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sábado, 23 de julio de 2011

Treatments

As a general rule, like most quick-fix solutions, in the short-term, medications can help but in the long-term they can actually exacerbate the situation and foster pharmacological dependence and tolerance. They're frequently over-prescribed and misused, especially in the USA. A lot of the research studies regarding these medications aren't so reliable either, as it's a profit-driven business. Regarding anti-anxiety or sleeping pills, the key is to use them sparingly; only when truly necessary, preferably no more their twice a week to minimize risk for dependence. The Dean of my Master's program asserts that to maximize treatment effectiveness, medications should almost always be accompanied with another form of treatment such as psychotherapy or MBSR (mindfulness-based stress reduction). 

Those less successful in the long-term:

Sleeping pills:
-high tendency for abuse, tolerance, dependence
-don't address underlying cause, only symptoms

Antidepressants: 
-Can regulate sleep but, still don't address underlying cause, only symptoms
-irritating side effects like impotence, decrease in sexual desire

Anti-anxiety medication:
-risk for tolerance and addiction
-don't address underlying cause, only symptoms

Those more successful in the long-term: 

Cognitive-Behavioral Therapy: Challenging and reframing the maladaptive thinking patterns associated with anxiety and insomnia
-almost always recommended if patient is taking some kind of medicine.
-a great deal of empirical support

Stimulus Control Therapy: treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene. Examples of such environmental modifications include using the bed for sleep and sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not result in a reasonably brief period of time after getting into bed (20-30 minutes); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during nighttime hours, and eliminating daytime naps.

Paradoxical intention: a cognitive reframing technique where the insomniac, instead of attempting to fall asleep at night, makes every effort to stay awake (essentially stops trying to fall asleep). One theory that may explain the effectiveness of this method is that by not voluntarily making oneself go to sleep, it relieves the performance anxiety that arises from the need or requirement to fall asleep, which is meant to be a passive act. This technique has been shown to reduce sleep effort and performance anxiety and also lower subjective assessment of sleep-onset latency and overestimation of the sleep deficit.

Practicing mindfulness, meditation:
-studies have concluded that a mindfulness practice reduced mental and bodily restlessness before sleep and the subjective symptoms of insomnia, restlessness, sleep effort 
-addresses the problem at its core! (the need to increase the body's relaxation)

EFT (Emotional Freedom Techniques) and Tapping: focuses on tapping on the body's 12 acupuncture points while the client focuses on a specific issue related to anxiety or insomnia.

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