393: TEAM for Insomnia

393 Marina Dyck on TEAM for Insomnia Today we feature Marina Dyck, a TEAM-Certified Clinical Counselor in private practices in Swift Current, Saskatchewan, Canada. She works with individuals and families struggling with trauma, anxiety, depression, and relationship issues. She combines the latest research in neuroscience, powered by TEAM-CBT, and what she calls the "whole person" approach.
Marina describes her innovative TEAM-CBT treatment for patients with trouble sleeping. Many of them toss and turn at night, unable to turn off their anxious and agitated brains, so they ruminate over and over about problems that are bugging them. Sound familiar?
Here’s David’s quick, step by step overview of Marina's treatment approach, which is based on the steps of TEAM and the Daily Mood Log.
Step 1. Let’s imagine you’re the patient (or the shrink), so you start with a brief description of the Upsetting Event at the top of the Daily Mood Log. It could be something as simple as ”Lying in bed for several hours, unable to get to sleep because I keep ruminating about a report I have not finished for work,” or some other problem.
Step 2. Identify your negative feelings and estimate how intense each one is on a scale from 0 (not at all) to 100 (the worst.) For example, you may be feeling:
Sad, down: 80% Anxious, panicky: 95% Guilty, ashamed: 70% Inadequate, incompetent, inferior: 90% Alone: 100% Discouraged: 80% Frustrated: 95% Angry, annoyed: 100% Step 3: Record your negative thoughts and how strongly you believe each one from 0% to 100%. For example, you may be telling yourself:
I have to get to sleep! 100% If I don’t get to sleep, I’ll never be able to function tomorrow. 90% I should have completed my report for my boss today. 100% I should get out of bed and work on it. 90% There must be something wrong with me. 100% etc. etc. Step 4. Identify the distortions in these thoughts, like All-or-Nothing Thinking, Fortune-Telling, Should Statements, Emotional Reasoning, Magnification, and more.
Now, if you’re a shrink, after you’ve empathized, do the A = Paradoxical Agenda Setting or Assessment of Resistance. If you’re a general citizen, you can do Positive Reframing. In other words, instead of trying to make your negative thoughts and feeling disappear entirely by pushing the Magic Button, you can ask two questions about each negative thought (NT) or feeling:
How might this NT or feeling be helping me? What does this NT or feeling show about me and my core values that’s positive and awesome? Example. In the current example you are 95% anxious and panicky about your report for work as well as the fact that you can’t relax and fall asleep. Could there be some positives in your anxiety and panic? For example, these feelings might show
Your intense commitment to your work. They may be a reflection of your high standards. Your anxiety, while uncomfortable, has probably motivated you to work hard and achieve a great deal. Your anxiety may protect you from danger and keep you focused on what you have to do to succeed and survive. Your anxiety could be an expression of your respect for your boss and for the company you’re working for. Your desire to do a good job is probably a reflection of one of your core values as a human being. You could make similar lists for other feelings as well, like feeling down, guilty, discouraged, angry, and so forth.
At that point, you can set your goals for every negative feeling.
For example, you might decide that 15% or 20% might be enough anxiety and panic, and that 15% shame would be enough, and so forth. You can record your goals for each negative feeling in the goal column of your Daily Mood Log.
This is much easier than if you try to reduce them all to zero by pressing the Magic Button. And even if you could, then all of the positives you listed would go down the drain, right along with your negative thoughts and feelings.
Instead, you can aim to reduce them to some lower level that would allow you to relax while still maintaining your core personal values.
Now we’re ready for the M = Methods portion of the TEAM session.
You will enjoy this portion of the podcast. Marina led Rhonda in three classic TEAM methods: The Paradoxical Double Standard Technique, the Externalization of Voices, and something Marina calls Distraction Training, which is actually a mix of Image Substitution, self-hypnosis, and relaxation training. Essentially, you focus on something positive and relaxing, as opposed to ruminating about all you have to do.
This approach will come to life when you listen to the podcast, and I think you will agree that it IS innovative and significantly different and from 99% of what is currently sold as “insomnia treatment!”
Marina emphasizes that you, the client, will have to agree to spend 15 to 20 minutes per day doing written work with the Daily Mood Log, or all bets are...

[@shivamkothari1532]

Listening to this at 4:00 am EST..what a coincidence as i accidentally woke up !! Hope to get some new insights. 😊

[@hortenziatrif5053]

I really loved this podcast! Thank you !

[@snakedogman]

I am wondering about the actual results from this approach. There are several key elements missing that are part of a normal CBT-I approach, especially on the behavioural side. This is something I notice on this podcast, that TEAM CBT (or at least what's discussed on the podcast) seems to almost exclusively focus on the C(ognitive) part of CBT and there's very little talk about the B(ehaviour) part. For insomnia, a very important behavioural intervention (in my opinion) is bed time restriction. Many people spend too much time in bed tossing and turning, trying to "catch up" on sleep by going to bed earlier but then struggling to fall asleep. The basic understanding must be that you cannot force yourself to sleep. But you can train your body to fall asleep more readily by (temporarily) restricting the time spent in bed, so the sleep drive increases (you allow yourself to get more sleepy) before going to bed. Scaring people about years of life lost due to not sleeping 8 hours is absolutely the worst thing you could do btw. Many people don't sleep 8 hours and don't need to sleep 8 hours. There's absolutely no conclusive evidence that this is bad for your health, let alone that it would take years off your life span. Also telling people to make sleeping their "top priority, whatever it takes" is really not a good idea either because a main cause of insomnia is people worrying about their sleep. You want to make sleep be not a big deal, natural, effortless, not something that has to be forced. Please stop scaring people who sleep normal 6-7 hours into becoming insomniacs.

[@marinadyck1701]

Thank you for your thoughtful and reflecting comment. As for the actual results, everyone I introduce this model to reports an improvement within a week or two period. I am 100% confident behind this approach. CBT-I is certainly complementary to this model but the focus of the podcast was to introduce the application of the TEAM-CBT model for addressing insomnia. As Dr. Burns mentioned, there are so many tools the models offers and there were only three discussed in the podcast. Behaviourally, the talk addressed spending 15-20 minutes of homework on training the brain to "take a hike" for night. The course I am working on is called Train Your Brain To Sleep and will cover all the other aspects of sleep. In my experience, as important the ergonomics of sleep are, the majority of the work involves harnessing the workings of the mind and the nighttime mental chatter. I agree that there is no way we can "force" ourselves to sleep, but we can learn to understand, negotiate and work together with the mind to turn it off for the night. "Sleep hunger" concept will also be addressed in the training. As for the stats and research on health and longevity, here are a few sources you can check into: Sleep and immune function: Besedovsky, L., Lange, T., & Born, J. (2012). Sleep and immune function. Pflügers Archiv - European Journal of Physiology, 463(1), 121-137. doi.org/10.1007/s00424-011-1044-0 Sleep and obesity:www.ncbi.nlm.nih.gov/pmc/articles/PMC2398753/ Sleep and mental health: Bellesi, M., de Vivo, L., Chini, M., et al. (2018). Sleep loss promotes astrocytic phagocytosis and microglial activation in mouse cerebral cortex. Journal of Neuroscience, 38(21), 5262-5273. Baglioni, C., Battagliese, G., Feige, B., et al. (2011). Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135(1-3), 10-19. Sleep and longevity: www.sleepfoundation.org/sleep-news/good-sleep-linked-to-longer-life pubmed.ncbi.nlm.nih.gov/25979105/ These are just a few sources for review. I agree it is somewhat worrisome to tell people consequences of the lack of sleep and wondering if it would be more helpful to re-word it to what they get instead when they have more sufficient sleep. It is also my belief, that it is more worrisome to leave them in the unknown when the 1st go to remedy is as close as their pillow and there is help available like never before. If one commits to using even the three methods introduced in the podcast for a week or two, I would be surprised if their sleep won't improve even slightly. In addition, if you need further guidance, please feel free to reach out: www.marinadyck.com. If anyone is worried, please reach out to a TEAM-CBT therapist who have been trained in this approach and went trough the training, or to me personally and I will connect you with a therapist in your area.