What treatments do psychologists use in insomnia?
Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) discuss the role psychologists have to play in managing insomnia. Moira also outlines the components of cognitive behavioural therapy for insomnia and other techniques she uses in managing insomnia in her clients.
- 00:00 – 01:59 Role of psychologists in managing insomnia
- 01:59 – 04:18 What is cognitive behavioural therapy for insomnia (CBTi)?
- 04:18 – 06:38 What other techniques do you use to manage insomnia?
Dr Moira Junge is a registered Health Psychologist and a member of the Australian Psychological Society and holds membership within the College of Health Psychologists. She has been in the healthcare field for over twenty years and is passionate about improving wellbeing. She is one of the clinic directors at Yarraville Health Group which was established in 1998. In addition to her work at Yarraville Health Group Moira also consults at the Melbourne Sleep Disorders Centre. Her areas of expertise include management of sleep disorders, smoking cessation, management of chronic diseases, reaction and adjustment to illness issues and loss and grief issues.
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David Cunnington: Moira, I have the pleasure of working with you in managing people with insomnia and psychologists really do have a big role in managing insomnia. But why such a big role?
Moira Junge: Well, that’s a good question. I think that we as psychologists are really well-trained to look at the big picture. We’re very much trained in the bio-psycho-social approach, at looking at biological, looking at social, looking at psychological factors and not to disparage anyone else who’s not doing that.
But sometimes particularly some colleagues, some professions look very, very, very straight – you know, this targeted fashion, just in looking at one component sometimes.
The other thing about psychologists is that we have a lot – we actually have the time as well. We structure our sessions that they’re always at least 50 minutes to an hour and usually the process is over many weeks and months. So we can actually support people over a much longer period of time. There’s not a lot of pressure necessarily to treat something on the spot, on the day.
In fairness to say GPs for instance, sometimes there is too much pressure on them. People expect them to fix it. Look, I’ve got this sleep problem. I want you to fix it now today and so there’s a pressure on them to get to write scripts.
We know that GPs don’t want to do that necessarily but sometimes it’s an easy option. Sometimes they might have psychologists to refer to or they might not – yeah, they just might – it’s hard to get into psychologists as well as expensive sometimes. So there are a lot of barriers to psychology but I think that we do have a really big role. I’m really passionate about talking about it. I’m really happy as you can tell. I’m going on and on with that.
David Cunnington: So one of the psychology-based treatments, cognitive behavioural therapy, CBT. When it’s used for insomnia, what does that look like? What does it consist of?
Moira Junge: OK. Well, CBT, as it sounds, there are cognitive components and behavioural components and they’re both really important and in fact research from last year talks about that combined, they are both equally important. But probably longer term, the cognitive appears even more important than the behavioural, which is controversial because there are plenty of people in my profession who would argue against that.
To say look now, behaviour – it’s all behavioural. It’s habits. Just get them changing in behaviours.
So the behavioural components of – called sleep consolidation and stimulus control and they’re big words for things that people are probably doing anyway. Like making sure that the environment is just about sleep, making sure that bed is just for sleeping. So no other things in bed, the TV, the radios, the iPads, the iPods, eating, arguing, that they just clear their environment and just have it – and if they’re awakened there too, then let’s get up and be out of bed.
This notion that bed equals sleep.
In terms of sleep consolidation, that’s also called other things like bed restriction, sleep restriction, other names over the years. But that’s essentially about making sure that you’re in there for the amount of hours that you’re really sleeping. It should match the time in bed with your hours of sleep.
To have chunky – one single block, rather than sleeping from 10:00 to 1:00 and then again from 4:00 to 7:00, trying really hard to get that chunk of time, getting five or six hours in one block, which everyone knows – people listening to this who have got insomnia would be nodding, saying, “Yeah. That’s what I want. I want a consolidated block.”
So the other things we’re looking at behaviourally, I’ve got strategies around that and then also the components of CBT. I talked about the cognitive. That’s a big thing in itself. Like cognitive therapy takes a long time, to many, many sessions and over weeks and months usually to talk to people about how their thinking is affecting the way – their relationship with sleep. Really the impact it’s having on their behaviours. Sometimes we have a lot of preconceived ideas and that can really – inadvertently we shoot ourselves in the foot.
David Cunnington: Research in this area is progressing, we’re looking at new things we can add to CBT. So what are some of the emerging treatments or what are some of the other tricks you’ve got up your sleeve if you need to do that a bit more?
Moira Junge: Yeah. Well, that’s a good thing to ask because I was just thinking that with the cognitive therapy. More recently over the last few years, I’ve been using mindfulness-based meditation, mindfulness-based stress reduction techniques as a bit of a platform or a framework for people to address the cognitions, to actually think about their relationship with sleep or how they’re thinking. They have to change their thinking but not in a way that we used to. Cognitive therapy is much more of a challenge trying to change your thinking like that. Like, it’s just alter that thought! Change it! Change to this.
But mindfulness space principles are more getting in touch with it all, accepting it, sitting with it and then thinking about how you can maybe change your thinking a little bit over time.
Other things in my bag of tricks are hypnosis and a lot of psychologists don’t do hypnosis and there’s a lot of people who do hypnosis that aren’t psychologists. So it’s not the domain of a psychologist. And I really like it. I get so many good results with it but I don’t use it with everyone. Primarily because sometimes it’s not appropriate and other times, people aren’t open for it. They’re not looking for it. They’re sceptical and I respect that. I understand that and also it’s not high in the evidence base in the same way that CBT is and the emerging evidence with mindfulness. They have very, very good empirical base. We know it works. It’s documented really, really well.
Hypnosis I know works. But in terms of the scientific research, it’s a little bit more patchy than it is for the other things. But I don’t – not patchy enough that I don’t do it. It’s just the rigor is not there in the same way. It’s a little bit esoteric still.
David Cunnington: But in clinical practice, that’s what we do. We need to incorporate evidence-based treatments, plus other little tricks that we’ve got because often we need all the tricks in the book to be able to get good results.
Moira Junge: Yeah, exactly. Sometimes you need to be flexible. You need to just be open to the complexity of the different – the uniqueness of the patients that come through the door.
David Cunnington: Thanks a lot Moira. That has been really helpful.
Moira Junge: My pleasure.
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