Have you ever been unable to sleep?
Have you ever been stuck in your own head?
Have you ever been caught in a circular pathway of recurrent, mostly negative thoughts?
Don’t worry if you answered yes to all of those, you are just human, like most of us 
Rumination is the process of continuously thinking about the same thoughts or emotions, which tend to be sad or dark. It is one of the most popular causes of insomnia.
Now the relevant question I am trying to answer here is: when we are caught in our heads, thinking too much, how do we get out?
Through my work, every day I deal with people who are experiencing anger, frustration, guilt, anxiety and sadness. I saw a lot of suffering and at one point in time, I felt that I needed to share tools to help them. I, myself, have been stuck in my head quite a few times in my life during stressful and painful events. My is ordinary, just like you, I experienced happiness and joy. Just like you, I felt the pain that life inevitably brings. Just like you, I survived. In these moments filled with worry, anger, guilt, regrets and sadness, I found ways out of my head and I was able to find a way out of insomnia. Here are a few tricks I learned in this journey and that I want to share with you.
Let’s be honest, we all talk to ourselves. We all have a self-narrative, a series of stories we tell ourselves that give meaning to our lives. These narratives, they often generate the recurrent emotions that haunt us at night.
The emotions that get us caught in a recurring pattern that we can’t get out of are usually negative. They most often are expressions of past negative event (guilt, sadness, anger) or about the fear of future events or consequences (anxiety and fear) and they threaten our self-narrative. The expression of these emotions comes in the form of recurrent phrases that we tell ourselves that trap our minds instead of freeing us. They usually start like ” I should’ve…” or include the word “Why…?”.
The easiest and most straightforward way to find freedom from guilt, anger, anxiety, fear, sadness and frustration is simply to share those emotions. When negative emotions are shared, they are divided. Remember that. This has been true since humans have walked on earth. We have always been social animals. Empathy is the glue that binds our social fabric. The reason for this is simple: when we work together, we accomplish more. When we make a connection with another human being, we share feelings and we feel understood and supported. When we share feelings, the positive is amplified and the negative is divided. You need a human being that will welcome your vulnerable, authentic, beautifully imperfect soul. It can be a therapist or a friend. We are all flawed in some way. We all make mistakes. Let’s accept this and find ways forward. Sometimes the pain we inflict ourselves, by building walls in our heads, keeps us awake at night, amplifies the felt pain, increases our suffering, and does not help resolve the situation.
But what if I am stuck in my thoughts and feeling in the middle of the night? I can’t share my feelings with someone at 3h00 AM? You are right, and I have another trick I’d like you to try when you not able to sleep because you are caught in circular thoughts and recurring emotions, and you feel like you are stuck in a hamster wheel, running but going nowhere.
Now brace yourself, I will suggest an idea that you will find totally crazy… but bear with me, this is backed by science.
Try talking to yourself and do 4 things. Validate your emotions. Change the perspective. Change the narrative. Find a healthy distraction.
Validate your emotions… Don’t fight what you feel; welcome the emotions as they are, and accept them. Emotions are useful, they give us information about our values and what we care about. Emotions come and go. They are useful in the right context, at the right time. When caught in recurring negative emotions, they often stop being helpful and can become harmful. Instead of fighting our own emotions, we should accept them as they are, label them with words, and let them go.
Change the perspective… Instead of thinking “I” start talking to yourself in the third person. Yes, talk to yourself like it’s another person, specifically a good friend. This process is called “self-distancing,” and it’s helpful to detach ourselves from our negative emotions. It goes like this, with a lot of kindness: “Martin, you feel sad/angry/guilty because (narrative) and it is OK.”
Change the narrative…. The story we tell ourselves usually comes from a perspective that we focus on. Here is a story, typical from a doctor’s perspective. Let’s be honest, I was in this situation at some point in my life, and most of my colleagues have also been there. So I am stuck with dealing with a complaint I got from a patient. I can’t sleep because I keeps getting those guilt-generating thoughts, “I should’ve… I didn’t…” and I fear the consequences. I am creating a story that keeps me awake at night. If you are a human being, reading this, you can probably relate to such a story because you have made mistakes in the past and you did experience guilt. But how can I change my narrative and free myself from the rumination that comes at night?
Find a healthy distraction… the last step of this process, if you are still caught in your head, if you can’t get out of those recurring thoughts, is to focus your attention on something else. Let’s be honest, distractions can become harmful if we avoid dealing with difficult issues but they can also be helpful if they help us get out of our heads and find sleep. What works for me, in the middle of an episode of insomnia, once I welcomed the emotion, and changed perspective and narrative, is to simply listen to a podcast with a sleep timer. It’s simple, healthy and effective for me.
The entire process would look like that, talking to myself, as I am lying down in the middle of the night, in bed, after trying to fall asleep for 2 hours, unable to find respite.
“Martin, it’s normal to feel this way because you received a complaint. Most doctors do feel some form of frustration or guilt when they get a complaint. You are asking yourself over and over if you did something wrong if you could’ve done better. You feel like this because you care about your patients, doing good work, and helping people. Going through this is tough, and it’s normal to feel like that. You are doing everything right, being honest and true to yourself. The next step happens next week, and tonight, there isn’t anything you can do but care about yourself. Now I want you to try to take a step back and think about all the grateful patients in your career, the lives you saved, and the times that you were an awesome doctor and human being… Compare that to the few times that did not go so well, where unexpected adverse outcomes happened. There is probably a thousand-to-one ratio of positive to negative. Do not focus too much on the one case that ended up in a complaint; focus on the nine hundred ninety-nine cases that went well and be proud of yourself. Be grateful for this wonderful opportunity that is work. Don’t give up. You’re a good doctor and a good human being. Sleep well, my friend.” Then I would select a podcast that is not too stimulating or interesting and just listen without the expectation of falling asleep. This last part is important… often the desire to fall asleep is exactly what prevents us from letting go.
The next time you catch yourself ruminating, unable to sleep, in the middle of the night, you can keep running on the hamster wheel of your mind for another hour until you are exhausted, or you can talk to yourself to get out of your head.
Validate your emotions. Change the perspective. Change the narrative. Find a healthy distraction.
If you find this relevant, please share.
Thank you.
Martin Pham Dinh 