Acceptance and Commitment Therapy for Insomnia

Written by Martin Reed, MEd, CHES®, CCSH. Reviewed by Nick Wignall, PhD✓ Evidence-based contentThis article has been reviewed for accuracy by Nick Wignall, PhD. Dr. Wignall is a clinical psychologist who earned his PhD at The University of Texas Southwestern Medical School..

What is acceptance and commitment therapy for insomnia?

Acceptance and commitment therapy (ACT) is a third-wave of behavior change therapy, coming after the development of earlier approaches such as cognitive behavioral therapy (CBT).

ACT for insomnia (ACT-I) is based on the idea that the more we try to control sleep and the difficult thoughts and feelings that come with it, the more we can end up struggling.

The more we struggle, the more we can suffer and the harder it can be to live the life we want to live.

ACT-I is a collection of techniques that can help you move away from the ongoing struggle that’s caused by things like:

• Trying to protect sleep
• Putting effort into sleep
• Putting pressure on yourself to sleep
• Trying to get rid of wakefulness when it shows up
• Doing less of what matters because of insomnia and how it makes you feel
• Trying to fight or avoid the difficult thoughts and feelings that can come with insomnia

If you recognize any of the above and you’re feeling stuck, it is very likely that you will find ACT-I helpful.

The goal of ACT-I is to help you move away from struggling with insomnia and all the difficult thoughts and feelings that often come with it.

This struggle often comes from an unwillingness to experience insomnia and those difficult thoughts and feelings.

This unwillingness is completely understandable because insomnia is not usually very pleasant!

If you reflect on your own experience, you might recognize that the more you try to resist insomnia and the thoughts and feelings that come with it, the more stuck you can feel and the more difficult it all becomes.

It’s quite likely that your efforts to fight or avoid insomnia have helped every now and then or for a certain amount of time. And yet, no matter how hard you try to fight or avoid insomnia, no matter how hard you try to fight or avoid certain thoughts or certain feelings, you have probably found that they always end up coming back at some point. And so, your struggle continues.

If you have exerted a lot of effort and invested a lot of time, energy, and attention in trying to control your sleep, what you think, or how you feel — and still feel stuck — this suggests that none of these things can be controlled. And trying to control what cannot be controlled might be creating a struggle that’s making things even more difficult.

ACT-I will help you develop new skills so you can respond to insomnia with less struggle. The less you struggle with sleep, the better conditions become for sleep to happen and the more energy and attention you will free up to live the kind of life you want to live.

Here’s a video by Dr. Russ Harris that can help explain how struggle can make things more difficult. Although he talks about struggling with difficult thoughts and feelings, the same applies when we struggle with sleep, too.

Key ACT-I Skills

Key skills that are often developed in ACT-I include:

 Accepting  that sleep and difficult thoughts cannot be controlled and allowing insomnia and all the thoughts and feelings that come with it to be present when they show up (even though you’d much rather not experience insomnia or those difficult thoughts and feelings).

How this helps: As you build skill in opening up to the presence of insomnia and acknowledging and observing difficult thoughts and feelings rather than battling with them, you will move away from the endless and exhausting struggle that makes everything more difficult.

 Refocusing  your attention on the present moment and the world around you when difficult thoughts and feelings distract you and try to pull you away from where you are and what you are doing.

How this helps: As you build skill in bringing yourself back to the present, you will be better able to move away from struggling with your thoughts and feelings, better able to do the things that matter, and better able to be the person you want to be and live the life you want to live.

 Committing  to actions that matter and doing things that are important to you, even after difficult nights and even in the presence of difficult thoughts and feelings.

How this helps: As you build skill in acting in ways that are aligned with your values and doing things that matter, even when difficult stuff is present, you will continue to move toward the life you want to live, expand the focus of your attention, and regain control over your life.

ACT-I is not about:

• Giving up
• Distraction
• Thinking positive
• Tricking your mind
• Endless meditation
• Spirituality or religion

ACT-I is about helping you create and maintain good conditions for sleep and responding to nighttime wakefulness and all the difficult thoughts and feelings that come with it in a more workable way.

ACT has been found to have a significant effect on insomnia and sleep quality.

It will help you move away from an endless, exhausting, and distracting struggle that can make everything more difficult.

It will give you an alternative way of responding to insomnia and the difficult thoughts and feelings that often come with it.

As you move away from trying to control sleep, conditions for sleep improve.

As you move away from trying to fight or avoid difficult thoughts and feelings, they will consume less of your energy and attention and they can become less noticeable, less distracting, less influential, and lose their power.

As your focus shifts away from trying to control things that cannot be directly or permanently controlled, you will free yourself from the insomnia struggle and be better able to live the life you want to live, independently of sleep.

Cognitive behavioral therapy for Insomnia (CBT-I) and acceptance and commitment therapy for insomnia (ACT-I) are two effective approaches for insomnia.

CBT-I aims to tackle the thoughts and behaviors that can perpetuate sleep disruption.

This is usually achieved through techniques such as reducing the amount of time allotted for sleep (sleep restriction), getting out of bed when sleep isn’t happening (stimulus control), and identifying, evaluating, challenging, and trying to change sleep-related thoughts.

ACT-I aims to explore whether trying to control sleep (and the thoughts and feelings that often come with insomnia) is a workable approach.

If your experience suggests that it is not, it can help you respond in a different way — a way that will move you away from an endless, exhausting, and distracting struggle that makes things even more difficult.

Sleep tracking: CBT-I vs ACT-I

CBT-I often involves filling out sleep diaries and tracking sleep every night.

You are far less likely to be filling out sleep diaries or tracking sleep with ACT-I — and that’s because the goal with ACT-I is to shift attention away from sleep (something that cannot be directly controlled) and toward actions that help move you away from struggle and toward the life you want to live (actions that can be directly controlled).

Responding to nighttime wakefulness: CBT-I vs ACT-I

CBT-I often involves getting out of bed if you have been awake for a certain amount of time. The idea is that too much time spent awake in bed can create an association between the bed and wakefulness and so the bed should be reserved for sleep and sex only.

ACT-I encourages the use of nighttime wakefulness as an opportunity to develop skill in experiencing wakefulness with less struggle. The idea is that wakefulness itself isn’t creating a problematic association with the bed — it’s struggling with wakefulness that can train the brain that the bed is a battleground rather than a comfortable place to be.

Since the goal with ACT-I is to practice experiencing wakefulness with less struggle, it means that you do not need to get out of bed just because you are awake. It’s OK to stay in bed and rest. And, since the goal isn’t to create an association between the bed and sleep, it means that other activities (such as reading) can take place in bed.

Responding to difficult thoughts and feelings at night: CBT-I vs ACT-I

CBT-I often involves trying to distract the mind at night by getting out of bed and doing something else or by practicing relaxation exercises with the goal of reducing arousal.

ACT-I questions whether trying to control the mind is workable and, if it’s not, offers an alternative approach that can involve practicing skills that will help you make space for difficult thoughts and feelings to exist and to come and go as they choose.

Responding to difficult thoughts and feelings during the day: CBT-I vs ACT-I

CBT-I usually involves identifying, evaluating and trying to change unhelpful or inaccurate thoughts and feelings. The idea being that unhelpful or inaccurate thoughts can create more difficulty.

ACT-I usually involves identifying, evaluating, and changing the way we respond to difficult thoughts and feelings. The idea being that the content of our thoughts isn’t the true source of difficulty — it’s our response to them, and our attempts to fight or avoid them, that can make things more difficult.

ACT has also been recognized as an alternative option for those who do not respond well to CBT-I.