ACT for Insomnia: How Acceptance and Commitment Therapy Can Help Your Insomnia
For those who struggle with insomnia, it can become a persistent battle, filled with frustration, anxiety, and exhaustion. While Cognitive Behavioral Therapy for Insomnia (CBT-I) has long been the gold standard in treating chronic insomnia, a newer, complementary approach known as Acceptance and Commitment Therapy (ACT) for Insomnia has been gaining recognition for its effectiveness. In this article, we'll explore how ACT works for insomnia, and why it could be an essential tool for certain individuals who struggle with it.
What exactly is Acceptance and Commitment Therapy (ACT) for Insomnia?
ACT is a form of insomnia therapy that focuses on accepting negative thoughts and emotions, rather than battling or trying to control them. The key principles of ACT revolve around psychological flexibility, mindfulness, and values-based living. Instead of eliminating difficult thoughts, feelings, or experiences (such as anxiety about sleep), ACT helps individuals change their relationship to these experiences, thereby reducing their impact and influence.
This shift reduces the emotional impact of thoughts like “I’ll never fall asleep tonight,” making it easier to break the insomnia cycle.
ACT operates through six core processes:
Cognitive Defusion: Learning to view thoughts as mental events, not facts.
Acceptance: Allowing unpleasant emotions (like anxiety about not sleeping) to exist without reacting to them.
Mindfulness and Present Moment Awareness: Staying grounded in the present.
The Observing Self: Understanding that thoughts and feelings are just parts of the whole self.
Values: Identifying what truly matters to you in life.
Committed Action: Taking action aligned with your core values, even when faced with sleep difficulties.
In the context of insomnia, ACT encourages people to accept the reality of sleepless nights without reacting to them with fear, frustration, or avoidance, which can paradoxically exacerbate the problem.
ACT for Insomnia: How Does It Work?
The hallmark of insomnia is a heightened sense of anxiety about sleep. For many individuals, insomnia becomes a self-perpetuating cycle: the more you worry about sleep, the harder it becomes to sleep. Traditional CBT-I techniques work by targeting these dysfunctional sleep-related thoughts and behaviors, such as unhelpful beliefs about sleep or ineffective sleep habits.
ACT takes a different approach. It focuses less on controlling sleep itself and more on changing the relationship between the individual and their insomnia.
Here’s how ACT specifically helps with insomnia:
1. Acceptance of Sleeplessness:
One of the most challenging aspects of insomnia is the anxiety it creates. The more you worry about not sleeping, the harder it becomes to sleep. ACT teaches you to accept wakefulness, helping reduce the emotional arousal that keeps you up at night.
2. Reducing Sleep-Related Anxiety:
Insomnia often triggers anxiety, creating a vicious cycle where worrying about sleep keeps you awake. ACT helps you distance yourself from catastrophic thoughts like “If I don’t sleep, I won’t function tomorrow.” By practicing acceptance, the pressure to sleep is reduced, which can naturally improve your ability to fall asleep.
3. Mindfulness for Better Sleep:
Many people with insomnia find themselves trapped in rumination—worrying about past events or future problems, which keeps them from relaxing. Mindfulness techniques in ACT encourage you to focus on the present moment, shifting attention away from anxiety-provoking thoughts and calming your mind for sleep.
4. Aligning with Core Values:
Insomnia can make you feel powerless and disconnected from your life’s values, such as being productive at work or spending time with family. ACT helps you refocus on what’s important and take meaningful action, regardless of your sleep patterns. This focus on values helps you feel empowered rather than defeated by sleeplessness.
5. Cognitive Defusion: Changing How You Relate to Thoughts:
People with insomnia often hold onto harmful beliefs, such as “I need 8 hours of sleep to function.” These thoughts add pressure and worsen sleep quality. Through cognitive defusion, ACT teaches you to see these thoughts as temporary, which helps reduce their power and negative impact.
ACT vs. CBT-I: What’s the Difference?
While both ACT and CBT-I are rooted in cognitive behavioural principles, there are important distinctions between the two approaches. CBT-I is primarily focused on changing unhelpful beliefs and behaviours that perpetuate insomnia. It involves a structured sleep window, stimulus control, and cognitive restructuring.
ACT, on the other hand, focuses on acceptance and psychological flexibility. Rather than challenging or changing sleep-related thoughts, ACT encourages individuals to change how they relate to those thoughts and to stop battling with insomnia. This acceptance of insomnia-related experiences, without trying to control them, paradoxically helps reduce their influence.
Evidence for ACT for Insomnia
The data for Acceptance and Commitment Therapy (ACT) for insomnia has been growing steadily, supported by clinical trials and research studies. While CBT-I (Cognitive Behavioral Therapy for Insomnia) is still the most widely recognized and recommended treatment for insomnia, ACT is emerging as a promising alternative or complement, particularly for individuals who struggle with anxiety, hyperarousal, or emotional distress related to sleep.
Studies showing the effectiveness of ACT include:
Shin, J-W et al., 2023: A pilot RCT comparing ACT and CBTI in patients with chronic insomnia.
Benefits of ACT for Insomnia:
Reduced Sleep Anxiety: ACT helps reduce anxiety by shifting the focus away from controlling sleep.
Improved Emotional Well-being: By accepting insomnia, you reduce the frustration and negative emotions often associated with it.
Better Sleep: Although ACT doesn’t directly aim to improve sleep, by reducing the emotional struggle, many find their sleep quality improves naturally.
Sustainable Approach: ACT helps you build resilience, making it a sustainable long-term solution for chronic insomnia.
When Should You Consider ACT for Insomnia?
ACT is a valuable option for people who find themselves stuck in a cycle of sleep-related anxiety, frustration, and control. It may be particularly helpful for individuals who:
Feel that a very gentle, less-structured approach appeals to them.
Have persistent insomnia that isn’t fully resolved with CBT-I.
Feel that anxiety and rumination are major contributors to their sleeplessness.
Are looking for a mindfulness-based, acceptance-oriented approach to coping with sleep difficulty.
Are seeking a way to live more fully, regardless of how well they sleep.
Conclusion
Acceptance and Commitment Therapy for Insomnia is a powerful, evidence-based approach that helps individuals break free from the vicious cycle of insomnia by fostering acceptance, mindfulness, and values-driven action.
By focusing less on controlling sleep and more on changing one's relationship with the experience of insomnia, ACT helps reduce the psychological struggle that often perpetuates sleep problems.
If you or someone you know is struggling with insomnia, ACT can be a transformative approach.
For compassionate, science-led support for your sleep and insomnia, get in touch here.
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