The worry tree
Trigger:
- Notice worry - ‘what if?’;
- Can I do anything about it?
- YES
- Can I do anything right now?
- YES
- Fix it! Think about:
- What’s the problem?
- What needs to changes?
- What do I need to do to make it happen?
- Action!
- Can I do anything right now?
- YES
- Can I do anything about it?
- NO
- Let the worry go! Save it for later, do something else.
- NO
- Can I do anything about it?
- YES
- Can I do anything about it right now?
- NO
- Can I do anything later?
- YES
- Plan a time to fix it! Now do something else.
- Can I do anything later?
- NO
- Can I do anything about it right now?
- YES
Worry time
This is your time to worry about the things that have bothered you in the day. If you start to worry in the morning, stop and tell yourself to save it up for your ‘worry time’ later that night.
- Put aside 15 minutes each evening: At the start of your worry time, think of what you have to worry about and then try to do so.
- Chances are you may not recall what it was, or
- you may feel it’s not worth the worry.
And even if you do, you might find it hard to bring on worry.
Thought-action fusing
This technique focuses on reacting to a thought as if it is the truth or as if it has actually happened.
Example:
- Sue has the (automatic) thought: “I’m going to do badly in my assignment”
- She finds herself becoming despondent and losing interest in the notes she was reading
- She imagines herself telling others that she has failed or got a really low mark
- She feels very low (mood) and stops studying (behaviour)
What actually happened is that she had a thought about failure, but her mood and behavior were as if she had actually failed.
Let’s try ‘de-fusing’ or ‘defusion’
Try this technique:
- Take the thought ‘I’m going to fail’
- Spend the next 20 seconds really believing it; say it to yourself like it’s going to happen
- Now, replace the thought for the next 20 seconds with: ‘I’ve just had a thought that I’m going to fail’
- And now, replace that thought (for the next 20 seconds) with: ‘I’ve noticed that I’ve had a thought that I’m going to fail’
What is rumination?
Have you ever been told you think too much?
Rumination means brooding or thinking in a circular and unhelpful way.
- This kind of thinking can lie at the heart of some anxiety conditions, such as generalized anxiety.
- It’s unpleasant, unproductive and can lead to low mood and/or anxiety.
Am I ruminating?
Ask yourself:
- Have I made progress towards solving a problem?
- Do I understand something about a problem (or my feelings about it) that I haven’t understood before?
- Do I feel less self-critical or less depressed than before I started thinking about it?
If you didn’t answer ‘yes’ to at least one question, you are ruminating!
Four strategies to stop or prevent rumination
- Remind yourself of the consequences of rumination. For example: ‘I feel more depressed and/or anxious than before I started thinking’.
- Problem-solve; come up with possible solutions, pro’s and con’s, time frame the problem, and evaluate whether outcome is worthwhile.
- Mindfulness; attend closely to sights, sounds, smells around you as they happen in the moment. Be mindful of thoughts, allow them to come and go, gently encourage an empty mind, be curious of thoughts, try not to respond to them
- Focus on the individual steps of the problem; what would I do first if I had to write an essay?
If all else fails: try to distract yourself.
We know this borders on avoidance behavior, so use this for rumination only.
How can I sleep better?
There’s no ideal length of sleep needed; your body will take what it needs in sleep. There’s no sleep deficit, and usually, our body adapts.
According to research, people with insomnia tend to:
- Overestimate the length of time it takes them to get to sleep
- Be overly sensitive to bodily symptoms, interpreting them as tiredness
- Underestimate the amount of time spent asleep
Quick tips to improve your sleep:
- Keep a diary of what you do, what you are thinking and what you are feeling before, during and after your disturbed night’s sleep. Is there a pattern of thoughts or feelings? Challenge negative thoughts and create new balanced thoughts.
- Develop regular sleep times: go to bed and get up in the morning at the same time regardless of how tired you are.
- Check for any medical explanations with a GP.
- Use your bed only for sleep and sex: avoiding it for other tasks.
- Do not drink too much liquid before bed: sleep can be disturbed by urinary urgency.
Three-step approach to treat insomnia
Pre-step: Attend to your sleep hygiene:
- Reduce screen time and create a buffer
- Check caffeine intake
- Check temperature (body needs to heat up and then cool down)
- Create a pre-sleep ‘ritual’, such as; read a book, set an alarm, trip to bathroom, etc.
Step 1: Calculate sleep efficiency
- Sleep efficiency is the percentage of time spent in bed actually asleep (as opposed to ruminating)
- You should aim for 80%
- Formula: Actual sleep time / total time spent in bed x 100
- For example: Tabitha sleeps for 5 hours (actual sleep) but goes to bed at 23:00 and her alarm goes off at 08:00 (total bed time is 9 hours):
- 5 / 9 = 0.55
- 0.55 x 100 = 55%
- Sleep efficiency = 55% (well below 80% target)
- For example: Tabitha sleeps for 5 hours (actual sleep) but goes to bed at 23:00 and her alarm goes off at 08:00 (total bed time is 9 hours):
Step 2: Sleep restriction
Narrow the sleep window by matching time in bed to time asleep, plus 30 minutes.
- For example: Tabitha –
- Currently spending 9 hours in bed but asleep for just 5 (sleep efficiency: 55%),
- Needs to be out of bed by 07:00 to start studying at 09:00
- Bedtime is now 5.5 hours backwards from 07:00: 01:30
- Her time in bed will be just 5.5 hours
- No daytime naps
- After each week, time in bed is increased by half an hour - but only if efficiency is 90%
Step 3: Re-learn sleep associations
- Aim: associate bed with sleep/sex only
- If not asleep after 15 minutes, get up and go to another room
- Engage in a passive activity (reading, writing to-do lists, crafts, etc)
- Return to bed when sleepy
- Repeat as necessary
The NHS’s Every Mind Matters has information and guidance all about sleep and how to improve your sleep quality, how fall asleep or stay asleep if you’re struggling. Check out NHS: How to fall asleep faster and sleep better.
You might also want to try out the NHS Mind Plan.