Author: Diana Gordon, Psy.D.
If you’re like many people, you sometimes feel like you don’t get enough sleep. Sleep problems have become so common that it’s become a social norm to reply “tired!” when people ask you how you’re doing. While occasional difficulty sleeping is normal, chronic sleep problems may indicate that you have insomnia. Insomnia doesn’t mean that you don’t sleep at all, but it does mean that you consistently have difficulty falling asleep or staying asleep and/or feel that your sleep is low quality. It can be difficult to do all the things we need to do in a day when we’re tired. The good news is, there are very effective treatments for sleep problems. Best of all, these treatments are drug free and you can see results in just a few weeks.
We can all benefit from what psychologists call “sleep hygiene” techniques. These are behavioral strategies for helping get your body and mind ready for bed. If you have mild sleep problems, these strategies may be enough to get you back on track. Try implementing a few of these at a time and see what works best for you.
If you’d like to try implementing some sleep hygiene techniques in your daily life, here are some of the most effective tips:
In addition to these behavioral changes, it’s also important to manage some of your anxiety and worry about sleep, work, relationships, and other stressors. Often anxiety and stress can keep us awake at night. Reserve some time in the evening to do things that you enjoy and that relax you. Try to avoid working or engaging in stressful activities in the few hours before bedtime. If you find yourself worrying in bed, try doing some deep breathing exercises or a guided meditation to relax. You can also try keeping a pen and paper next to bed and jotting down any concerns that you’d like to address tomorrow. When a worry or idea comes into your head, jot it down and tell yourself that you’ll make sure to revisit it the next day. Try not to worry too much about whether or not you will fall asleep, because this can add unnecessary and unhelpful pressure to sleep. Remember that even if you’re tired tomorrow, you can still make it through the day.
It can be very challenging to make some of the changes we’ve outlined above. Good sleep hygiene requires a lot of time and effort. But the results can be dramatic, and getting more sleep can be very rewarding. If you’ve tried the strategies above and they haven't worked for you, don’t be discouraged. If your sleep still isn’t where you’d like it to be, you might want to consider seeing a sleep specialist who is trained in CBT for insomnia. A psychologist who specializes in sleep can evaluate your personal habits and provide tailored recommendations. Many people notice changes after just a few sessions of CBT for insomnia. In part 2 of this blog post, you can learn more about CBT for insomnia and how it might improve your sleep. Don't hesitate to contact us to find out whether CBT-I might be helpful for you.
Tolerating Uncertainty: 7 strategies for managing worry and staying grounded in the face of uncertainty
Author: Kari Kagan, Psy.D.
If you are a human being, then chances are you have experienced what it is like to worry. From a scientific perspective, worry is defined as a “cognitive phenomenon, it is concerned with future events where there is uncertainty about the outcome, the future being thought about is a negative one, and this is accompanied by feelings of anxiety” (MacLeod, Williams, and Bekerian, 1991). In other words, it is that experience in which you find your mind wandering to the uncertain future and predicting the worst possible outcome, leaving you with feelings that can range from mild stress to paralyzing dread. This definition is notable because it highlights the role of uncertainty in our understanding of worry. Research has found a strong relationship between worry and intolerance of uncertainty, which is difficulty accepting the uncontrollability of the future that leads to intense anxiety and discomfort. In essence, it is the fear of the unknown.
Why is worrying so common? The truth of the matter is, there are times in which worry can serve us well. For example, without some amount of worry, we might not be motivated to set alarms so we can make it to work on time or to brush our teeth so we don’t get cavities. Seems pretty useful to worry, right? Although worry can motivate some positive behaviors, it is not as useful as we might think. For example, individuals who worry chronically believe that it facilitates problem-solving, but scientific research suggests that it is more likely to impair successful problem-solving (Davey et al., 1992). For chronic worriers, most of their time spent worrying is unproductive and has negative consequences, such as difficulty sleeping and irritability, yet worry persists. Why is that?
Unfortunately, worry reinforces itself. Let me explain how this works. Because of intolerance of uncertainty, or difficulty accepting the possibility of negative events occurring in the future, people attempt to gain control over the future by worrying about all the possible outcomes. Perhaps you have thought to yourself, "if I worry about it enough than I can prevent the worst from happening." That is how worry gets you--it creates the illusion that you have more control over the future than you really do. This is one of the reasons that worrying is hard to give up – it is associated with the belief that the prediction of potential future negative outcomes allows for control over these outcomes. However, research finds that worry does not accurately predict future events because people with chronic worry tend to overestimate risk of negative outcomes. As such, worrying is an ineffective attempt at control that gets reinforced by a false illusion that the future is more certain because we worried about it (Roemerm Orsillo, and Barlow, 2004).
Worrying is understandable because the alternative means admitting that despite our best efforts, there is a disconcerting amount of uncertainty in what lies ahead. However, accepting uncertainty does not mean giving up and leaving our lives up to “fate”. Rather, it means learning how to distinguish between worries that are amenable to problem solving and those that are not. When worrying is constructive, take action! Do something that resolves the potential problem. However, when worrying is unproductive and not leading to any solutions, learning how to manage it and tolerate the uncertainty will be much more effective in the long-term because it will free you from the agony of trying to predict the future and allow you to be an engaged participant in your present life. Of course, this is much easier said than done, but what follows is a list of strategies to help distinguish between constructive and destructive worry, to manage excessive worry, and to increase tolerance to uncertainty.
1. Increase awareness of worries by recording them in a given week.
Studies show that the mere act of keeping a diary or log (i.e., food, exercise, and in this case, worry) leads to changes in behavior. For one week, keep track of what you worry about and how often. Just seeing how often you worry might be enough to recognize it’s problematic effects and to be willing to make a change.
2. Distinguish between constructive vs. maladaptive worry
Ask yourself, am I able to take action on any of my worries today?
3. Challenge unhelpful worry thoughts
Identify the thoughts associated with anxiety and worry and question their accuracy
As mentioned above, worry is often associated with overestimating the likelihood of negative outcomes. In challenging these predictions, an important goal is to counter these “catastrophic” thoughts and more realistically assess the probability of threat. Here are two key questions to ask yourself:
How likely is this negative outcome to occur?
4. Plan “behavioral experiments” to challenge worries
Behavioral experiments are a strategy that allows us to challenge our worries and catastrophic predictions through action.
This could be a useful tool to challenge erroneous positive beliefs about worry. You have probably worried so much in your lifetime that you have experienced some positive benefits of it. But is worrying really necessary in order to attain the positive outcomes or prevent the worst from happening?
In designing a behavioral experiment, be specific! Here are steps to help you:
5. Relaxation strategies
Identifying excessive or maladaptive worry is one thing, but how do you turn it off once you realize it is not helpful?
Unfortunately, there is no way to just shut off worry. It doesn’t work like a faucet or a light switch that we turn on or off. But you can learn to cope with it.
According to Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction (MBSR), mindfulness means “paying attention in a particular way; on purpose, in the present moment, and non judgmentally."
Whereas worry takes place in the future, mindfulness involves being fully present in your current experience. As such, it also involves acceptance and willingness to be with whatever your present experience is, positive or negative.
In the case of intolerance of uncertainty, acceptance might mean willingness to tolerate the discomfort of being uncertain. People get stuck when they decide they cannot be the person they want to be or do what they want to do until they feel more grounded or certain about what the future holds. When using an acceptance approach to coping, it means that regardless of anxiety and fear of the unknown, you can continue to act in line with what is most important to you, in line with your values.
7. Gain a different perspective
Instead of dreading the unknown and predicting the worst, is there any way you can embrace it? Perhaps look at the unknown and see adventure rather than doom.
In conclusion, worry and difficulty tolerating uncertainty of the future is an inevitable part of the human experience. In fact, it can even be adaptive at times! But for those times when our worry is causing more pain and suffering than good, these are strategies that can be very useful and effective. Practice is key: although we may never completely get rid of worry, we can certainly learn to effectively manage it and increase our tolerance to uncertainty.
If you'd like to learn more about these and other strategies for managing worry and anxiety, please reach out to us for a free initial consultation.
Diana Gordon, Psy.D., Kari Kagan Psy.D., and Katie Leoni, Psy.D.
Drs. Gordon, Kagan, and Leoni practice psychotherapy in downtown San Francisco and Oakland. Their areas of expertise include anxiety, sleep, stress, depression, and addiction. They blog about these topics to provide research-based information about common problems and strategies to help manage them.