Category Archives: insomnia

Set-Ups, Near Occasions & Solution-Focused Brief Therapy

Haven’t we all had times we felt set up for failure?

Near occasions. Think of them as set-ups. Human beings are spectacularly good at setting ourselves up, for good choices and for the not-so-good, too.

We Catholics refer to near-occasions of sin – the people, places, things and behaviors that we might see as “set ups” for us to make poor choices. There’s nothing inherently “bad” about gathering at a bar and grill with friends, but if you are trying hard to maintain your recovery as an alcoholic, it is a “near occasion.” It’s a set-up to make good choices even tougher. Likewise, the trip to the mall to “just walk around” when you’re trying to work your way out of debt. Why set yourself up for failure?

In the same way, there are what may be called “near occasions of Grace,” the people, places, things and behaviors that increase our odds of making good choices. The friends who are uplifting and don’t gossip; the entertainment that doesn’t feed envy or anger; the activities that make the rest of the day better. We “set up” the likelihood of good choices, too.

Solution Focused Brief Therapy (SFBT) similarly looks at people, places, things and behaviors. You may be thinking, well, duh, what sort of therapy does NOT focus on solutions? Different forms of therapy have different emphases in terms of finding solutions. For example, psychodynamic therapy emphasizes developing insight that leads to new choices; behavior modification focuses on step-by-step actions to guide the client towards reaching goals. In SFBT, there is a particular emphasis on the clues (factors that set up outcomes) in people’s lives and using these clues and the client’s strengths to develop solutions. In many ways, it is looking for near occasions of the goals the client has for therapy. When has the goal in question already happened, or part of it happened?  What was going on then? What was happening right before that? What were you doing? What were others doing? As a team, we investigate the near occasions of success so the client can use the clues to develop solutions that make sense for that client’s life.

Just as a quick example, let’s consider the person who realizes that getting the morning off on the right foot tends to lead to a better day, all-around. We look at examples of those “better days.” What did happen in the morning? What happened the day before that might have contributed to that morning? There are usually plenty of clues and examples of times when the person has been successful in doing things that either led to a “better day” or set the stage to some degree.  Some clues might be eating a reasonably healthy dinner, getting to bed “on time” and not using the phone or other screened device, getting up on time and getting out of bed right away instead of starting the phone-scroll. The person identifies the factors and then we look at how to increase the incidence or likelihood of those recurring. Breaking it down further, let’s take the dilemma of the phone next to the bed and its appeal as a way to deal with insomnia, or its interference with just getting out of bed on time. “I can’t leave it in the kitchen. It’s my alarm clock,” people will assert. Yes, I understand- and I understand that I bought a little travel alarm clock – a couple of AA batteries that have thus far worked for years – that wakes me reliably every morning whether there’s a power outage or not, and I do not have my phone over there, flashing lights and buzzing every time an artist friend posts a painting. It seems many other artists are night owls. The solution, if what is wanted is actually a reliable alarm clock function, can be had for less than fifteen dollars.  If the phone is off in another room, you’ll have to get out of bed to get to it. And by then you will probably have done something besides scroll – brushed your teeth or started the coffee or fed the dog. You will be vertical, approximately on time, and therefore have “set up” a more likely success story about getting into your day “on time.” The phone by the bed is a “near occasion” of extra time awake during the night, more time in bed, and then being rushed, grumpy and unprepared for the day. Nothing is inherently bad about the phone – but it might be part of a “set up.”

We all have “near occasions” – of sin, grace, good choices, bad choices. The negative ones have less power when we know what they are, and the good ones can exert their power when we focus on them.

Quitter’s Day – part 1

On New Year’s Day morning, Fr. Mike noted in his homily to those of us at early Mass that the second Friday in January is known as “Quitter’s Day,” because by then 80% of people would have quit their New Year’s Resolutions.

Perhaps you find yourself in the 80%. If so, may I suggest considering one or more short experiments – trying on a change, for a week or two – and assessing its usefulness for you. These are simple but not easy.

If making such changes were “easy,” we’d be a country overflowing with clear-thinking, peaceful, energetic, well-rested and generous-hearted people. Based on my 15-minute daily ration of news, that seems to not quite be the case.

Starting with the most basic – the marker of life at birth – breathing, which turns out to be something that we so easily can get wrong. If you are in good health and your medical provider doesn’t object, you might experiment with a practice of better breathing. This can be as simple as practicing slow, deep breathing for a few moments three times a day and then as needed when you want to calm yourself.  Breathe comfortably, slowly and deeply, so that the belly expands, rather than a quick, panting breath. Breathing out through the nose can help. “Slow” doesn’t mean make yourself dizzy or lightheaded; it means comfortable and relaxed. This kind of breathing impacts the nervous system in the abdomen and signals the brain to slow down its fight-or-flight, anxious mode.

It’s an experiment that you might try early in the morning, again when you shift gears between day and evening, and at bedtime.  You can find plenty of tutorials online with demos on relaxation breathing. If you have any medical conditions, of course, be sure that this is safe for you by consulting your healthcare provider.

Some people find this very useful as part of changing between activities, such as stopping work for lunch or at day’s end; before a stressful activity such as a presentation or dealing with a negative person; and when preparing for rest at night.

Thanks for reading!

Stress…And a Lesson From Cognitive Behavioral Therapy for Insomnia

Cognitive Behavioral Therapy for Insomnia (CBTi) helps people with insomnia via examining and, where appropriate, helping them change their behaviors and thoughts surrounding the issue of sleep.  One important factor we explore are called “Sleep Safety Behaviors.” These are habits which people believe are helpful for sleep.  Some sleep safety behaviors are in fact very helpful, such as avoiding screens for a couple of hours before bedtime, using soft, warm light sources in the evening, and avoiding upsetting discussions before bedtime. Other sleep safety behaviors are counter-productive, but if a person is convinced that they are helpful the anxiety around giving them up ends up disrupting the process of falling or staying asleep. The objective is to have positive habits around sleep, not unhelpful sleep safety behaviors. It is not as easy or obvious as it might sound.

For example, many people use alcohol as a type of sleep safety behavior. They believe it helps them relax and unwind, and seem to either not know, or disregard, that it actually is a sleep disruptor. Alcohol-fueled sleep usually involves waking up in the middle of the night as the effects of alcohol wear off. It also disrupts the quality of sleep. However, the person convinced that they “need” a drink to sleep may become so anxious about going without the drink that they have difficulty falling asleep, which they attribute (wrongly) to the absence of alcohol.

In the same way, don’t most people have some sort of “stress safety behaviors” to cope with stressful situations or extended times of stress? Some are helpful and constructive, and others are terribly unhelpful and even destructive.  Some are fairly neutral until taken to excess; an ounce or so of chocolate as a snack is one thing; a pound is another. Odds are, you know someone who clings to a stress safety behavior even though it is clear as day that it is unhelpful and even harmful. You may have encountered the futility of trying to convince the person that the extra drinks, the avoidance, the angry outbursts to vent over and over, merely get in the way.

Imagine a person for whom life has delivered a set of one-two punches – illness, a hurricane or two, unexpected car repairs. There are all sorts of paperwork and bills to tackle, and after a long day of work it is all too much. He takes an evening off to binge watch a favorite series, and then, the next day, everything is one more day behind, one more day piled up, and even more overwhelming – too much to be tackled, again, after a long and wearying day. Surely there is a half a season or so of something that will distract from the looming piles of paper.

Perhaps the person doesn’t binge-watch. Perhaps she enjoys a glass of wine, or two, or three, or, heck, why leave only one glass in the bottle? She adds poor sleep and the three days it takes for the full effect of alcohol to leave the brain to the problems still piling up on the table. Perhaps he gets caught up in a vortex of videos about things he cannot afford – certainly not at this moment – and adds envy and resentment to the problems at hand.

Odds are, too, you know people who have some good “stress safety behaviors.” Those habits reinforce resilience. You might notice some people seem to surf through the ups and downs of stressful times without falling apart or adding to the trouble at hand. If you are that someone, that’s wonderful; stick with it. If you know some people like that, but are not one yourself, perhaps you might give some positive stress safety behaviors a try.

If I were making an official list of Stress Safety Behaviors (which I am not at the moment), I’d probably include these:

Sleep: getting regular and adequate sleep – not feast or famine approaches to the weekly rotation, where you pretend you can “get by” on four hours during the workweek and really make it all up to your brain with a long sleep on Saturday.

Move regularly and adequately. Exercise, appropriate to your overall health and physician’s guidance, is essential. The machine needs regular movement to function properly.

Limit exposure to negative influences. Don’t feed your envy, your insecurities, or your bad habits.

Minimize exposure to media and people that encourage you to compare yourself to other people.  Do you think it’s a coincidence that so many magazines and websites feature articles about improving oneself – and a surfeit of advertisements for products that will, in theory, improve those things?

Treat Sabbath time seriously. Set aside one day each week for renewal. Pray, rest, read, enjoy time with family and friends, play, create.

Journal. There are lots of ways to journal. There’s the quick “5 things you’re grateful for” at bedtime journal. There are prayer journals and journals that are brief paragraphs on the events of the day. Maybe it’s that annoying journal assignment your therapist gave you. The act of writing – more than just “thinking about it” – brings more of your brain into the process. This way, for example, you benefit more from noticing good moments during the day, recollecting them in the evening, writing them down, and seeing your words on the page.

Positive stress safety behaviors are simple, common sense…but they can appear to be just one more thing to keep you from getting things done. If you think, for example, that a short walk is just a waste of time, that you’d be better off using those fifteen minutes for the big mess at hand, well, that might be true if that were, in fact, what would happen. But if the thing that would actually happen was a big sigh or a venting of angry frustration and the welcome distraction of a text message from a friend – well, then, the short walk to breathe deeply, move quickly and focus yourself for action might be less of a time-waster than it seemed.

If you’ve taken a look at the task manager window on your computer, you know there are dozens of programs running even though you may be only engaged in one. Start clicking on random programs to turn them off and watch the warnings pop up that this will interfere with the proper functioning of the computer. It’s the same with these sleep and stress safety behaviors. The people who do these things do them consistently, even when things are smooth and rolling along just fine.  These habits operate like a background program, always running. They keep the system working properly but without a big fuss. Turn off, or pause, those background programs and the system stops working properly, or perhaps just shuts down entirely.

Even good programs need updates. Taking that weekly break gives you a chance to notice if you need to make changes to the routine. Ignoring necessary updates usually makes the whole system a bit glitchy.