Acceptance and Commitment Therapy, Insomnia and The Cognitive Shuffle
mySleepButton is designed to help you fall asleep, and return to sleep. As I’ve indicated elsewhere on this site, it can be used in concert with other strategies that promote psychological well-being. In this post, I discuss “acceptance and commitment” concepts and therapy (“ACT”), which also can be helpful for insomnia, and can be used in combination with mySleepButton (the cognitive shuffle).
If you’d like personal guidance on the matter, contact a clinical psychologist who has been trained in acceptance and commitment therapy. Clinical psychologists are the professionals who are best trained to help you with individual psychological concerns. Access the web site of the Psychological Association of your province or state for referrals.
Addressing Dysfunctional Thoughts
Difficulty falling asleep can be a consequence of how you relate or respond to stressors (such as financial uncertainty, impending big decisions, pressures at work, conflict or health concerns.)
Some people assume that the key to happiness is to eradicate “irrational thoughts” or “dysfunctional beliefs”, such as “If I lose this job (or this relationship, or this house, or whatever) I will be ruined”. They are right that such thoughts can cause unpleasant emotions. And these thoughts and emotions, experienced at bedtime, can keep you awake.
They are also right that one can, to a certain extent, change one’s thinking and consequently one’s feelings.
There’s plenty of research to support all of that.
However, there’s a catch:
You Cannot Fully Control Your Mind: “Perturbance” and Moods
No matter how hard one tries to change one’s thinking, the mind will continue to generate ‘irrational’ thoughts and unpleasant feelings. This is because, as I explain in Cognitive Productivity, the human mind is composed of many simple components that are not under its direct control. In other words, the “CEO of your brain”, which discharges its “executive functions”, is limited. Try, for example, to order your brain to remember the names of everyone whose name you knew in your Grade 11 math class. Not likely to work. Yet the information might be stored in your brain, just not accessibly. Psychological tests can prove that there is much more information available in your brain than you can explicitly remember. For example, you might recognize names that you can’t recall. Similarly, you might rationally conclude “I can handle this stressful situation” and yet your autonomous mind (as Prof. Keith Stanovich calls it) may continue to generate thoughts that contradict this belief.
It’s as if we all have Tourette’s syndrome, a condition in which people involuntarily say or do things. Someone with Tourette’s might frequently and uncontrollably utter “Bird!”, or whistle, in meetings. Except in the normal condition, the “behaviors” are silent, mental processes, whose products include “Judgments”, “Images”, “Motivators” and “Stories” amongst others. (The mnemonic Mental JISM might help you remember this classification. Motivators are wishes, wants, desires, whims, and any other mental content treated by the brain as valuable and that tend to move one, including judgments, images and stories–meaning that we’re dealing with a recursive concept.)
When a particular cluster of motivators is very insistent, you are in a special type of emotion Prof. Aaron Sloman, Dr. Ian Wright and I call “perturbance” or “tertiary emotion”. Here your mind produces affective content (motivators) that tends to distract your attention, even when you try to keep your mind off the motivators. For example, if one of your children or someone near and dear to you has recently died, or your sweetheart has left you, odds are that insistent JISMs will tend to distract your attention in various circumstances regardless of your desire to focus. You might think you know full well that there is nothing you can do about the loss. But this knowledge might never fully reprogram your mind. Thoughts about and motives towards the loved one might keep coming back to your mind for decades. Grief is thus one of the purest (and most scientifically interesting) examples of perturbance. Trauma, where horrible images recur indefinitely, provides other examples. Milder emotions involve similar experiences on a briefer time scale.
Furthermore, unpleasant feelings can arise independently of “cognitions”. Moods, for instance, are a function of energy levels and activation levels.
So, while it is important, to a certain extent, to regulate one’s thinking, this will not necessarily quel one’s affective states. Other strategies must be used. For instance, Robert E. Thayer’s excellent Calm Energy book contains lots of helpful information and recommendations about the sources of moods and how to regulate them with exercise, rest and other strategies. And there is ACT.
Accepting Unwanted Thoughts
With acceptance and commitment therapy, one learns to view some of what the mind generates as background noise or even mental garbage. One is trained to recognize one’s feelings and other JISMs and to accept them. This involves “mindfulness” training. In other words, one learns to make peace with the components of one’s mind that generate unproductive mental content. And one learns to accept these products (JISMs and feelings). And finally one learns to move on. That is, to focus one’s attention and resources on productive pursuits.
Some Core Concepts: Mindfulness, Meta-Cognitive Shifting, Balance, and Equanimity
Acceptance and commitment therapy involves a host of concepts, many of which are shared by other modern (“third wave”) psychotherapies, such as “meta-cognitive therapy”. (ACT is in a sense meta-cognitive.)
Mindfulness involves being aware of one’s mentation (thoughts, feelings, JISMs, etc.) and accepting them.
Meta-cognitive shifting involves changing one’s stance towards one’s mentation. If you notice that you are treating a thought (such as “This investment will be my demise!”) as wise, important, and worthy of further rumination, you might then shift your stance towards the thought, and treat it as just mental content or even as mental garbage. The investment might be important, but the thought about it is just a thought, not necessarily worth pursuing.
In the context of mindfulness, balance refers to one’s transient equipoised attitude towards mentation. It’s a mean between being overly attracted to something and overly repulsed by it. If you have a balanced attitude towards a desirable mental “object”, then you’re not consumed by the motivator to obtain it; nor are you consumed by the threat of losing it or by its actual loss. Similarly, if you have a balanced attitude towards an undesirable one, then you’re not consumed by the threat of its appearance or its presence.
Equanimity is well defined in the dictionary “mental calmness, composure, and evenness of temper, especially in a difficult situation”. This concept always reminds me of one of my heroes, Winston Churchill. In his autobiography, My Early Life, he described a scene during the Cuban War of Independence (1895), where, with bullets flying in the vicinity, he went to sleep peacefully in a hammock between two large men. He also later claimed to never have lost a night of sleep during the Second World War. That’s equanimity.
Defining all these virtues is one thing. Developing them is quite another!
How Does All this Affect Sleep?
If preoccupation with concerns and rumination tends to delay sleep onset, then one would expect mindfulness to facilitate sleep onset. This is actually a tougher proposition to verify than it might seem. For one thing, mindfulness is difficult to manipulate and to measure. For another, one can’t run gold standard experiments in which we subject participants to very challenging circumstances, half of whom get mindfulness training, half of whom don’t. Still, there’s a large body of research that points in the expected direction.
- Jason C. Ong, Christi S. Ulmer and Rachel Manber, in a 2012 paper in Behaviour Research and Therapy reviewed some of the evidence and provided a conceptual framework that I recommend reading. In a prior study (without a control group, however), Jason Ong, Shauna Shapiro, and Rachel Manber found that mindfulness training was associated with reductions in sleep-related distress, reductions in pre–sleep arousal, and improvements in nocturnal symptoms of insomnia.
- In a correlational study in 2008, Andrew J. Howell, Nancy L. Digdon, Karen Buro and Amanda R. Sheptycki reported that mindfulness (a) directly predicted well-being; (b) indirectly predicted well-being, as mediated by sleep quality. (See also their 2010 publication on the subject.)
Incidentally, Prof. Nancy Digdon (who is co-author of the two papers in the previous bullet) and I are conducting a study of the effects of the cognitive shuffle on sleep onset latency. Our first publication on the subject will be a poster at the CogSci 2015 Conference in Pasadena this July.
Returning to my hero, Winston Churchill. While he was not subjected to psychological tests, it is extensively documented that, like Steve Jobs, he was extremely capable of focusing under all kinds of circumstances. One can’t draw causal inferences from the case of Winston Churchill—we could debate whether he evinced the other aspects of mindfulness. Furthermore, correlation does not imply causation. However, to me he remains a symbol of how to relate to mental content, and the benefits this can have for sleep. ( Churchill, by Roy Jenkins, documents Churchill’s intellectual virtues–and his personal foibles. Regarding the latter, Jenkins, who has written many biographies, wrote “I have become increasingly convinced that great men have strong elements of comicality in them”. (p. xv))
But How to Accept and Move On? Some Resources
I’ve extolled the virtues that ACT seeks to develop. But how does one develop them independently? A starting point is to become conversant with the knowledge base.
- For a very accessible introduction to ACT, consider The Happiness Trap by Russ Harris. Available in iBookstore.
- It’s worth learning about Buddhism because ACT has much in common with secular Buddhist tenets (not the mystical ones). See Hayes, S. C. (2002). Buddhism and acceptance and commitment therapy. Cognitive and Behavioral Practice, 9(1), 58–65.
- It’s also worth learning about stoicism, which has some of the same ideas as Buddhism but easier for Westerners to grasp. Rationally Speaking Podcast Episode 114 dealt with stoicism. (The co-host, Massimo Pigliucci, also wrote about it on Scientia Salon.)
- I’d also recommend reading Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. The Guilford Press. Available in iBookstore. That book is written for therapists themselves, which has its advantages and disadvantages for the non-therapist. Sometimes psychotherapy book publishers specifically “prohibit” sale to Muggles; just ignore that injunction. Science-based practice needs to be transparent. Still, non-clinicians can skip Part I and Part II; and focus on Part III, particularly the chapters that deal with defusion, acceptance, connecting with values, and action.
Developing acceptance and deeply committing to one’s values is more demanding than acquiring a new skill or habit. Mindfulness is more than a typical skill set, as it also requires a shift in deep rooted “affective” processes (e.g., attitudes). That’s not easy! “Bibliotherapy” is not really transformative unless one has a system for converting knowledge into “mindware” (the software of one’s brain). That’s why I wrote Cognitive Productivity: Using Knowledge to Become Profoundly Effective.
In Part I of that book, I discuss the opportunities and problems we face in using high caliber knowledge resources to transform ourselves deeply. In Part II, I present cognitive science that is relevant to solving these problems. In Part III, I provide detailed recommendations for achieving this type of transformation. In Part IV, I specifically, but briefly, deal with acceptance and commitment therapy.
Because the changes required by ACT are so deep, it helps to work with a professional, such as an ACT psychologist, as I mentioned in the introduction.
Combining ACT and “the Cognitive Shuffle”
There are many ways to use ACT concepts together with the cognitive shuffle (mySleepButton or DIY). For example:
- Before settling into bed is a good time to remind yourself of some ACT concepts, such as not to treat mental JISMs as being necessarily pertinent. This is called “cognitive defusion”. Here you accept that you’re having these JISMs but you realize they are “just that.”
- Then, as you settle into bed you can spend a moment becoming non-judgmentally aware (i.e., with acceptance) of the tension in your body. This can actually be quite relaxing.
- Then you can begin the cognitive shuffle and pursue it in a mindful manner. It’s practically a meditation.
Whereas the cognitive shuffle keeps your mind off your concerns, and bedtime is not normally an appropriate time to engage in problem solving, it is not an “avoidance strategy”. Nor is “cognitive defusion”. It is a positive mental activity that many people find engaging, entertaining and yet conducive to sleep onset.
There are other ways to combine “third wave” psychological ideas with the cognitive shuffle (mySleepButton or DIY). We will have more to say about them in future posts.
I really enjoyed your blog on ACT and sleep. ACT is definitely an effective resource for insomnia and other sleep problems. I wanted to let you know that my colleague and I have recently published a book that uses ACT strategies for insomnia. It provides an overview of CBT for insomnia (CBT-I)and weaves in how ACT tools such as willingness, cognitive defusion, and mindfulness can improve your sleep outcomes. It is called End the Insomnia Struggle, published by New Harbinger Press, and released October 1, 2016. I hope you will consider it as another accessible resource for ACT.
Thanks, Colleen. I’ve added it to my reading list.
Readers: the link to their book is https://www.amazon.com/End-Insomnia-Struggle-Step-Step/dp/1626253439
Colleen, do you also do research? I’d be interested to get feedback about mySleepButton (both the mindfulness pack and the cognitive shuffle pack(s), which can be combined), or just the DIY techniques ( http://mysleepbutton.com/support/do-it-yourself-cognitive-shuffle-sdi/) from Veterans Affairs.
We have two studies in progress and are planning more.
I get nightmares constantly, i want to get rid of them, I will happily participate your study.