Behavioural Therapies
Cognitive behavioural therapy for insomnia significantly improved sleep for patients with chronic neck or back pain and also reduced the extent to which pain interfered with their daily functioning, according to a study by University of Rochester Medical Centre researchers.
The study, published online by the journal Sleep Medicine, demonstrates that a behavioural intervention can help patients who already are taking medications for pain and might be reluctant or unable to take additional drugs to treat sleep disturbance.
'This therapy made a major difference to these patients,' said Carla R. Jungquist, F.N.P., Ph.D., of the Medical Centre's Sleep and Neurophysiology Research Laboratory, who is the lead author of the Sleep Medicine article. 'We saw very good treatment effects.'
For the study, a nurse therapist delivered the eight weeks of cognitive behavioural therapy, which included sleep restriction, stimulus control, sleep hygiene, and one session devoted to discussion of catastrophic thoughts about the consequences of insomnia.
'This study really shows that this therapy can be delivered successfully and very effectively by advance practice nurses,' Jungquist said. 'Training nurses in the delivery of this type of therapy will result in better access for patients. Currently, access to this therapy is limited as there are few trained therapists and most are psychologists.'
Patients with chronic pain often use sleep as an escape. They seek sleep when not sleepy, sleep in places other than the bedroom, and engage in non-sleep behaviours, such as watching television and resting a painful back, in the bedroom, the researchers report.
Using behavioural therapy instead of adding to their list of medications is a healthier and safer method of treating sleep disturbance, Jungquist said.
'We establish a structure for the times or hours spent in bed,' Jungquist explained. 'We focus on a patient's negative thoughts about sleep and address unhealthy sleep behaviour. We address habits, including use of caffeine or alcohol. We tell people to do nothing in bed except sleep or [Bleep].'
Twenty-eight patients took part in the study. They were tracked through detailed sleep diaries. Their pain and mood were measured using several standard methods throughout the study period. The patients were followed for six months after treatment. Researchers expect to report soon on the duration of the effects of the treatment.
The researchers believe that cognitive behavioural therapy is as effective as other tested treatments for insomnia and chronic pain and, in some cases, is more effective than other therapies.
The researchers have developed a unique, user-friendly manual that described each step of every treatment session. It can be used to train more therapists.
This approach to coaching is known as cognitive behavioural therapy (CBT) and by focusing on negative thoughts and feelings and changing them to positive thoughts the life coach can help change the client's behaviours.
Dieting to Dancing, a Life Coach can Help
The life coach will arrange to meet the client on a regular basis and over the first few sessions identify with the client what issues to deal with in the short, medium and long term. The issue for the client, in the example below, is how to overcome feelings of anxiety.
A good approach taken by coaches is to ask the client to keep a diary. The diary is used to capture the thoughts, emotions, feelings and actions of the client during the instances of the pattern of behaviour he wants to change. Thus if the client is working to manage his anxiety attacks then whenever he becomes anxious he will be asked by the coach to capture in his diary the situation that led to him become anxious, the emotions he felt, how he felt physically and what actions he took.
Over time a pattern of behaviour will be established by the coach and the trigger for the behaviour can more easily be identified. The coach will then work with the client to consider how to change the unhelpful thoughts and behaviours - to scratch out the negative tape that is being played and replace it with more positive thoughts.
A good life coach will then take a supporter & facilitator role to help the client change their thoughts and behaviours. After the client identifies the thoughts he wants to change, the life coach will help him by using the diary to question his self-critical thoughts and replace them with more helpful ones. The coach will also help the client recognize the behaviours that, in the long run, will make him feel worse and identify how to do something more helpful.
Life coaching is beneficial in that it can help individuals deal more positively with situations they face in daily life. An approach to life coaching usually involves cognitive behavioural therapy, which tries to unearth the negative thoughts that are leading to a particular behaviour; these negative thoughts are replaced with positive thoughts which ultimately lead to different behaviour.
