by Karen Kerschmann | Apr 8, 2025 | Uncategorized
Do you struggle to fall asleep, stay asleep, or wake up feeling unrested? If so, you’re not alone. Insomnia affects millions of people, and its ripple effects can touch every aspect of life—productivity, health, mood, and even relationships. Fortunately, there’s a highly effective, evidence-based treatment that doesn’t involve medication: CBT for Insomnia, or CBT-I.
What is CBT-I?
CBT-I is a structured, short-term form of psychotherapy specifically designed to help individuals address the thoughts and behaviors that
perpetuate insomnia. Unlike sleep aids, which provide temporary relief, CBT-I equips you with tools to improve your sleep in the long term by targeting the underlying causes of poor sleep.
The Core Components of CBT-I
Cognitive Behavioral Therapy for Insomnia typically involves five key components tailored to each individual:
- Sleep Education:
Understanding the basics of sleep—its cycles, what constitutes “good” sleep, and how much you need—can demystify the process and set realistic expectations.
- Sleep Restriction Therapy:
While it sounds counterintuitive, this technique limits the time spent in bed to match your sleep time. This helps consolidate sleep and reduce nighttime wakefulness.
- Stimulus Control:
This component focuses on strengthening the bed-sleep connection. Rules such as using the bed only for sleep and avoiding wakeful activities like watching TV or scrolling on your phone can help retrain the brain.
- Cognitive Restructuring:
Challenging unhelpful thoughts about sleep, such as “I’ll never sleep well again,” can reduce anxiety and create a more positive sleep mindset.
- Relaxation Techniques:
Learning relaxation methods such as progressive muscle relaxation, mindfulness, or breathing exercises can calm the mind and body and promote restful sleep.
Why Choose CBT-I Over Medication?
While sleeping pills can be helpful for short-term relief, they may not address the root causes of insomnia. CBT-I, on the other hand, is as effective as medication in the short term and more effective in the long run, with no risk of dependence or side effects.
What to Expect from CBT-I?
CBT-I typically requires 6–8 weekly sessions with a trained cognitive behavioral therapist. Each session builds on the last, guiding you through adopting healthier sleep habits and addressing psychological barriers to sleep. Additional sessions can be useful to maintain these new skills over time.
Results don’t happen overnight, but with commitment and patience, most people experience significant improvement in both sleep quality and quantity.
The Research Speaks Volumes
Numerous studies have validated the effectiveness of CBT-I. According to the American Academy of Sleep Medicine, it is the first-line treatment for chronic insomnia. Research shows that 70–80% of individuals who complete CBT-I experience substantial and lasting improvements in their sleep.
Ready for Restful Nights? Try This Tonight
Part of CBT-I is to practice relaxation techniques during the day as well as right before bed. Progressive Muscle Relaxation (PMR) works because it helps break the cycle of physical tension and stress by actively engaging the body in the relaxation process. By tensing and then releasing muscle groups, PMR encourages awareness of muscle tension and teaches the body to release it more effectively. This process triggers the body’s relaxation response, lowering heart rate, reducing blood pressure, and calming the nervous system. Below are some resources to help guide you through the process:
PMR- Written Instructions
PMR- Recording
PMR- For Kids
CBT for Insomnia can help you reclaim restorative sleep if you’re tired of being tired. As an Academy of CBT diplomate specializing in anxiety-based disorders, I offer CBT-I therapy tailored to your unique needs. Together, we’ll address the patterns keeping you awake and work toward lasting, restful sleep.
Take the first step today. Please schedule a consultation with me to discuss CBT-I in San Diego. Your path to better sleep begins here!
by therapyinsdcom | Dec 19, 2024 | Uncategorized
Throughout his tenure, the U.S. Surgeon General, Dr. Vivek Murthy, highlighted loneliness as not just a crisis in America but an epidemic. Feeling alone isn’t just an unpleasant emotion to endure—it also impacts our physical health. Research shows that loneliness can lead to inflammation, heart disease, and other health issues. Unsurprisingly, holiday loneliness is quite common.
Feeling isolated occasionally is natural, and 1 in 3 Americans feel lonely at least once a week. Fortunately, understanding why it happens and addressing it promptly can prevent it from deepening. This article explores the roots of loneliness, its manifestations, and actionable strategies to combat it.
The Many Faces of Loneliness
To fend off holiday loneliness, it’s crucial to understand its different forms. According to Psychology Today, there are seven distinct types of loneliness:
-
New-Situation Loneliness – You’re in unfamiliar territory. You may feel disconnected if you’ve started a new job, moved to a different city, or joined a new school.
-
I Am Different Loneliness – You feel out of place among those around you. Perhaps you’re passionate about a cause that no one else shares, or you’re the only newcomer in a close-knit group.
-
No Romantic Partner Loneliness – Not having a significant other during the holidays can amplify feelings of solitude.
-
No Pets Loneliness – Longing for the companionship of a pet but being unable to have one can create a unique sense of absence.
-
No Available Friends Loneliness – Life changes—whether yours or your friends—can lead to a sense of isolation when loved ones aren’t around. Travel can increase a sense of holiday loneliness.
-
Bad Friends Loneliness – Even in a crowd, distrust or lack of meaningful connections can leave you feeling unfulfilled.
-
No Warm Body Loneliness – Living alone, even if you’re otherwise satisfied with your social life, can feel particularly tough during the holidays.
10 Ways to Keep Holiday Loneliness at Bay
-
Find Like-Minded People – Join a group or community activity like a book club, workout class, or Meetup.com gathering to build connections.
-
Prioritize Health – Ensure you get enough sleep, eat well, and stay active. These habits improve your mood and overall well-being.
-
Strengthen Current Bonds – Deep, intimate connections are key to happiness. Invest time in nurturing existing relationships, whether near or far.
-
Learn from Loneliness – Reflect on what your loneliness teaches you and use this insight to foster stronger relationships in the future.
-
Practice Mindfulness – Pay attention to your thoughts when you feel lonely. Recognize self-defeating ideas as fleeting and avoid attaching undue importance to them.
-
Cultivate Self-Compassion – Show yourself kindness through self-care, meditation, or self-love. Practice self-soothing techniques to comfort yourself.
-
Enjoy Your Own Company – Embrace activities alone without self-consciousness. Learning to appreciate solo time can lead to greater personal fulfillment.
-
Consider a Pet – Adopting a pet can enhance your happiness and boost feel-good hormones if it’s feasible. Alternatively, visit a dog park or petting zoo.
-
Plan Ahead – Anticipate potential loneliness and prepare a list of activities or goals to tackle when it strikes.
-
Give Back – Volunteering your time or skills can create a sense of connection and purpose.
Conclusion
During the holiday season, loneliness can feel overwhelming, but it’s essential to remember that you’re not truly alone. If you’re feeling down, be gentle with yourself, and try some of the tips above. By taking proactive steps, you can transform moments of loneliness into opportunities for growth and connection.
by Karen Kerschmann | Jun 17, 2024 | Anxiety, Anxiety and Stress, Anxious Feelings, Anxious Thoughts, Cognitive Behavioral Therapy, Uncategorized
Video- How Does a Therapist Treat Anxiety Disorder? An Introduction to CBT Skills
If you are reading this, chances are you already know that symptoms of stress can feel overwhelming and, if untreated, can evolve into an anxiety disorder. The good news is understanding the biological roots can be the first step toward success. In this video, ‘Master Your Mind: Essential CBT Skills for Anxiety Symptoms,’ Dr. Rosalie Zuniga from Postpartum Wellness and I discuss what information I provide to clients in the first stages of anxiety treatment. If you want to know about the mind-body connection when you experience anxiety symptoms, check out the first part of this video to dive into the biology of stress. You can find more content in the second part if you’d like to try some practical strategies for managing anxiety disorder. Are you curious but not ready to watch the whole video? You can find an overview below.
The Biological Roots of Anxiety Disorders
Anxiety is more than an emotion; it’s an interplay of biology and psychology. The ‘fight, flight, freeze, fawn’ response is an instinct we have to stress or danger. This is also known as the ‘stress response’. In the modern world, this is not particularly useful. In very few situations, this phenomenon may be helpful (like if a bear is chasing you). However, when we ruminate about our fears, our brain believes we are actually in physical danger, and if it persists, it can evolve into an anxiety disorder.
Anxiety Symptoms
The symptoms of anxiety can vary but have some specific themes:
- Excessive Worry: Constant, uncontrollable worry about everyday things.
- Physical Anxiety Symptoms: These can include increased heart rate, sweating, trembling, dizziness, and shortness of breath.
- Trouble Concentrating: Difficulty focusing on tasks or making decisions.
- Sleep Problems: Trouble falling asleep, staying asleep, or restless sleep.
- Avoidance: Avoiding situations that cause anxiety can impact daily life and activities.
- Panic Attacks: Sudden episodes of intense fear or discomfort, often accompanied by physical symptoms like chest pain or a feeling of choking.
It’s the Thought that Counts
As you have learned, biological reactions to specific triggers creates the stress response. It’s just as important to recognize that avoidance of triggers and catastrophizing will feed the belief that we can’t handle our complex emotions, which leads to anxiety. Below is a helpful equation from Dr. Aaron Beck, the father of Cognitive Behavioral Therapy (CBT)
Dangerous Thinking + Helpless Thinking = Level of Anxiety Symptoms
Dangerous Thinking:
Imagine someone who experiences a setback at work, such as not receiving the promotion they expected. They might engage in dangerous thinking by catastrophizing the situation. For instance:
“I failed, which confirms I’m not good enough. What if people find out? Everyone at work will know I’m incompetent.”
Helpless Thinking:
Helpless thinking involves believing that whatever the imagined catastrophe is, they will not be able to handle it.
Using the same situation, this person may think, ‘I am so embarrassed, and now I have to go to work after this rejection. I’ll be in the bathroom crying all day. I will sit in silence in meetings, and I won’t be able to be of any use now because I’ll be a mess. I don’t think I’ll be able to date because I’ll just keep thinking about how inferior I am.’
CBT in Action:
The video ‘Transform Your Anxiety Symptoms: CBT Skills to Help You Feel Better’ discusses several interventions, such as ‘Decatastrophizing the Fear (Worst Case Scenario)’ and the ‘What Ifs’ to examine and test dangerous thoughts.
Although in a stressed state, we overpredict dangerous outcomes, the reality is that the worst case can happen. Our helpless thinking kicks in when we anticipate we can’t handle the worst-case scenario. I will ask my clients, ‘How could you cope in a healthy and strong way?’ ‘Is there a way you visualize managing the catastrophe in a way you would be proud of?’ My clients who come to me for anxiety treatment in San Diego often will hear me joke that we are not the fragile flowers we believe we are. All humans can survive and thrive under challenging circumstances, which is a vital understanding to manage anxious thoughts.
Where to Find More Information: Therapy in San Diego
For more details about this insightful session and to explore additional resources, visit Therapy in San Diego and Postpartum Wellness. If you are curious about your anxiety symptoms and wonder if you would benefit from treatment, head to Anxiety Treatment in San Diego – Assessment to see where you land on the anxiety disorder scale.
by Karen Kerschmann | Feb 23, 2024 | Anxiety, Anxiety and Stress, Uncategorized
Small Steps, Big Impact: Emily’s Story of Reaching Her Goal
Emily had a burning desire to become a renowned painter, but she often felt overwhelmed and anxious by the enormity reaching her goal. She would head to art shows, wondering how anyone could reach such recognition. This left her feeling stuck as she continued working her well-paying, albeit unexciting, manager position at a Fortune 500 company. Her free time consisted of watching TV, going to the gym, and visiting art museums with good friends. Her life was not dull, but she knew she was avoiding going after what she wanted.
One Saturday, Emily decided that instead of grocery shopping and cleaning the house, she would focus on doing one thing that aligned with her dream. She grabbed her sketchbook and pencils and went outside to simply draw what she saw around her. No more, no less. After thirty minutes of sketching, Emily felt accomplished. She didn’t worry about creating a masterpiece; instead, she had fun improving her skills one drawing at a time, giving herself an internal ‘gold star’ for every improvement she made. It was her first small step to reach her goal.
As days turned into weeks, Emily’s confidence grew, and her anxiety waned. She started experimenting with different techniques and subjects, pushing herself to explore new styles and perspectives. Some days were challenging, and overwhelm would creep in, but Emily reminded herself to take smaller steps. She found that breaking tasks into manageable pieces made her anxiety more manageable and helped her stay focused on her goal.
Eventually, Emily’s hard work began to pay off. Her sketches caught the eye of a local art gallery owner who offered her a small exhibition space. Excited but anxious, Emily accepted the opportunity, knowing this was another critical step to reach her goal.
The night of her art show arrived, and Emily watched people admire her artwork. She felt a sense of pride, knowing that each piece represented countless small actions taken toward her dream. Some visitors even expressed interest in purchasing her work, leaving Emily feeling even more energized.
With each sale, Emily felt herself climbing higher on the ladder of success. She realized that reaching her goal wasn’t about making one giant leap but embracing the journey of growth and perseverance, one step at a time.
Years passed, and Emily’s reputation as an artist continued to flourish. She traveled the world, showcasing her paintings in prestigious galleries and sharing her story of reaching her goal. Young women would approach her in awe, asking how she accomplished such an outstanding reputation. Emily explained that the minuscule day-to-day work led her to success. As she learned, it wasn’t the height of the ladder that mattered but the patience and openness to understand that small steps are the key to managing anxiety and overwhelm.
The Science of Small Steps When Reaching Your Goals
BJ Fogg, behavioral researcher and founder of the Behavior Design Lab at Stanford University, asserts that our baby steps are the path to success in his book Tiny Habits: The Small Changes that Change Everything. “It’s easier to create habits and change than most people think, and it’s faster than most people think,” he explains. “It can even be fun if you do it correctly,” Fogg states in an interview with NPR.
Most of us have heard the old Chinese proverb, “A journey of a thousand miles begins with a single step.” This wisdom can help you visualize how to reach your goal. Imagine two ladders of the same height but with a different number of rungs. The ladder with more rungs allows for smaller, more manageable steps to the top. Oftentimes, we dismiss our small efforts as “not enough” or a waste of time. However, conceptualizing progress as climbing a ladder with many small rungs makes even the most daunting goals feel achievable.
While the idea of big goals may lead to overwhelm and shutdown, it’s the small, consistent actions taken toward them that pave the way to reach your goal. You can make significant strides throughout your journey by embracing the importance of tiny efforts.
In Emily’s story, we see how incremental actions enabled her to overcome anxiety, build confidence, and ultimately achieve what once seemed impossible. Let Emily’s journey inspire you to take that first small step today. No matter how ambitious your dreams may be, the key to success is to break them down into manageable pieces and keep moving forward, one small step at a time.
by therapyinsdcom | Feb 3, 2020 | Anxiety, Anxiety and Stress, Cognitive Behavioral Therapy, Uncategorized
Your mental health is important, why mental health apps? Sometimes you cannot afford to see a therapist, do not have time to go to one, or one isn’t accessible where you live. Perhaps you aren’t ready to see one but would like to see what therapy all is about. Maybe you see a therapist, but need help to put the helpful techniques they have given you into practice. Mental health apps can be very beneficial, free, low-cost or affordably priced, and offer a way to help give you therapeutic help on the go. So which ones are best? There are so many out there!
Mental health apps that I recommend:
1. Headspace
Headspace is an app that just about anyone can use, whether you are dealing with stress, anxiety, lack of focus, or sleeping difficulties. It teaches you to “meditate and live mindfully”. Meditation has been shown to reduce stress, lessens anxiety, support emotional health, and enhances self-awareness. This app provides small meditation modules to accommodate people’s busy schedules and “SOS exercises in case of sudden meltdowns.” You can take advantage of their free trial and if you like it, you can make the jump to a monthly subscription.
2. Youper
Youper is an app that is powered by AI – “your emotional health assistant”. This app allows you to have conversations, guidance through meditations that are personalized for you and trackers that help you monitor your emotional health and mood. This technology created by doctors, scientists and engineers;focuses on the science and pursuit of happiness – helping those with depression and anxiety live happier lives with treatments personalized for them. This app also works in conjunction with seeing a therapist, as you can ‘share’ your information. Many of my clients use this app as complements many of the CBT techniques we use right in session.
Youper is free to download and have some free features; more advanced features are based on a subscription plan.
3. FitMind
This app offers meditation training as part of a “mental fitness” approach. FitMind uses traditional techniques used since ancient times with western science. Using daily challenges, along with access to meditation instructors; FitMind can help you learn to meditate in a way that works for you. Again, meditation is a useful tool for improving mental health because of all of the health benefits you get from practicing it. This app is free and offers in-app purchases.
4. Sanvello
Sanvello is an app designed for stress, anxiety, and depression using strategies and resources that can help you with the symptoms and situations you are dealing with at the moment. You can customize goals; like mindfulness, building confidence and thinking positively. Based on clinically proven techniques, this app offers tracking for mood and sleep, tools for relaxation and meditation and you can connect to a group of your peers for further support. Free to sign up and install.
5. MoodKit
This mental health app uses four tools that are designed to enhance your mood, identify and change unhealthy thinking, track mood, and create journal entries. Managing negative feelings thoughts by identifying situations that cause stress, changing how you think, monitoring your mood through tracking, and developing self-awareness through writing is all of the ways MoodKit is designed to help you improve your mood and mental health. This app is only available on the iPhone and iPad, but is just $4.99.
Mental health treatment is no longer limited to the office and self-help books. Whether you are on the road, want quick help, or establish a daily cognitive behaviorally based self-care routine, there has never been so many options on how to start. It’s good for you, and most apps have a free trial! Jump in and let us know how it goes.
by therapyinsdcom | Aug 30, 2017 | Intern Supervision, Uncategorized
Earning your clinical license opens up a world of possibilities, so you want to begin gaining ASW supervision hours as soon as possible. Regardless, the process can be confusing for the best of us. Throughout my years of providing ASW and LCSW supervision, there are certain questions that I’m asked on a regular basis. Here’s a nice compilation of many of these inquiries, as well as one vital tidbit that is often overlooked:
I have all of my hours, but I’ve been putting off the exam for months/years. Is there a timeline?
So, there are a couple of key points to remember:
The 6-Year Rule-
You can spend 10+ years earning IMF/ASW supervision hours, however, the only ones that count are the ones accrued during the last 6 years.
Abandonment of Application-
You don’t want this to happen! The consequences of abandonment can range from paying a new application fee to starting from square one. Per the BBS website, the criteria for abandonment are the following:
- Associate Social Worker does not submit the remaining documents or information requested in the application deficiency letter within one (1) year from the date of the deficiency letter
- Applicant does not complete the application within one (1) year after it has been filed
- ASW does not sit for an examination within one (1) year after being notified of initial eligibility to take the examination
- Applicant does not take an examination within one (1) year from the date the applicant was notified of failing an examination
- The applicant fails to pay the initial license fee within one (1) year after notification by the Board of successful completion of ASW requirements.
I’d like to obtain my ASW/LCSW supervision through video conferencing. Am I eligible?
Per the California Business and Professions Code section 4996.23 videoconferencing can be used for LCSW supervision when an intern works/volunteers at one of the following:
- Any government entity
- A school, college, or university
- An agency that is both charitable and non-profit. You can find out if your workplace meets these criteria by checking if they are considered a ‘501(c)(3); by the IRS
The ASW supervisor is responsible for ensuring client confidentiality, including a HIPAA compliant platform for video sessions. Skype is not HIPAA compliant, but there are other programs that are- your supervisor should be able to tell you what platform they are using and how they know it’s in line with privacy regulations.
My hours are complete, and my exam is scheduled! Am I still required to maintain weekly LCSW supervision?
Until you have your license in hand, you want to complete an hour of individual or two-hours of group LCSW supervision.
Do I really have to sit for the Law and Ethics exam? Is this something I need to retake annually until I earn my license?
Yes! There are no loopholes on this one- no matter how much training and classes you have taken.
Once you pass the Law and Ethics exam, you have completed your requirement as long as you keep your license active. Get this done quickly, as you may not be able to complete your annual renewal without a passing score.
Which study guide do you recommend?
The majority of my interns recommend the Therapist Development Center (TDC) programs for both the exams. TDC not only provides materials on content but also test taking strategies that will help IMF/PCCI/ASW interns approach the exams in a logical and educated manner.
When can I start collecting LCSW Supervision hours?
It’s exciting to finally earn your graduate degree, and you’re probably chomping at the bit to start collecting hours. Many have contacted me and said, ‘I’m waiting for my BBS number, but I want to start supervision this week!’
In this case, patience is the key. Don’t spend time and money on clinical supervision until you have that intern number in hand, as hours won’t count until then.
My former supervisor can’t be found. How can I verify my hours?
At the beginning of ASW intern supervision, it’s critical that you and your supervisor create and sign the following documents, all located on the BBS’s website.
- Supervisor Responsibility Statement
- Supervisory Plan
- Any letters of agreement or other documentation agreeing to the ASW Supervisor/ Intern relationship.
Just as important, discuss how you plan to document logged hours. I encourage all of my supervisees document their hours in detail and have me initial and sign it each month.
As soon as your time with each supervisor is complete, print out the Experience Verification Form and complete this together.
ASWs are fully responsible for all original paperwork. If you follow these guidelines, you will be in good shape if for any reason you can’t connect with your previous supervisor(s)
I am the only social worker/counselor at my job. How can I earn my hours if I don’t have a clinical supervisor at my agency?
There are a lot of ASWs in a position where clinical supervision is not readily available. Fortunately, your intern supervisor does not need to be employed by your agency.
If you are the lone ranger in your company, I recommend searching out some group supervision to expand your support system, increase your exposure to new opportunities, and see what others in the field are doing. Several of my interns that were in group have helped connect one another to jobs, resources, and even have partnered in private practices!
There’s one question I’ve never been asked, but what everyone should know……
The 104- week rule
Several years ago, an ASW Intern I had been supervising for a year came to my office to get her last hours signed. She had been working with several supervisors throughout her time and worked hard to get her hours wrapped up as soon as possible, often putting in 60+ hours a week so that she could meet that 40-hour clinical max.
As we were finishing up her paperwork, we came to the realization that although she had easily met 3200 clinical hours, she was two months under the 104-week requirements. She was terribly disappointed, and we spent two more months getting those last few weeks in.
The story has a happy ending- Margaret Miller, LCSW now has a thriving private practice at my office- you can check her website out here. So now you know- in addition to the 6-year window, interns have to meet a minimum of 104 weeks of ASW supervision, so expect to spend between 2-6 years gathering your experience.
If you find this article down your alley, check out some similar blog posts:
All Interns Should Ask Themselves these 3 Questions….
FAQs: ASW and LCSW Supervision
perpetuate insomnia. Unlike sleep aids, which provide temporary relief, CBT-I equips you with tools to improve your sleep in the long term by targeting the underlying causes of poor sleep.
Emily had a burning desire to become a renowned painter, but she often felt overwhelmed and anxious by the enormity reaching her goal. She would head to art shows, wondering how anyone could reach such recognition. This left her feeling stuck as she continued working her well-paying, albeit unexciting, manager position at a Fortune 500 company. Her free time consisted of watching TV, going to the gym, and visiting art museums with good friends. Her life was not dull, but she knew she was avoiding going after what she wanted.
