Acceptance and commitment therapy for insomnia lessens the brain’s level of nocturnal arousal, encouraging a state of rest rather than a state of insomnia

We’re constantly being told we have to strive to be happy, “turn that frown upside down” or – my personal favourite – “cheer up, love – it might never happen”. Consumerism aims to make us happy, and product design is there to make us feel better. So, it’s unsurprising that we subconsciously decide that feeling happy is “right” and feeling unhappy is “wrong” or something which must be changed to restore order.

Teaching the four noble truths, the Buddha tells us suffering is normal: an unavoidable part of being human. So, what does this mean? Should I sit here miserable and never try to feel good?

No, not at all.

The pressure of happiness

I was speaking with a client recently. It was her first session in therapy, and she was understandably nervous. “The goal,” I said, “isn’t to make you happy. It’s to help you to notice when you’re not happy and to be OK with it”.

After I said this, she told me that suddenly a pressure was lifted: she had been yearning and striving for most of her adult life to “be happy”. She felt obliged to be happy for her family, who had invested so much time and effort into helping her achieve her dream of becoming a vet. But then, here I was, saying she could take the lows with the highs and relax a bit.

The non-judgemental part of mindfulness allows us to see our thoughts and feelings with fresh eyes and not to place them into the “good” or “bad” category – they just are

The non-judgemental part of mindfulness allows us to see our thoughts and feelings with fresh eyes and not to place them into the “good” or “bad” category – they just are. If we are truly focused on our thoughts and feelings, we’ll see that we can have many feelings all going on simultaneously: some upbeat and some downbeat.

Every lifetime, every year, every day, there are going to be difficult times, thoughts and feelings, and there are also going to be joyful times, thoughts and feelings. It’s like running for a bus in the rain. You race through the downpour without an umbrella, splashing through puddles in your sandals, and you manage to get on the bus just the second it leaves; you’re delighted you made the bus and you’re soaked through and miserable at the same time.

ACT for anxiety

In the early 1980s, Steven Hayes developed “ACT” or acceptance and commitment therapy (which we have discussed in a previous article on re-entry anxiety post-COVID). During this, he observes that it’s not just what you feel and think that matters – it’s more important to notice how you relate to those thoughts and feelings.

It’s not just what you feel and think that matters – it’s more important to notice how you relate to those thoughts and feelings

ACT has many applications in therapy. Large randomised controlled trials have provided the evidence base for its application in the treatment of depression, anxiety, addiction, insomnia, chronic pain and cancer. But it can also be used with many other difficulties, such as psychosis, stigma, fear of failure and grief.

Anxiety is often due to a lack of psychological flexibility. It’s an inability to come into the present moment and open up to your emotions; to see your thoughts as they are and accept them rather than judging them as too unpleasant to bear. 

ACT teaches you to focus on what’s really important to you so you can proceed towards it rather than being paralysed by anxiety. You can develop a sense of self beyond the limited story you’re used to telling about yourself and others – the one that gets in the way.

Carrying on with your day while shouldering these feelings of anxiety and panic isn’t easy, and it takes enormous courage, discipline and practice.

ACT-i

Continuing with ideas of increasing your psychological flexibility, acceptance and commitment therapy for insomnia, or “ACT-i”, aims to increase people’s willingness to experience the conditioned psychological and physical discomforts of being unable to sleep. Paradoxically, this acceptance lessens the brain’s level of nocturnal arousal, thus encouraging a state of rest and sleepiness rather than a state of arousal and insomnia.

Natural sleep involves a slowing down of the psychological pressures and tasks of our daily life at the end of the day. This includes problem solving, social interactions, decision making and being alert, and also a slowing down of physiological parameters, such as heart rate, breathing rate, blood pressure, bowel movements and muscle tone.

Paradoxically, [ACT-i] lessens the brain’s level of nocturnal arousal, thus encouraging a state of rest and sleepiness rather than a state of arousal and insomnia

On the other hand, insomnia is a difficulty with sleeping that typically involves hyperarousal and worry about not sleeping, which causes more arousal leading to even more poor sleep. It is our unwillingness to experience the unwanted thoughts, emotions and physical sensations associated with not sleeping and the ensuing struggle with them that heightens our arousal levels and perpetuates sleeplessness. We’ve all been there – you’re so fed up with lying awake that you can’t let go of that annoyance which also keeps you awake.

So, how can mindfulness help? Well, mindfulness is focusing on the present moment non-judgementally. In other words, it is the ability to objectively and non-judgementally take notice of your internal and external experiences as they unfold.

Mindfulness in conjunction with ACT can help insomniacs stand back and observe their level of wakefulness, unwanted thoughts and emotional reactions without becoming overly entangled with them or judging them – a quality inherent in the normal act of falling to sleep.

How do I do it?

Simple body scans and breath meditation techniques are a great place to start.

However, during these, your active mind might notice that it doesn’t feel sleepy yet. It can become the judgemental voice in your exhausted head and shouts that because it isn’t asleep yet, you must be trying to trick it, so it judges it all as a sham.

[Your active mind] can become the judgemental voice in your exhausted head which shouts that because it isn’t asleep yet, you must be trying to trick it, so it judges it all as a sham

Using these techniques, noticing the thoughts and feelings that arise when you find you’re still awake, and, most importantly, not judging them as wrong but instead accepting that they exist, is a worthwhile direction to take towards what seems to be that elusive good night’s sleep.