about the link between thoughts and feelings. Now, let’s see how this link can be applied to poor sleep.
What might Mary’s thoughts be in the example below? The situation is waking up in the morning after a poor night of sleep and feeling nervous and upset.
MaryWhen I noticed my eyes feeling sore and my brain feeling foggy, I remembered that I hadn’t slept well last night. That made me feel nervous about whether I would be able to sleep tonight, and if I’d cope the next day. I guess I then worried that there was nothing I could do to feel better and that made me feel upset.
Event/Situation
Thought
Feelings
Didn’t sleep well last night
Mary thought that:
• ____________________
Nervous
• ____________________
Noticed eyes feeling sore, and brain feeling foggy
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Upset
Most of us would feel nervous and upset if we thought that not getting enough sleep would lead to not coping, sleeping poorly the next night, and not being able to do anything about it. Now we can better understand her feelings.
It is helpful to be able to spot thoughts that are overly negative, as they can have a big impact on how we feel.
<target id="page_241" target-type="page">241</target>Becoming Aware of Negative ThoughtsThoughts can occur automatically and come in the form of:
words (e.g. ‘I’ll never be able to sleep, I can’t cope’);
images (e.g. seeing yourself tossing and turning in bed).
The questions in the figure can help you catch and resolve negative automatic thoughts.
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781315643793/a121ca36-09ef-4fc3-9a96-2287eed9222a/content/fig18_4.tif"/>Ask yourself these questions until you have identified the thoughts that help you understand your emotional reaction. You may need to ask yourself these questions two or three times to uncover the automatic thoughts.
See if you can become more aware of negative thoughts this week and notice the impact they have on your mood.
If you notice an overly negative thought, remind yourself that this is just a thought or opinion, not a fact. You can choose whether or not you listen to the thought.
What thoughts do you have when you haven’t slept well?
What thoughts to do you have when you are having trouble sleeping at night?
Do you notice the same thing during the day?
What do you feel like doing after experiencing these thoughts and feelings?
<target id="page_242" target-type="page">242</target>Managing Negative ThoughtsHow can we change the thoughts and feelings that interfere with sleep and getting activated during the day?
The benefit of learning that thoughts, not situations, create feelings is that it is then possible to manage feelings by changing thoughts.
To address unhelpful thoughts, we need to apply the 3 Cs.
The 3 Cs
Catch it
Identify the unhelpful, overly negative or intrusive thought
Check it
Identify evidence that supports and disputes the thought
Change it
Change the thought so that it is more accurate and helpful
Having Trouble with the 3 Cs?Try writing down what is bothering you on a piece of paper or in a journal, or try one of the strategies already discussed today. Writing down or drawing your thoughts and feelings can often have a positive effect on dealing with negative thoughts.
Writing down or drawing thoughts and feelings can have a positive effect, as it may you help to:
become aware of the link between thoughts and feelings;
detach from the thought/image, get some distance, and assist in making the thought feel less intense;
manage the negative thought/image by developing a new perspective that could be more helpful.
WorksheetsYou can also try using the next two worksheets on the following pages to help you manage negative thoughts.
The Negative Thoughts Record (Catch It) can be used to help identify overly negative thoughts and feelings.
The Managing Unhelpful Thoughts (Check It and Change It) worksheet can help you check and change unhelpful thoughts related to sleep.
<target id="page_243" target-type="page">243</target>Negative Thoughts Record (Catch It)The Negative Thoughts Record is used to catch overly negative thoughts. Use it by noting down the thoughts/images you are having when you are experiencing difficult emotions (e.g. feeling down, guilty, scared, or anxious).
Thoughts and Images
Feelings
Write Down the Unhelpful Thought or Image that Is Going through Your Mind
Tick how the Thought/Image Makes You Feel
Positive feelings:
Happy
Content
Excited
Negative feelings:
Weak/useless
Guilty/ashamed
Angry/frustrated
Anxious/scared
Sad/depressed
Others:
_________________
_________________
_________________
Rate how strong the feeling(s) you’ve ticked is from 0 to 10 (circle below):
0 1 2 3 4 5 6 7 8 9 10
Not strong at all Extremely strong
<target id="page_244" target-type="page">244</target>Managing Unhelpful Thoughts Worksheet (Check It and Change It)Now that you’ve identified the overly negative/unhelpful thought that’s bothering you, use this sheet to help you question and change it.
Catch it: The unhelpful thought I’m working on:
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Check it: Should I listen to this thought?
How much do I believe this thought, from 0 to 100 per cent? Colour in how much on the thermometer.
How does this thought make me feel? ________________________________
Is it a helpful thought? ❐ Yes ❐ No
Thinking of my calmest, most rational, and most supportive friend, carer, or family member, what advice would they give?
Would I feel better if I chose to not listen to this thought? ❐Yes ❐No
If a good friend was in this situation, what would I tell him/her?
https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781315643793/a121ca36-09ef-4fc3-9a96-2287eed9222a/content/fig18_5.tif"/> Source: Created by John Lim, www.sightstage.wix.com/homeChange it: What is a more helpful thought?
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How much do I believe the new thought (0–100 per cent)? _______ per cent
How much do I believe the old thought (0–100 per cent)? _______ per cent
<target id="page_245" target-type="page">245</target>Managing a Busy Mind at NightTry these skills before going to bed to help manage a busy mind.
Winding Down before BedRemember the wind-down activities discussed in the first session. Doing your wind-down activities each night may help break the ‘circuit’ of a busy mind getting in the way of sleep.
Winding down involves relaxing activities 1 hour before bed and a fixed bedtime routine right before bed, where you might have a warm drink (e.g. cup of cocoa or milk), brush your teeth, and do a relaxation exercise.
To-Do Lists and PrioritisingTo-do lists are a way of putting the ‘day to bed’ and busy thoughts out of mind, so that you can go to sleep.
The list may be done before leaving work at the end of the day, after dinner, or any other time you feel it would be handy.
Some people like to keep their list by their bed, so that they can jot down more items if they come to mind while they are in bed (no need to even turn on the light).
When would be the best time for you to make a to-do list? ________________
Can you set a reminder on your phone to make sure you do this?
Avoid Watching the Clock OvernightIt is hard to put the mind to rest if you are always checking the time to see how long you have been lying awake or calculate whether you will get enough sleep for the night.
If you find that you often check the time when you are having trouble falling back to sleep, try the clock watching experiment we talked about for Activity 22.
How will I avoid watching the clock at night? __________________________
Setting your alarm for the morning can help you worry less about whether you will wake up on time for the next day.
<target id="page_246" target-type="page">246</target>Relaxation ExercisesLet’s practise a couple of simple relaxation strategies you can try out before bed:
Shoulder shrugs: Raise your shoulders as if trying to touch your ears with them and breathe in while doing this. Feel the muscles in your neck and shoulders tense. Then, all at once, let your shoulders drop while you breathe out. Feel the tension leaving the muscles of your neck and shoulders. Repeat the shrug a few times, inhaling on the shrug and exhaling on the release. Keep your jaw relaxed as you do this.
Releasing tension: Become aware of the difference between holding tension in your body and letting go of this tension. Bend your toes up as if to touch your shins. Hold them there while you tighten your thighs, buttocks, and fists. Take a deep breath and hold it while you clench your jaw and close your eyes. Hold all that tension for 5 seconds. As you exhale, let it go all at once, feeling the tension drain from your body.
Cued relaxation response: Pick a word or phrase that has a positive or neutral meaning (‘Easy’, ‘I am relaxed’, or ‘Sparkle’). Sit quietly, in a comfortable position, and begin breathing slowly and naturally. On the exhale, say to yourself your word or phrase. If your mind starts to wander, that’s OK; just come back to your breathing and to repeating your cue word or phrase.
Equalising breathing: Take 4 seconds to breathe in and 4 seconds to breathe out. That is, as you inhale, count ‘1 . . . 2 . . . 3 . . . 4’, and do the same as you breathe out. Do this four or five times. Avoid holding your breath after the inhalation or the exhalation; just smoothly transition from one phase to the other.
Your relaxation place: Begin with a few, slow relaxation breaths. Then, with your eyes closed, take a moment to create, in your mind’s eye, an ideal spot to relax. You can make it any place you’d like, such as the mountains, beach, lake, prairie, or park. It can be either a real or a made-up place. See yourself comfortably enjoying this place. Now, once you have created it, go use it for 15 seconds or so, whenever you feel the need to relax.
Remember that relaxation requires practice. It may take many tries before it is found useful. There are also many different types of relaxation and meditation exercise out there. Find one that you feel comfortable learning.
Try giving one or two of these relaxation exercises a go during the week, and see if it helps with your sleep.
You can also check out App downloads on topics related to meditation, relaxation, and breathing.
See www.k-state.edu/paccats/Contents/Stress/Quick%20Relaxation%20Strategies.pdf
<target id="page_247" target-type="page">247</target>The Main Things I Learned Today_________________________________________________________________
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My Action Plan for the WeekMy regular rising time for each morning is: ______________________________
Some energy-generating activities and changes to my sleep routine and hygiene that I will keep working on:
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Start to manage overly negative thoughts:
Watch out for overly negative thoughts and the impact that they have on my sleep and energy.
How and when will I do this? _____________________________________________
When thoughts/images are disturbing me from winding down or falling asleep at night, write them down on a piece of paper/journal.
Remember the 3 Cs—Catch it, Check it, Change it (I can challenge the unhelpful thoughts by using the worksheets provided).
Strategies for dealing with a busy mind:
Experiment with strategies for managing:
low mood and/or anxiety (see Activity 23);
intrusive thoughts (see Activity 24);
voices, visions, other unusual sensations (see Activity 25).
Continue with winding down before bed.
To-do list: How and when will I do this? ______________________________
Avoid watching the clock when I can’t sleep: Try the clock watching experiment.
Relaxation or imagery: Practise this during the day for short periods at first. When I become more skilled, I will be able to use it more effectively at night.
