This is the latest in a series of interviews with APA Books authors. For this author interview, David Becker, a Development Editor at APA Books, talked with Jason Ong, PhD, about his recent book, Mindfulness-Based Therapy for Insomnia.
Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.
Jason C. Ong, PhD, is an associate professor in the department of neurology at the Northwestern University Feinberg School of Medicine. Dr. Ong developed mindfulness-based therapy for insomnia (MBTI) as an innovative group intervention for treating chronic insomnia. MBTI unites the principles and practices of mindfulness therapy with the behavioral strategies of cognitive–behavioral therapy for insomnia (CBT-I). He writes about the theoretical foundations of MBTI and its implementation in his recent publication with APA Books, Mindfulness-Based Therapy for Insomnia. He also recently released a video, Mindfulness for Insomnia, in which he demonstrates how to conduct an MBTI session. Dr. Ong’s work has been published in various academic journals, including JAMA Internal Medicine, SLEEP, Behavior Research and Therapy, and the Journal of Clinical Psychology.
Chronic insomnia is a notoriously difficult disorder to treat. Even when treatments provide some relief, it only seems to be temporary in many cases. Why is insomnia so resistant to treatment?
Chronic insomnia is often perpetuated by cognitive and behavioral changes that develop in response to persistent sleep disturbances. For example, people who experience several nights of poor sleep may try to go to bed earlier or stay in bed longer in the morning as a means of coping with the sleep disturbance. This also sets the stage for worrying about sleep and modifying behaviors based on contingencies (e.g., going to bed earlier in anticipation of needing to “function well” the next day). As a result, more effort is put into making sleep happen, which disrupts the brain’s natural regulation of sleep.
What is mindfulness-based therapy for insomnia (MBTI)? How is it similar to or different from other mindfulness-based therapies?
MBTI is a new treatment for insomnia that uses the practice of mindfulness meditation to help people with insomnia. It is primarily aimed at decreasing the effort to sleep through the principles of mindfulness and allowing the brain to regulate sleep without “getting in the way.” MBTI is similar to other MBTs such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in its use of mindfulness principles and meditation practices. Unlike other MBTs, MBTI includes specific behavioral recommendations that are designed to promote sleep regulation. Therefore, it might be seen as a version of MBSR that is tailored for people with insomnia.
What are some of the most common challenges that instructors and clients encounter in MBTI, and how are they addressed?
For clients, it can be difficult to practice the principles of non-striving and non-attachment to wanting more sleep. Insufficient sleep does have consequences, such as low mood and energy, so it is very challenging to be patient while practicing mindfulness and allow the brain to regulate sleep. Most people are used to being problem solvers and putting forth more effort to accomplish something, but this is one situation where trying harder does not help. For example, doing internet searches for different ways to sleep (e.g., drinking chamomile tea, reading a boring book) and then trying each of these techniques until something works tends to promote anxiety about sleep rather than relaxation.
For instructors, it can be difficult to listen mindfully to the client who is suffering or to refrain from trying to fix things for the client. MBTI instructors are most effective in teaching mindfulness skills when they
What inspired you to develop MBTI?
On a personal level, I have always had an interest in Eastern philosophy. As a student, one of my favorite hobbies was reading books on Buddhism, especially those by the Dalai Lama. As I moved into my professional career, I really enjoyed working with insomnia patients. I was trained in cognitive–behavioral therapy (CBT) but found that sometimes the traditional CBT approaches were not sufficient. Some people reacted negatively to getting out of bed or spending less time in bed, and it seemed like a power struggle to get these patients to comply with CBT. By bringing my personal interests into my clinical work, I found that mindfulness and self-compassion could provide a different approach to help people work out of the problem of chronic insomnia. I was fortunate enough to have a mentor who supported this idea, and off we went!
In your book, you clarify that MBTI is series of group exercises that should be administered by a licensed instructor. It’s not simply a matter of meditating oneself to sleep. Even so, is there a simple mindfulness exercise and/or a key piece of advice that you can offer readers who suffer from insomnia—something that they can use in their everyday life?
The trainspotting exercise can serve as a good starting point for understanding mindfulness and working with racing thoughts associated with insomnia. The exercise entails imagining oneself standing on a train platform and observing thoughts going by as if they were trains passing through a busy station. Inevitably, the mind will wander and we will “step into a train” by engaging in a thought or analyzing it. Here, we practice self-compassion by acknowledging that we have stepped into a train and without judgment, we step off the train and return to platform to continue trainspotting.
By practicing how to just watch thoughts rather than engage with them or analyze their contents, we learn how to work with a busy mind in a different way. Instead of trying to clear the mind to make sleep happen (which is not likely to work) we can be a trainspotter of the mind, which reduces the struggle to control thoughts and allows sleep to emerge.