#28 - Do You Think About "Everything and Nothing"?

“What do you worry about when you have trouble falling asleep?” I asked the client sitting in front of me.

“That it will take me a long time to fall asleep” the client answered.

“OK. So what worries you about taking a long time to fall asleep?”

“That I won’t get much sleep that night”

“And what worries you about not getting enough sleep?”

“That I will be really sleepy the next day”

“What worries you about feeling sleepy?”

“That I won’t do well on a test”

“What worries you about not doing well on a test?”

“That I will get bad grades” … (by now you can see that my client is not an adult, right?)

“What worries you about getting bad grades?”

“That I won’t be able to get a good job and support my kids”.

At this point I stopped. I had to stop. Because I’d run out of room on my interview.

You see, this line of inquiry - where you keep asking the client what worries them about each concern - is called a ‘Catastrophising Interview’.

We had read an excellent paper by Prof Alice Gregory and colleagues where they had tested catastrophising in school-aged children and linked it to sleep problems. The way it is scored is by counting the number of ‘catastrophising steps’ - or the number of worry statements that were voiced. In the above example, the number of worries maxed out at 6. Keeping in mind that the last worry actually contained 2 worries (ie, worrying about getting a job - and - not being about to support his kids … which he didn’t have yet).

If you don’t know by now, catastrophising is a form of worry, where one worry compounds on another. It’s a type of thinking style where there is no ‘space’ in between each worry - where the person can stop and evaluate the probability of the thought coming true. And even if it did come true, asking the ultimate question - “So f#cking what?”.

The catastrophising interview became part of our standard series of questions when we first saw a client. And we used it for clients across the lifespan.

For example, for school-aged children, it gave us insight into their cognitive abilities. Whether they could identify their own thoughts. And if so, it flagged to us that they could learn the complexities of cognitive therapy for insomnia.

But we also used the catastrophising interview to research it’s role in sleep - and also whether we could improve catastrophising without having to do cognitive therapy.

For the former situation, we found that catastrophising certainly played a role in emotions and a person’s ability to fall asleep. You can download the paper here.

For the latter situation, we also found that for teenagers who fell asleep quite late (known as delayed sleep-wake phase disorder), their catastrophising decreased in response to bright light therapy. You can read more about the study here.

But what surprised me the most about this particular interview was the age of the client.

He was 9 years old.

But he worried like so many of the adults that I had interviewed over the years. And it really cemented for me that insomnia was a phenomenon experienced in under 18s.