As ACT therapists, we understand that insomnia is not just about the physical inability to sleep; it’s deeply intertwined with a client’s thoughts, emotions, and responses to their experience of sleeplessness. When clients struggle with insomnia, they often become entangled in self-critical or fear-driven thoughts, which only amplifies the problem and makes their daily struggles more difficult to ease too. This 3-step strategy, shared by Dr Maja Schaedel as part of our expert tips for ACT series, offers a practical and compassionate way to help clients relate to their thoughts differently when suffering with insomnia.
Here’s how you can apply this approach with clients suffering from sleeplessness:
Step 1: Recognising and labelling thoughts
The first step is to help clients develop awareness of the particular thoughts that arise when they’re struggling to sleep. In practice, this involves teaching them to notice when they’ve become “hooked” by unhelpful thoughts about sleep, such as “I can’t sleep at all tonight” or “I’ll be so tired tomorrow.”
To make this step more tangible, you can guide individuals in identifying their most common sleep-related thoughts. Encourage them to label these thoughts when they appear, using language such as “Here’s my ‘I’ll never sleep again’ thought.” This labelling creates cognitive distance and helps clients to see these thoughts for what they are: mental events, not facts.
To reinforce this skill, you could also use metaphors like the “passengers on the bus” or the “radio playing in the background,” reminding clients that they don’t have to engage with every thought that comes up.
Step 2: Making peace with the thoughts
The second step involves encouraging acceptance of these sleep-related thoughts, rather than trying to suppress or fight them. It’s crucial to help clients understand that their thoughts are not inherently harmful, they are simply the mind’s way of trying to assist, even if the result feels unhelpful.
You can guide clients to respond to their thoughts with compassion and openness. For instance, they might say, “Thank you, mind, for trying to protect me,” or “I notice that thought is here, but I don’t need to act on it.” Normalising the presence of these thoughts and framing them as part of the human experience can help to reduce the struggle.
ACT exercises like the “leaves on a stream” or “clouds in the sky” visualisations can be particularly helpful here. These practices encourage clients to allow thoughts to come and go without getting caught up in them, creating a sense of calm and detachment.
Step 3: Doing something different
The final step is about guiding clients to shift their attention and break free from the cycle of overthinking and frustration. This involves encouraging them to step away from the struggle and engage in a different activity or focus.
With clients, explore what might work best for them in these moments. For some, this might mean getting out of bed to read a book or listen to calming music. For others, it could involve practising mindfulness by focusing on the sensations of their surroundings, such as the texture of their sheets or the sound of their breathing.
This step also provides an opportunity to discuss the concept of choice within ACT. While clients may not have control over the appearance of intrusive thoughts, they do have a choice in how they respond. Help them to see that by choosing to shift their attention, they are stepping into a space of greater psychological flexibility.
A metaphor like the “itch you don’t scratch” might be useful at this stage to illustrate how resisting the urge to engage with troubling thoughts can ultimately lead to longer-term relief.
Tailor this strategy to your client’s needs
As with all ACT interventions, these 3 steps should be adapted to the unique needs, values, and experiences of your client. Some clients may find it challenging to let go of their struggle with insomnia, particularly if they’ve been stuck in this pattern for a long time. In these cases, normalise their experience and approach it with curiosity and compassion.
You might also integrate this strategy with other ACT processes, such as clarifying values. For example, explore how improving their relationship with insomnia connects to the broader values they hold – whether that’s being present with loved ones, excelling in their career, or simply enjoying life more fully.
Through teaching clients to recognise and label their thoughts, make peace with their inner experiences, and shift their focus to something different, we can empower them to relate to their sleeplessness with greater acceptance and flexibility.
As ACT therapists, our goal is not to eliminate insomnia but to help clients build a more workable and compassionate relationship with it. In doing so, we support them to move away from struggle and towards a life that aligns with their value, even during those sleepless nights.