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Section 14
Behavioral Intervention for Stress Management

Question 14 | Test | Table of Contents

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In the last section, we discussed techniques for relaxation. For the purposes of sleep disorders, we discussed three techniques for relaxation.  The three techniques for relaxation that we discussed were stretching, mind games, and autogenic training. 

Before that we discussed some mental imagery techniques used by clients who benefited from various forms of guided imagery. But what about sleep disorder clients who have difficulty getting to sleep as a result of the frustration, anxiety and tension that comes from feeling as though they have no control over a situation?

In this section, we will discuss taking control.  We will examine worry time and reducing tension and coping with stress. Sound interesting?

First, let’s discuss worry time.  Drew, age 39, was the type of insomniac who often found himself lying in bed worrying about finances, his job, and his relationship with his wife. Drew stated, "It’s like I have all these thoughts buzzing through my head and I can’t stop them. I end up spending hours trying to get some shut eye, but I just keep thinking about all my problems." I felt that the ‘worry time’ technique might benefit Drew. I stated to Drew, "Sometime during the evening, long before you go to bed, schedule a half hour to do the work of worry so don’t have to do it in bed."  Drew asked, "Yeah, right.  How do I do that?" 

♦ 4-Step "Worry Time" Technique

Step 1: Write the Worries Down
I stated, "First, go into a quiet room so your family won’t bother you, not even for telephone calls.  Take 30 or 40 blank three-by-five cards and a pencil with you.  Then, just sit and relax.  As a worrier, you won’t have to do anything and before long worries will start buzzing around.  As they come, write each one down on one of the cards.  They don’t all have to be important worries.  They can be dumb worries or little worries, but whatever bothersome thought comes into your head, write it on a separate card." 

Drew asked, "What if I’m sitting there and worries don’t come?"  How would you have responded to Drew?  I stated, "If you sit there for half an hour and no worries start buzzing around, that’s OK.  You’ve simply used the time to relax.  Don’t worry that you might not have any worries."

Step 2: Categorize the Worries
For Drew, the second step in the ‘worry time’ technique was to categorize his worries. Clearly, the purpose of this step is for the client to begin to establish order regarding the perceived chaos of the situations over which the client feels they have no control. I stated to Drew, "You might have one batch of worries about your finances, another for your relationships, and so on.  About three to seven categories should suffice." 

Some clients I have treated classify their worries by content, others by their perceived importance of specific worries. Would you agree that how clients classify their worries matters less than how applicable the categories are to a client’s situation? 

Step 3: Find Solutions
I continued to describe the ‘worry time’ technique to Drew.  I stated, "Once you have your worries categorized, think about each group carefully and see what you can do with the worries in that group. At the bottom of each card, write down what seems to be the best solution."  For example, one of Drew’s worries was that he only had $500 in the bank, but $800 worth of bills to pay. At a later session, Drew stated, "I immediately decided which bills to pay and which ones to let go. I wrote it all down on the card, including who I needed to call to explain and make payment arrangements with." 

Step 4: Identify Problems you Cannot Help
Clearly, the idea here is for clients like Drew to write down a solution in order to take control and let the worry go.  At our next session, Drew stated, "What should I start doing about the worries that I really have no control over?"  I responded, "In that case, write down, ‘I will not deal with this worry today,’ or ‘This worry is out of my control.’" 

Drew stated, "One thing that continues to bother me is my relationship with my wife.  For the last two weeks I’ve tried coming up with solutions, but nothing seems to work.  How should I handle that?"  How would you have responded to Drew?  I stated, "If you have concluded that you have done everything you can, write that down on your card next time.  You might write, ‘I have done everything I can.  The ball is in her court and now I have to wait until it comes back.’" 

Drew began to utilize the ‘worry time’ technique to help him avoid remaining awake at night worrying.  Drew kept additional worry cards by his bed that he used periodically when his ‘worry time’ failed to get of rid all his worries.  Think of your Drew.  Could ‘worry time’ as a behavioral intervention benefit your client? 

♦ 3-Step "Reducing Tension and Coping with Stress" Technique
In addition to ‘worry time,’ let’s discuss reducing tension and coping with stress. One productive method for sleep disorder clients to reduce tension and cope with stress is for clients to read through the list of suggestions included in your reproducible client worksheets under "Reducing Tension and Coping with Stress."

--Step One: I suggest to clients that as they read through the suggestions, they mark those that might apply.
--Step Two: Then, clients go through the list again and put another mark next to the ones they would like to do something about. 
--Step Three: Then clients choose the one thing which is most applicable to work on first.  Drew tried this technique and, as I explained to him, clients can always go back and work on other suggestions later. 

For example, the suggestion that Drew found most applicable to himself was suggestion 9.  It reads as follows:  "How much energy are you putting into being scared?  Does your fear sometimes turn to anger?  Try cooperation instead of fear and anger.  You don’t always have to back away from or push away the other person. Learn to recognize and stop destructive feelings." 

Drew stated, "I think it might be fear more than anything.  Isn’t worry and fear kind of the same thing?"  How would you have responded to Drew?  I chose to validate his feelings and we began to work through some of his fears and insecurities. What treatments would you have chosen to implement with Drew? After you read through the "Reducing Tension and Coping with Stress" portion of the worksheets, consider your client. Which suggestions can you identify as being likely choices for your client? 

In this section, we discussed taking control. We examined worry time and reducing tension and coping with stress.
Reviewed 2023

Peer-Reviewed Journal Article References:
Almén, N., Lisspers, J., Öst, L.-G., & Sundin, Ö. (2020). Behavioral stress recovery management intervention for people with high levels of perceived stress: A randomized controlled trial. International Journal of Stress Management, 27(2), 183–194.

Blackwell, S. E. (2019). Mental imagery: From basic research to clinical practice. Journal of Psychotherapy Integration, 29(3), 235–247.

Haghighi, M., & Gerber, M. (2019). Does mental toughness buffer the relationship between perceived stress, depression, burnout, anxiety, and sleep? International Journal of Stress Management, 26(3), 297–305.

Willert, M. V., Thulstrup, A. M., Hertz, J., & Bonde, J. P. (2010). Sleep and cognitive failures improved by a three-month stress management intervention. International Journal of Stress Management, 17(3), 193–213.

QUESTION 14
What are two techniques for sleep disorder clients who have difficulty getting to sleep as a result of the frustration, anxiety and tension? To select and enter your answer go to Test.

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