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What is Acceptance and Commitment Therapy for Insomnia (ACTI)?

Acceptance and Commitment Therapy (ACT) is a cognitive-behavioural therapy, and ACTI is an adaptation of ACT specifically tailored to address insomnia and related sleep issues.

ACTI is based on six principles that promote better sleep through increasing what is called psychological flexibility – the ability to accept and adapt in ways that are helpful, rather than with psychological INflexibility. Psychological inflexibility increases stress, anxiety and arousal – arousal being the key driver for chronic insomnia.

These principles include cognitive defusion, acceptance, mindfulness, committed action, value clarification, and self-as-context.

Cognitive Defusion

Cognitive defusion techniques help you detach yourself from unhelpful sleep-related thoughts and beliefs. Instead of ‘going down the rabbit hole’ and getting caught up in these thoughts, you learn to observe them and question them – ‘does this thought represent the full reality of the situation’? This can give you some space from the emotions and anxieties that the thoughts and beliefs can create.

Acceptance

Trying to force sleep or straining very hard to create change only increases stress and sends signals to our ‘safety brain’ that we are in danger if we don’t sleep. This creates worse sleep. Acceptance in this context does not mean rolling over and not doing anything to create change. It means to drop the ‘struggle’. In the context of ACTI, this means accepting the presence of sleep difficulties and the discomfort you are feeling rather than spending energy on unproductive worry or attempts to force sleep to happen.  

Mindfulness

Mindfulness has many shapes and forms but ultimately cultivates awareness of what is happening through observing yourself, your thoughts and your feelings. This can make it easier to detach the rollercoaster of emotion that can be associated with ‘watching for sleep’. Practising mindfulness, even outside the context of sleep, can improve your sleep by setting up a mental environment where there is less volatility and anxiety. Also, mindful observation can help you develop a greater understanding of your sleep so that you can take more effective action. Mindfulness helps you choose action rather than react. 

Committed Action

Committed action means doing the things that you need and want to do, despite the challenges that may exist. This can involve taking action directly related to improving your sleep – but it can also involve doing the things in life that are meaningful to you, even when you aren’t sleeping well or it’s difficult to do. 

Values Clarification

What is most meaningful to you? In order to take committed action and make sensible choices, you need to develop a deep understanding of your WHY (which is always more than ‘just wanting to sleep better) and what things in life are most important to you. The process of values clarification helps people with insomnia make conscious choices that align with goals and overall well-being, including sleep – and this can dramatically improve a person’s quality of life while they are recovering, as well as promoting recovery from insomnia.

Self-as-Context

Self-as-context refers to the idea that our thoughts and feelings are not who we are but are experiences that come and go. This perspective helps you detach from the emotional impact of your sleep problems. For many people coming to this understanding is a huge place of healing on the journey to recovery.

 

How is ACTI different from CBTI? 

CBT-I is another evidence-based treatment for insomnia, focusing on changing unhelpful thoughts and behaviours that fuel your sleeping difficulties. While both ACTI and CBT-I share some similarities and can overlap, ACTI places greater emphasis on acceptance, mindfulness, and values-based actions. Emphasising these aspects can be very helpful to those who are especially anxious or fearfully trying to ‘control’ sleep.  

ACTI and CBTI can be used together – although some purists might argue that they clash. For example, is it ‘unaccepting’ of insomnia to apply a strict sleep window? This might come from a misconstrual of the idea of ‘acceptance’ (it is not rolling over and doing nothing) – or from what sleep compression can look like (it is about tilting people’s biology to promote sleep, and doesn’t always look like a ‘sleep window’ in the classic sense).

 

ACTI vs Relaxation Techniques

Relaxation techniques, such as progressive muscle relaxation and deep breathing exercises, are commonly used to help individuals with insomnia relax and fall asleep. While learning to relax can be helpful in the short term, it doesn’t address the ‘fuel’ that is feeding the insomnia. In fact, ‘teaching a relaxation technique’ can promote the idea that we can ‘control’ sleep or ‘whip out a trick’, which ultimately can add to the insomnia problem. ACTI addresses the underlying psychological perpetuating factors – the unhelpful thoughts and emotions – and can help you sleep better in the long term.

ACTI is evidence-based 

Several randomised controlled trials (RCTs) have shown that ACTI can lead to large improvements in sleep quality, insomnia severity, and daytime functioning. These studies have demonstrated that ACTI is an effective treatment for both primary and comorbid insomnia and is as effective as the current ‘gold standard’ CBTI approach. Like CBTI, ACTI has been shown to lead to ongoing sleep improvement at 12 months following treatment; This makes it a great option, especially for those who cannot do some of the components of CBTI.

Anyone who has worked with me knows I blend both CBTI and ACTI approaches, depending on the needs of the person. If you’d like to talk about working with me, book a free 20 minute call using the calendar at the bottom of this page.

 

The information contained above is provided for information purposes only. The contents of this post are not intended to amount to advice and you should not rely on any of the contents of this post. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this post. Tracy Hannigan disclaims all liability and responsibility arising from any reliance placed on any of the contents of this post.