What To Do If CBT Doesn't Work For My Insomnia?

The traditional, non-drug approach to treating insomnia is cognitive behavioral therapy CBT (or CBTI, where the I stands for insomnia).

CBT aims to eliminate insomnia by challenging your beliefs, thoughts, feelings, and actions that may cause sleep problems. The focus is on cognitive restructuring, which is confronting your negative thoughts and changing them.

But what if this approach of challenging your difficult inner experiences doesn’t work for you? What if you’ve tried all the different sleep hygiene methods or got out of bed at night when awake for more than 20 minutes, but the same unhelpful thoughts, sensations, and urges persist once you return to bed?

Then you should consider adopting a more acceptance-based approach. In this article, I want to give you some details about why that can have benefits and, more importantly, how ‘acceptance’ works, meaning what exact steps you can take to help you with your insomnia.

What means acceptance?

Because the word acceptance is filled with different definitions and many people associate it with simply surrendering to pain, some people don’t like to use it and instead use words like opening up, expanding, or allowing.

But acceptance is not resignation; it simply refers to the process of giving space to unpleasant thoughts, feelings, and sensations, rather than trying to avoid or repress them.

By opening up and encouraging our thoughts and feelings to come and go without obsessing over them, running away from them, or giving them unnecessary attention, we find that they bother us much less. They also leave more quickly instead of staying and annoying us.

How is it different from CBT?

Imagine when someone says, ‘I’m too nervous about speaking up in a meeting. I’m so afraid that I’ll say something foolish.’

Using CBT methods, we would usually deny the person’s pessimistic perception that they are a lousy speaker. Instead, we would try to replace their insecure feelings with optimistic, assertive ones, e.g., that they are fascinatingly good at speaking or a valuable contributor to the team.

This approach usually involves a battle of words, as the different voices within us – the supportive and the denying – demand recognition. Such a mental struggle takes a lot of energy and stress and can therefore lead to additional pain.

We get a different result if we approach the issue with an accepting attitude.

With acceptance, we notice, we don’t suppress

Let’s assume we’re sitting in a meeting wishing to contribute to the discussion. We are anxious and have a thick lump in our throat.

We would begin to scan our body and find that we have the most extreme anxiety.

Then we would examine the lump’s feeling, like a scientist who has never seen anything like it. We would note the lump’s shape, weight, vibration, temperature, pulsation, and other dimensions.

We would breathe into the lump to make room for it, to encourage it to be there even when we don’t want it or want it to be there.

We would practice observing the lump, not trying to get rid of it, but just letting the feeling of it, and probably other feelings associated with anxiety, come and go as they will.

So we notice them and don’t suppress them, but we don’t get hooked by them either.

We need to get in touch with the present moment

To encourage us to notice and accept the sensations, emotions, and thoughts that have arisen, we need to get in touch with the present moment.

Living in the present moment is a skill we can continually improve. It means reflecting on everything we do and fully perceiving the experience of the here and now with curiosity and receptivity, rather than focusing on the past or thinking about the future.

We are deeply connected to what is happening right here, right now. In the present moment, we can ground ourselves wherever or however we want, tuning into our body.

Focus on routine actions to strengthen present-moment awareness skills

For example, you can contemplate some small part of the experience you are having while showering: feeling the water as it reaches your skin and runs down, watching steam rising in the bathroom, smelling the scent of soaps or other items applied to your body during the shower or post-shower treatment.

Another exercise in connecting with the present moment is to observe the tiny specifics of washing dishes after dinner: the clink of plates on top of the bench, the sensation as the soapy water flows over them, the sight and sound of the squeak as things get completely clean, and the visual experience as you place them on the drain board.

Another way is to eat a single food, such as a dried fig (or any other small food you like), and focus on nothing but enjoying it. Intrusive thoughts and emotions may arise; they may come and go as they please, but your mind should remain focused on the fruit.

Contact with the present moment through the observing self

The observing self is a powerful component of our consciousness that is often overlooked. However, it is a consistency of consciousness that is unchanging, ever-present, and non-judgemental, meaning it can’t hurt you.

The observing self is proof that you are your body, and you are more than your body; you are more than your feelings, and you are more than your mind.

To understand the concept of the observing self is to realize that when we become aware of our feelings, two mechanisms are operating: that of thinking and that of observing reflection. In other words, there are the feelings that occur, and there is the self that experiences them. That’s your observing self in action.

You can also think of it this way: the observing self is the sky, while the thinking self is the ever-changing weather.

Your observing self is neutral by nature

Therefore, from the perspective of the observing or witnessing self, no inner perception such as thought, emotion, image, or urge is harmful or limiting.

The relationship to the present moment takes place for the observing self. The observing self is non-judgmental by nature. It does not grapple with reality but sees things as they are without fighting them.

We avoid things when we judge them as evil, unfair, or mean. Then our mind tells us that life should not be the way it is, that we would be better off if we were somewhere else, someone else, or somehow different.

On the other hand, the observing self is unaware of these judgments or resistances. On the contrary, it will approach every sensation and encounter with openness, curiosity, and interest.

Start making use of your observing self

When you turn on the observing self and notice and allow difficult inner experiences to be, you often find that the things you were afraid of are much less troubling than before.

And over time, and with some practice making use of the observing self, you find it easier to accept your unwanted thoughts, feelings, sensations and urges, and you begin to see things differently.

How to use present-moment awareness when awake at night?

An accepting approach toward insomnia starts with ending the draining struggle by accepting wakefulness. I know that’s not easy, but that’s what paying attention to the present moment can help you do.

Start with noticing your body as it lies on the bed. Where is it touching the cover? How heavy does it feel on the mattress? Pay attention to all your senses around you: if there are any textures, temperature changes, etc.

Once you have noticed these senses, slowly scan your body for sensations such as vibrations, tingling, heaviness, pressure, movement, heat, and coolness.

Perceive these sensations without trying to change them, but simply with a mindful awareness of curiosity and openness to the present moment.

When you begin to think about or judge the sensation or think about something else, notice it. Then try to see if you can return to the feelings and sensations in your body.

Present-moment awareness is not a control strategy

Remember that we don’t want to establish another unhelpful control strategy with present moment-awareness techniques. The exercise is not meant to ‘fight insomnia’ and eliminate or change your thoughts, feelings, or sensations but to disentangle yourself from them.

If you’re willing to accept everything that’s showing up in your body while lying awake in bed, you stop the struggle with your difficult inner experiences. That has a calming effect on your mind, and only then can restful sleep set in.

What To Do If CBT Doesn’t Work For My Insomnia?