How CBT-I is Done WRONG
CBT-I is the gold standard treatment for insomnia, but it's frequently done incorrectly.
I explain 4 ways CBT-I is done wrong, WHY this happens, and how to do CBT-I RIGHT.
Mistake #1: Misunderstanding Sleep Restriction
Mistake #2: Incomplete Treatment Implementation
Mistake #3: Incorrect Expectations
Mistake #4: Mislabeling CBT-I
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WHAT I DO:
I help people overcome insomnia and get good sleep (without medication, drugs or supplements).
To Your Sleeping Better!
- Steve
RESOURCES
CBT-I Playlist
00:00 Introduction to CBT-I and Common Mistakes
01:11 Common Mistake #1: Misunderstanding Sleep Restriction
04:28 Common Mistake #2: Incomplete Treatment Implementation
06:09 Common Mistake #3: Incorrect Expectations
09:51 Common Mistake #4: Mislabeling CBT-I
12:49 Why These Mistakes Happen
14:41 How to Do CBT-I Correctly
16:19 Conclusion and Next Steps
RESOURCES
Introduction to CBTI and Common Mistakes
Today, I'm going to talk about how CBTI is frequently done wrong. CBTI is Cognitive Behavioral Therapy for Insomnia, which is the gold standard treatment for insomnia. And I talk a lot about it on this channel.
And quite often, this treatment is implemented incorrectly. Therefore, it doesn't really work or doesn't work that well. And the person with the insomnia concludes, Oh, it doesn't work, when what's going on is it's just being implemented in the wrong way.
So what I'm going to highlight today are four common ways that I see this implemented incorrectly. And the way I know this is many clients will come to me and I'll usually do, you know, a full history or an assessment when I first meet with them and I frequently find out that they've tried some form of CBTI or some part of CBTI, but they weren't, doing it correctly. They weren't being taught how to implement it in the right way. And therefore it wasn't that effective or it was effective for a certain period of time.
So let me go over those four common ways, so you're aware of them. So either [00:01:00] if you've tried CBTI before, or if you're thinking about it, you'll know kind of what to look for and how to make sure that you're going to a provider who's going to give you the full CBTI and the correct way.
Common Mistake #1: Misunderstanding Sleep Restriction
So number one. Sleep restriction. So sleep restriction, which is a misnomer, but essentially it's reducing the amount of time that you're spending in the bed for sleep because you're spending a lot of time in the bed not sleeping and that's one thing that feeds insomnia. But frequently sleep restriction, or what I call in my own program, sleep scheduling is done incorrectly.
Number one, the sleep is reduced too much. And you don't want to reduce it too much. below a certain level because otherwise you're not giving the person with the insomnia enough time to be able to get, you know, enough sleep and also be able to have time to fall asleep, to wake up, they're having trouble sleeping.
And if that window is shrunk too much, it creates too much anxiety and stress and pressure on being able to sleep within the, that those limited hours.
And in fact, [00:02:00] the reason why I don't like the term sleep restriction is we're actually never restricting sleep. So you should never restrict your sleep. You're only reducing the amount of time that you're in bed based on how much you've actually been sleeping over the last week.
So for example, if you've been sleeping five hours and you're giving yourself eight hours in bed to sleep. That's three hours that you're not sleeping in the bed, which is just a waste of time. And that, that actually is one of the poor sleep behaviors that feeds insomnia. So it's better to reduce it. So even if you continue to sleep five hours, but instead you're in bed for seven hours or six hours, you're getting the same amount of sleep, but what happens is your sleep efficiency goes up. That means the amount of time you're actually sleeping in the bed goes up and that is really important for overcoming insomnia.
What happens when sleep restriction is implemented incorrectly is that window of time in bed is shrunk too low to not give yourself the opportunity to be able to sleep as much as you [00:03:00] can. And then it also raises anxiety and stress on the person because, you know, the time is more limited.
The second thing that happens here is that the sleep schedule, which is the time you get into bed, your bedtime, your wake up time and the amount of time that you're given to actually sleep is done generically, meaning it's not personalized to you.
When someone has insomnia their pattern of sleep is different than someone else with insomnia. So everybody has a different sleep pattern, even though the underlying causes of insomnia are the same for everybody. And the process for overcoming it is the same in terms of the skills, but how you apply those skills depends on the type of insomnia and the pattern of your sleep, particularly over the last seven days, because we want to make sure the skills are fit to exactly where you are right now, like a glove, because that's going to be the most effective way to overcome the insomnia.
And what happens quite often with sleep restriction is you go to a provider and they just give you a generic bedtime and wake up time. Quite often, this is like midnight to [00:04:00] five or one to five or something like that. Even though that may not fit your biology. It may not fit your lifestyle and most importantly that it doesn't actually fit your current sleep pattern based on the numbers from the last seven days.
So to implement this correctly, it has to be done in a way that it's personalized but also in a way that fits your biology and where your sleep currently is at based on the previous seven days because your sleep changes over time. So that's number one, sleep restriction.
Common Mistake #2: Incomplete Treatment Implementation
Number two, you only do one or two parts of the treatment.
So CBTI is a multi faceted treatment. There's really four key skills and then there's maybe two or three other skills that are added to that just to, you know, make it stronger and to help your sleep get back in a stronger way. But really there's four key pieces and all four of those things need to be in place and being applied in a certain way, in a certain sequence, for it to be effective for it to actually get rid of the insomnia and keep it away and quite often what [00:05:00] happens is The person only implements one piece or they go to a provider and the provider just has them do one or maybe two pieces And very often that sleep restriction or they might have them keep a sleep log or they might say do this and this. And they're leaving out one or two or three really key important parts of CVTI and just kind of picking and choosing between a couple of skills out of context with the entire treatment.
And that is not going to work because CBT is the process that's been developed for 50 years. It's been studied. It's been developed by different psychologists and different providers in different places, and it's been improved and added to and built on over many, many years and then tested to really optimize its effectiveness.
And therefore, there's a certain combination of skills that's used to sort of address all the main issues that are causing the problem. But if you only take one of these skills and throw it at the problem, sometimes the person will get some improvement over a while, but [00:06:00] ultimately it doesn't work because you're not doing the other pieces that are addressing other aspects of the problem.
So that's another thing that happens very frequently.
Common Mistake #3: Incorrect Expectations
Okay, the number three way that CBT-I is implemented in the wrong way is, incorrect expectations are set. So what that means is if the person, let's say you're trying to do it on your own because you're reading something online or, you know, you're trying to figure it out and you have expectations. So everyone has expectations when they're doing some kind of treatment or behavior. You want to know like what's going to happen and how is this going to go?
And quite often with, insomnia and trying to implement this treatment of CVTI, the expectations are way off. You know, the person is expecting it to go a certain way and it goes another way. There's a couple of areas where this happens a lot.
Number one, the number of sessions or weeks it's going to take to actually overcome the insomnia. Now, to learn the skills of CBTI, which is this treatment that I've [00:07:00] talked about a lot on this channel, and I'll put a link in the video below to where I have a playlist that goes into CBTI in more detail.
But normally, You can learn all the key skills of CBTI within around five weeks, meaning you've learned and you're applying all the core skills by that time, but you're not generally over this, the insomnia at that point. You have to keep applying all those skills, The way that you've learned them consistently every week, and you're also adjusting every week based on the numbers that you're tracking to make sure the skills are being applied again, as I said earlier, to where your body is at currently.
So sometimes someone comes in and thinks, well, it said online, it only takes like five or six weeks. And then they get to four or five weeks and they're not over the insomnia and they're still having issues and they freak out. And they think, Oh, this isn't working. And they throw it away and they go to something else.
That is a really key skill. One of those core skills that you need to implement CBT-I correctly and get over insomnia is knowing how to manage [00:08:00] your thoughts and your emotions. Because there's a lot of worry, there's a lot of what are called negative sleep thoughts, there's anxiety and frustration and your emotions are going all over the place.
And you can't let that sidetrack you. You have to be able to manage that to stay on track. And to be able to do that, you have to have correct expectations.
So, in my program, the first thing we do in the first week is we get you into the right frame of mind, so you have the right outlook and expectations for, you know, what to actually expect from the process, which is something very positive.
But also, what is it going to look like along that path, you know over the next several weeks? What is it going to look like? What are you going to experience? What should you expect or not expect so that doesn't derail you so you're not sort of just freaking out When you have a difficult night along the way and you'll be able to manage those bumps along the way more effectively.
Another expectation is that it's going to be a linear process. What that means is you think that, well, the longer I'm doing it, things are going to get progressively better and better and [00:09:00] better, you know, incrementally every night, every week. And it's just sort of this straight line of improvement.
But that really never happens in the human body. You know, there's always like steps forward and then a step back and then three steps forward and two steps back and you kind of keep doing that. It's a nonlinear progression where it's variable over time with overall. Improvement until finally you break that pattern and then it is consistent and it is positive and there is no, you know difficult nights
But to get there, it's nonlinear meaning It's not a straight line and that's another really critical thing to know in terms of your expectations So you don't get derailed and freak out when you know You're having a difficult night or a few nights or even a difficult week even as you're going through this process That's normal when the body is going through change And you're making changes to your body through different behaviors.
Common Mistake #4: Mislabeling CBT-I
The number four way that CBT-I is implemented or done incorrectly is that the provider calls what they're doing [00:10:00] CBTI when it's actually not. So I see this happen a lot. So I'll have somebody come to me that they have insomnia. I'll do like a, you know, a session where they'll consult with me and I'll assess that where their sleep is at.
And I'll ask them always, well, what have you tried? And they'll say, well, I've tried sleep restriction or this, or sometimes they'll say CBTI and I'll say, Oh, tell me what they did. And I'll have them tell me what the provider had them do and Almost always, I would say 90 percent of the time, The provider is leaving things out or they're not even really doing CBTI, they're doing more like sleep hygiene, which is things like, you know, make sure you stop drinking coffee and don't drink alcohol and exercise during the day and get light exposure.
Or just like meditate. What you really need to do is learn how to relax and do these relaxation exercises. And then they just talk to them about the insomnia. It's kind of like a combination of talk therapy and relaxation exercises and mindfulness skills and all that stuff is great, but it won't get rid of the insomnia because insomnia can't be gotten rid of by just talking about it or by [00:11:00] doing relaxation exercises. You have to actually shift some key behaviors in your sleep and it has to be done in that way I was saying earlier in the video.
And the problem here is people are misled and I don't think therapist or the provider is doing this knowingly. I think they think this is, you know, the treatment for insomnia because they learned some CBT in grad school or they read a book or something like that, but they're calling it CBTI, cognitive behavioral therapy for insomnia, when it's actually not the full correct proper treatment Therefore the client is getting you know The wrong guidance and gets frustrated and doesn't make a lot of progress or make some progress But it doesn't really solve the insomnia. So that's the number four thing.
So let me just quickly review those four. Number one, the reduction of time in bed, which is frequently called sleep restriction, is done incorrectly. It's done in a generic way and done in a way where it isn't personalized to your body and your sleep.
Number two, the provider or you, if you're trying to do it on your own, [00:12:00] are only doing one or two parts of the process instead of the four key things, plus a couple of extra things done in a certain way in a certain sequence. It's a multifaceted process and therefore it doesn't work if you're just kind of doing one or two things.
Number three, incorrect expectations are set. So you're going in with the wrong expectations about how things are going to go over the next several weeks and what to expect. And then when what you expect doesn't happen, you freak out or you get worried or you think it's not working. And then that derails you and causes you to stop You know the process.
And then number four you go see a provider because they're telling you hey I do CBT I and what they actually do is not CBT I but some form of like talk therapy or relaxation exercises or sleep hygiene, and none of those things will work for insomnia
Why These Mistakes Happen
So, the question here is why does this happen and why does this happen so often?
Well, number one, there's just a lot of wrong information on the internet. I'm sure you've seen this with other things [00:13:00] outside of insomnia, is that Googling something can be, you know, can be very helpful sometimes, but there's nobody checking all that information. And, You know, the information from there is gotten from providers or the media and the media gets that information from providers or doctors who don't get any training in sleep in school or therapists who don't get any training in sleep in school and it just gets passed on and then it ends up on Google and you end up getting a lot of false or conflicting or misleading information that then leads you down the wrong path.
Number two, because of the lack of training and specialty in sleep in the medical field and in the mental health field, most therapists and doctors don't know very much about sleep or insomnia. So they don't learn this treatment and they don't learn a lot about this unless they specialize in it and really study it and learn it and practice the treatment.
So they pick it up. in some other way, they might watch some videos themselves, or they read a book on it or something, and then they try to implement it with their clients, and it's done incorrectly, and they make the mistakes that I kind of [00:14:00] highlighted in this video.
Another problem is the provider doesn't have enough experience, so they maybe got some training, actual training in CBTI, but they haven't had a lot of practice in implementing it and knowing how to do it correctly and learning how to do it with a lot of different clients, which is how you learn any skill.
It's a skill to be able to apply this, and you have to practice it, and you have to work with like many, many different clients to Who are coming in with many different types of insomnia to know how to work with it effectively.
And I think those are the main reasons why that CBTI is so frequently often implemented incorrectly, either by the person when they're trying to do it themselves, or they go to a provider and the same kind of problems crop up because of the things that I said.
How to Do CBT-I Correctly
So to do CBTI right, you have to kind of do what I highlighted in each of those four things. You have to, first of all, make sure the provider, or if you're doing it yourself, are teaching you the key skills and all of the skills, and you're implementing all of those things in the right way for it to be effective.
Number two, make [00:15:00] sure it's personalized to you. So CVTI has to be personalized. The main way we do that is through keeping a sleep log or tracking key data. There's certain key numbers that we need to know and we need to do that throughout the process because we need to know where is your sleep at now, particularly from the last seven days to know how to actually apply the skills and create a sleep schedule.
And to implement all the parts of CBTI effectively, we need to know where your sleep is at and we need to fit it to where your, you know, individualized sleep pattern is for it to be effective.
Third, make sure the provider is experienced. So if you go see a provider, make sure they have experience. A lot of providers say they work with everything. You'll see a whole list of every mental health problem you can think of and they'll have sleep and insomnia on there. But what you want to make sure is they have a specialty in that area because it takes a specialty skill to be able to know how to implement this treatment correctly and they have the experience and the knowledge to be able to do it with a lot of different types of people.
And then how do you do that? Well, [00:16:00] you know, you have to do your due diligence. Just like you have to do to find a good mechanic or a good medical doctor. You have to research, go to their website and read about them. See the training that they've had. See if you can do a call with them and find out if it's not clear on their website.
And really do your research to find out where to find a provider who is qualified.
Conclusion and Next Steps
Now, I'm going to do another video soon, probably in the next week or two where I just talk about how do you find CBT I and how do you make sure that you're getting it, the treatment properly done, that where you can find a really good experienced provider or you're finding a way to guide yourself if you're trying to do it yourself in a way that's effective, where you're going to be doing all these elements and you don't end up making the same mistakes that I highlighted in this video.
So I'll be doing that in the next week or two, you can look out for that.
So I hope this video was helpful, especially if you've tried CBT I or if you're thinking about it in this way you can, you know, make sure that you're going to be doing it in the correct way. And if you liked the video, just press the like button and you can also subscribe to the channel. I do two of these [00:17:00] videos every week.
And if you have questions about CBT I or any part of insomnia that you want me to answer, then just post that in the comment section below the video. I do Q& A's. every week or so when, you know, I get enough questions, then I'll do a Q and A video and answer those questions in the video, so I could do the same for you.
So just post that in the comment section below and I hope you have a good rest of your week and I'll see you next time.