Why CBT Works Better with Repetition (Even if You’re Totally Bored by It)

Sometimes you get bored doing CBT (cognitive behavioral therapy) as self-therapy. It does get repetitive. The worrying statements that you write down in one session are usually the same ones you wrote down in the previous session. Nothing really changes that much in 12 or 24 hours, so if you wrote down “I am afraid I’ll get sick because I’m not getting enough sleep” on Tuesday, you will likely have the same worry on Wednesday.

Most of us have our “favorite” five or six statements that express the actual content of our sleep anxiety, and they don’t change very much from day to day. As I have mentioned in this article, most of our worries alternate among several universal sleep anxiety worries. Here they are once again (in case you were too tired to click here):

  • Feeling tired, fatigued, exhausted and otherwise bad the next day.
  • Becoming ill, losing resistance to illness, catching colds, flu or other immune-system-weakness stuff.
  • Losing our minds, becoming mentally ill or unstable (hallucinations from sleep deprivation anyone?).
  • Not performing well at work, losing our competence on the job and our reputations along with that.
  • Damaging our relationships with family, friends, coworkers, clients, etc. because we can’t function as well as we did with so little sleep and so much anxiety about sleep.
  • Never sleeping well again.

We tend to get stuck on the same few statements over and over because worries are just, well, sticky. We have them. They don’t go away. There they are. And so it gets repetitive. Sort of like this paragraph and possibly this entire article. So the repetition of our same worries is one thing that may contribute to the CBT process feeling monotonous and boring.

What can we do about this? Or SHOULD we do something about this?

As it turns out, repetition is one of our most valuable tools for learning.

As much as we wish otherwise, the only way the brain learns to change its dominant thought processes is through repetition. The brain NEEDS repetition to change a thought pattern. Wait, did I just repeat myself? Well, in this case, good! Let’s do it again!

A frequent… persistent… long-term… feeding of repetitive statements to our brain… is what HELPS us change a thought pattern from an anxious, discouraging and depressing one… to a calm, rational and encouraging one.

Think about it. How do we “learn” to worry in the first place? Isn’t it the constant repetition of worrying, anxious thoughts about sleep that fuels the vicious cycle of sleep anxiety? Haven’t you lain awake at night staring at the ceiling while repeating the same lines over and over again?

So it makes sense that to change our worrying thoughts, we need to repeat the new rational, encouraging, supportive thoughts over and over again in response. While no one knows exactly how many times a new thought needs to be repeated before the brain sees the light and sets a new habit, it’s quite likely that we always underestimate that number.

But repeating the same thoughts over and over is boring, right?

So How Do We Make CBT Fun and Exciting? Well OK, At Least Less Boring?

The best way to counter the boredom is to continuously write fresh dialogue and speak it out loud every day. Repetition helps your brain change, but freshness keeps your bored, tired brain engaged in the process. Even if it doesn’t feel like it, the old gray matter will listen and pay attention when you prove you’re serious about this whole change thing. And one way to prove you’re serious is to avoid rote repetition of your dialogues. Keep writing new statements and new answers even if you have to just rearrange the words a little.

One of the questions I get asked the most when people contact me goes something like “do I have to keep coming up with new statements all the time or can I just use the ones I wrote down before?”

And what is my helpful answer? “Yes and no.”

OK, maybe not so helpful. Here is the long, wordy version:

The “yes” part: Write new statements every day to keep your brain interested in the process.

Let’s say you pick up your CBT notebook and say, “well, I’m thinking the same thoughts I had yesterday so why don’t I just read yesterday’s thoughts and while I’m at it, I can read yesterday’s answers as well, because nothing much has changed, so why not?” Does that work as well as doing the whole process again from scratch?

Probably not. When something is repetitive, it’s very easy to go on autopilot. So you give your 30-minute CBT session half your attention while the other half is recalling the great plays of last night’s game or planning the menu of tonight’s dinner.

Repeating yesterday’s exercises is better than not doing anything at all. But it’s not as effective as starting from scratch and putting some effort into the process.

See, there’s a difference between being repetitive and being lazy. Part of the act of writing down thoughts is reminding your brain why you’re sitting here with the notebook. The more action we put into the process the more it drills down to the stubborn gray matter where it counts the most. And we get closer to the 100 percent focus that we really need.

Let’s get back to our original statement:

“I am afraid I’ll get sick because I’m not getting enough sleep.”

You have three options here. You can

  • Write the exact same thought down again. Even if it seems silly, writing the same thought down again is more helpful than reading yesterday’s recycled thought. You are moving the pen (or your fingers if you work on a device). You are forming the words. Doesn’t seem like much, but there’s more action involved.
  • Write the same thought but express it differently. This is a better option. The difference doesn’t have to be great. But you can say something like “I am very worried about getting sick from lack of sleep and I hate being sick.” Or “When I can’t sleep I worry obsessively about getting sick even when I have no signs of illness.” Or “I wish I could stop worrying about getting sick when I can’t sleep.” You see, the possibilities are almost endless. You can take this one thought and express it a dozen ways, yet each version adds just a little something new. Your brain has to get a little more engaged in the process. And more engaged means the change might come a little faster.
  • Find an entirely new thought to work with. It can still be related to the original, but maybe it expands on it, or maybe it goes deeper into the heart of the worry. This is always a good thing. For example, again with the original thought:

    “I am afraid I’ll get sick because I’m not getting enough sleep.”
    You take this thought and ask a question:
    What worries me most about getting sick from lack of sleep?

    This is similar to what we do to begin the whole process of CBT. We ask “what worries me most about not sleeping?”

    You might come up with something like: “I hate getting sick because then I can’t do my job and I get behind in my work” or “I’ve already used up my sick leave and if I get sick again I might get fired.”

    These worries are lurking behind the original fear so you might as well dredge them up and deal with them using the same calming, rational, encouraging voice. For example…
    “Just because I’m not sleeping well doesn’t mean I’ll get sick. But if I do get sick, it probably won’t be as bad as I think at this moment. I will find a way a deal with whatever happens. I am stronger than I think and I’ll be OK no matter what happens.” And any other statements you find effective.

To Review (And Repeat) the Yes and the No

“Yes” — Write new stuff! Don’t recycle yesterday’s CBT dialogue today to save time and effort because your brain will get bored and direct its attention to more interesting things. See if you can write more versions of the same thought, and while you’re at it, maybe by asking a few more questions you’ll coax some brand new thoughts out of the deep recesses of your anxious and worried mind!

“No” — Go ahead and recycle the same statements you used before if you are short on time or patience. It is far better than not doing anything at all. Just try to focus and stay off autopilot!

Don’t forget—30 minutes a day keeps the old anxious thoughts away!

POSTSCRIPT: Since writing this article, I have been personally experimenting with a method of changing thinking habits that uses even more repetition than the suggested 30 minutes of CBT per day! It may turn out to be a helpful addition (or possibly even an alternative) to the traditional CBT process for those suffering from sleep anxiety. When I’ve completed my experiments, I will write about them here. Stay tuned!

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