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InsomniaInsomnia is a prevalent condition affecting about 10% of the adult population on a chronic basis. It involves either difficulties falling asleep, staying asleep, early morning awakenings, or nonrestorative sleep. Insomnia can occur as a unique disorder, as in primary insomnia, or may be secondary to an another medical (e.g., cancer) or psychological condition (e.g., depression or anxiety). Chronic sleep disturbances are often associated with negative daytime consequences such as fatigue and mood disturbance, thus significantly affecting one’s quality of life. Despite its high prevalence and potential impact on social or occupational functioning, only a small portion of individuals with chronic primary insomnia actually receives any treatment. For those who do seek relief for their insomnia, the first interventions are usually self-initiated and generally involve medications bought over-the-counter, natural products, or the use of alcohol. When insomnia is brought to the attention of physicians, pharmacotherapy is the most widely used and often the only recommended treatment option, despite the controversy existing over the long-term use of hypnotic medications. In the past 20 years, there has been an increasing interest in psychological and behavioral factors contributing to insomnia. This had led to the development of diverse psychological therapies for insomnia, many of which have been shown to produce significant and durable effects. However, these interventions remain underutilized because they are not well known to health care practitioners and are less easily accessible, both physically and financially, than pharmacotherapy. A self-help treatment for insomnia is a valuable alternative to overcome some of these barriers by making treatment more accessible, at a low cost, to a larger number of individuals with insomnia. Self-help treatment refers to any intervention, either for a psychological or physical condition, that is implemented with the assistance of printed material (e.g., books, pamphlets), audio- or videotapes, or any other medium (e.g., Internet). It can be implemented with or without guidance from a health care professional. Self-Help Treatments for InsomniaCognitive Therapy for InsomniaPoor sleepers tend to entertain faulty beliefs and attitudes about sleep, which feed into the vicious circle of insomnia, emotional distress, and more sleep disturbance. As such, insomnia often becomes a self-fulfilling prophecy. For instance, the belief that 8 hrs of sleep is an absolute necessity, or the perception that one is unable to function after a poor night’s sleep is often enough to produce anxiety and exacerbate sleep disturbances. The objective of cognitive therapy is to alter these types of sleep-related cognitions by challenging them and replacing them with more adaptive substitutes. Several clinical procedures, modeled after those used in treating anxiety and depression, can be used for changing patients’ misconceptions about sleep. Such techniques include attention shifting, reappraisal, reattribution training, and decatastrophizing. Cognitive therapy is also used to teach patients strategies to cope more adaptively with residual difficulties that recur occasionally even after treatment. |
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