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What Is Paradoxical Intention?

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Updated March 21, 2013

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Question: What Is Paradoxical Intention?

There are a variety of behavioral interventions that can be effective in treating chronic insomnia. Some of these treatments rely on changing the way you think about or perceive a situation (so called cognitive-behavioral therapy). One such option is something called paradoxical intention. What is paradoxical intention?

Answer:

Paradoxical intention is a cognitive therapy in which you learn to confront the fear of staying awake and the potential adverse effects. It may be learned from a psychologist, psychiatrist, or a physician trained in sleep medicine. Paradoxical intention helps to relieve the "performance anxiety" of falling asleep.

Rather than attempting to force yourself to sleep -- in a sense, to perform on demand -- you instead remain passively awake without any effort to fall asleep. The anxiety of not being able to sleep is thus gradually relieved as you learn to accept quiet wakefulness as an acceptable alternative when you are in bed.

Paradoxical intention may be particularly helpful in people who have insomnia that is characterized by a difficulty falling asleep at the start of the night. It has been demonstrated to be effective and has no risks of side effects.

Sources:

Broomfield, NM et al. "Initial insomnia and paradoxical intention: An experimental investigation of putative mechanisms using subjective and actigraphic measurement of sleep." Behav Cogn Psychoth 2003; 31:313-324.

Morgenthaler, T et al. "Practice Parameters for the Psychological and Behavioral Treatment of Insomnia: An Update." SLEEP 2006; 29:11:1417.

Schutte-Rodin, S et al. "Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults." Journal of Clinical Sleep Medicine 2008; 4:5:487-504.

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