Combining Methods of CBT and Progressive Relaxation for Treating Primary Insomnia: A Case Study

摘要

Primary insomnia is a mental health problem that is often reported due to the combination of either difficulty in falling asleep or maintaining sleep. It is known that people with primary insomnia experience an increased arousal of physiological, cognitive or emotional process, combined with negative conditioning that is associated with sleep. Progressive relaxation is one of the methods known to be effective in minimizing primary insomnia due to the person's need to release their tension. Frequently, the problem that causes primary insomnia derives from anxiety and muscle tension. Further work on the field is needed to show more the effectiveness of progressive relaxation in primary insomnia, especially in Indonesia, due to the lack of papers showing an intervention effect toward mental health problems. This paper presents a single case study of a graduate student who was diagnosed with primary insomnia. Graduate students are more likely to experience sleep deprivation, due to academic pressures and poor sleeping habits. Primary insomnia was diagnosed in this participant because they met the criteria of primary insomnia, such as frequent complaints of inability to fall asleep, and maintaining sleep for at least one month and an impairment in social and occupational functioning. It was shown during counseling that the participant was experiencing distress mainly caused by family problems. The participant felt burdened about the future due to their family's expectations on several subjects such as career, relationships and academic performance. The participant felt the need to fulfill all of the family's requirements. Another intervention, such as the ABC model from cognitive behavioral therapy (CBT), was needed due to the participant's negative core belief that made them unable to see their own positive traits. The participant also learned a mantra to cancel out unnecessary negative thoughts that caused sleep disturbance. The intervention was conducted for five sessions over a period of three weeks. The participant reported that before she was introduced to progressive relaxation, she had difficulty maintaining her sleep, she woke up five or six times during her sleep, and she was able to sleep only after midnight. After being taught progressive relaxation, the participant reported that her primary insomnia symptoms had decreased. She was able to sleep without any disturbance and fall sleep at 10 p.m. The participant's anxiety toward her family's expectations also decreased markedly. She reported that she was able to focus on what matters in the present, able to distinguish between her own needs and her family's expectations. Mantras were constantly used by the participant even a year after the intervention. She reported that using a mantra was the most efficient way for her to cancel out negative thoughts. This single case study showed that a short-term intervention was capable of providing an effective outcome for an individual with primary insomnia. It was also shown that progressive relaxation was successful in treating primary insomnia. This single case study showed the need to reduce anxiety for people with poor quality of sleep. It is suggested for further study to replicate progressive relaxation for reducing primary insomnia symptoms due to the successful outcome of this single case study.