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Saba SK, Davis JP, Prindle JJ, Howe E, Tran DD, Bunyi J, Hummer JF, Castro CA, Pedersen ER. Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing Factor. Psychosom Med 2024; 86:44-51. [PMID: 37774110 PMCID: PMC10841244 DOI: 10.1097/psy.0000000000001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Military veterans who were injured in combat very often report pain along with co-occurring perceived stress and preexisting depressive disorder. The systems model of pain is a theoretical model suggesting that pain and perceived stress are bidirectionally associated at the within-person level, and associations are heightened among those with depressive disorder. However, the systems model of pain has not been adequately tested. Testing the systems model of pain could illuminate salient treatment targets for combat-injured veterans with pain and co-occurring psychological problems. METHODS The present study empirically tests the systems model of pain among a sample of combat-injured veterans ( N = 902) surveyed five times during an 18-month period. We used a multigroup, autoregressive latent trajectory with structured residual statistical model to test the within-person associations between pain and perceived stress and determine whether associations differ between veterans with and without a positive screen for depressive disorder. RESULTS In line with the systems model of pain, pain and perceived stress were bidirectionally associated only among combat-injured veterans with depressive disorder. Among such veterans, perceived stress was positively associated with subsequent pain ( b = 0.12; 95% confidence interval = 0.06-0.17), and pain was positively associated with subsequent perceived stress ( b = 0.44; 95% CI = 0.11-0.77). CONCLUSIONS Our work highlights the interplay between pain and its psychological correlates among a particularly at-risk population. Clinicians addressing pain and perceived stress among combat-injured veterans should be prepared to identify and address depressive disorder.
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Affiliation(s)
- Shaddy K. Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 St, Los Angeles, CA 90089
| | - Jordan P. Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 St, Los Angeles, CA 90089
| | - John J. Prindle
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 St, Los Angeles, CA 90089
| | - Esther Howe
- University of California, Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA 94720
| | - Denise D. Tran
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033
| | - John Bunyi
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 St, Los Angeles, CA 90089
| | | | - Carl Andrew Castro
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 St, Los Angeles, CA 90089
| | - Eric R. Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033
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Galante J, Friedrich C, Dalgleish T, Jones PB, White IR. Individual participant data systematic review and meta-analysis of randomised controlled trials assessing adult mindfulness-based programmes for mental health promotion in non-clinical settings. NATURE. MENTAL HEALTH 2023; 1:462-476. [PMID: 37867573 PMCID: PMC7615230 DOI: 10.1038/s44220-023-00081-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/24/2023] [Indexed: 10/24/2023]
Abstract
Introduction Mindfulness-based programmes (MBPs) are widely used to prevent mental ill-health that is becoming the leading global cause of morbidity. Evidence suggests beneficial average effects but wide variability. We aimed to confirm the effect of MBPs on psychological distress, and to understand whether and how baseline distress, gender, age, education, and dispositional mindfulness modify the effect of MBPs on distress among adults in non-clinical settings. Methods We conducted a pre-registered systematic review and individual participant data (IPD) meta-analysis (PROSPERO CRD42020200117). Thirteen databases were searched in December 2020 for randomised controlled trials satisfying a quality threshold and comparing in-person, expert-defined MBPs in non-clinical settings with passive control groups. Two researchers independently selected, extracted, and appraised trials using the revised Cochrane Risk-of-Bias Tool (RoB2). Anonymised IPD of eligible trials were sought from collaborating authors. The primary outcome was psychological distress (unpleasant mental or emotional experiences including anxiety and depression) at 1 to 6 months after programme completion. Data were checked and imputed if missing. Pairwise, random-effects, two-stage IPD meta-analyses were conducted. Effect modification analyses followed a within-studies approach. Public and professional stakeholders were involved in the planning, conduct and dissemination of this study. Results Fifteen trials were eligible, 13 trialists shared IPD (2,371 participants representing 8 countries, median age 34 years-old, 71% women, moderately distressed on average, 20% missing outcome data). In comparison with passive control groups, MBPs reduced average distress between one- and six-months post-intervention with a small to moderate effect size (standardised mean difference (SMD) -0.32; 95% confidence interval (CI) -0.41 to -0.24; p-value < 0.001; 95% prediction interval (PI) -0.41 to -0.24 (no heterogeneity)). Results were robust to sensitivity analyses, and similar for the other psychological distress time point ranges. Confidence in the primary outcome result is high. We found no clear indication that this effect is modified by baseline psychological distress, gender, age, education level, or dispositional mindfulness. Conclusions Group-based teacher-led MBPs generally reduce psychological distress among community adults who volunteer to receive this type of intervention. More research is needed to identify sources of variability in outcomes at an individual level.
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Affiliation(s)
- Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Claire Friedrich
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- NIHR Applied Research Collaboration East of England, Cambridge, UK
| | - Ian R. White
- MRC Clinical Trials Unit at UCL, University College London, London, United Kingdom
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Hunt CA, Letzen JE, Krimmel SR, Burrowes SAB, Haythornthwaite JA, Keaser M, Reid M, Finan PH, Seminowicz DA. Meditation Practice, Mindfulness, and Pain-Related Outcomes in Mindfulness-Based Treatment for Episodic Migraine. Mindfulness (N Y) 2023; 14:769-783. [PMID: 38435377 PMCID: PMC10907069 DOI: 10.1007/s12671-023-02105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 04/07/2023]
Abstract
Objectives Mindfulness-based interventions (MBIs) have emerged as promising prophylactic episodic migraine treatments. The present study investigated biopsychosocial predictors and outcomes associated with formal, daily-life meditation practice in migraine patients undergoing MBI, and whether augmented mindfulness mechanistically underlies change. Methods Secondary analyses of clinical trial data comparing a 12-week enhanced mindfulness-based stress reduction course (MBSR + ; n = 50) to stress management for headache (SMH; n = 48) were conducted. Results Pre-treatment mesocorticolimbic system functioning (i.e., greater resting state ventromedial prefrontal cortex-right nucleus accumbens [vmPFC-rNAC] functional connectivity) predicted greater meditation practice duration over MBSR + (r = 0.58, p = 0.001), as well as the change in headache frequency from pre- to post-treatment (B = -12.60, p = 0.02) such that MBSR + participants with greater vmPFC-rNAC connectivity showed greater reductions in headache frequency. MBSR + participants who meditated more showed greater increases in mindfulness (B = 0.52, p = 0.02) and reductions in the helplessness facet of pain catastrophizing (B = -0.13, p = 0.01), but not headache frequency, severity, or impact. Augmented mindfulness mediated reductions in headache impact resulting from MBSR + , but not headache frequency. Conclusions Mesocorticolimbic system function is implicated in motivated behavior, and thus, motivation-enhancing interventions might be delivered alongside mindfulness-based training to enhance meditation practice engagement. Formal, daily-life meditation practice duration appears to benefit pain-related cognitions, but not clinical pain, while mindfulness emerges as a mechanism of MBIs on headache impact, but not frequency. Further research is needed to investigate the day-to-day effects of formal, daily-life meditation practice on pain, and continue to characterize the specific mechanisms of MBIs on headache outcomes. Preregistration This study is not preregistered.
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Affiliation(s)
- Carly A. Hunt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA
| | - Janelle E. Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samuel R. Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shana A. B. Burrowes
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02218, USA
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Keaser
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
| | - Matthew Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick H. Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology, University of Virginia, VA, Charlottesville, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201, USA
- Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, MD 21201, USA
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Johnson AH, Wilson J, Magner D, Urban RW, Martin S, Zhang Y. Exploring Meditation Profiles and Predictors in Nursing Students. J Holist Nurs 2022; 41:142-154. [PMID: 35620800 DOI: 10.1177/08980101221102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Nursing students face unique academic and clinical workloads linked to increased stress. Previous studies indicate formal and informal mindfulness meditation provide stress-reducing benefits. This practice aligns with holistic nursing core values of self-care and self-reflection; little is known about meditation practice in nursing students. Objectives: Our study aimed to describe meditation practice and predictors in pre-licensure nursing students. Design: Cross-sectional, multi-site. Methods: Qualtrics surveys queried individual demographics, personal meditation and exercise habits, and indicators of wellbeing. Results: Of 417 participants, 65% (n = 271) reported at least one type of meditation practice. Prayer/spiritual activities were most prevalent (almost 70%), followed by breathing exercises (41%). Meditators reported good or excellent self-rated health status or engaged in exercise (p < .05). Meditators also reported more self-compassion, happiness, and satisfaction with life, and perceived less stress than non-meditators (p < .05). Of all factors studied, only engaging in exercise significantly predicted practicing meditation (OR = 2.05, 95%CI 1.10-3.82). Conclusion: Nursing students who engage in meditation report signs of health and well-being and utilize holistic methods such as prayer and breathing. The intrinsic motivation to engage in healthy habits such as exercise may also help students engage in mindfulness meditation and is an important finding for nursing educators.
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Yang Z, Chen F, Liu S, Dai M, Zhang H. Psychometric Properties of the Chinese Version of the Brief-Mindful Self-Care Scale: A Translation and Validation Study. Front Psychol 2021; 12:715507. [PMID: 34484076 PMCID: PMC8414633 DOI: 10.3389/fpsyg.2021.715507] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to translate the Brief-Mindful Self-Care Scale (B-MSCS) into Chinese and validate its reliability and validity among hospice nurses. Methods: A total of 510 hospice nurses were recruited from three provinces in China. The reliability of the translated scale was measured by internal consistency, split-half reliability, and test-retest reliability. The validity of the translated scale was evaluated by expert consultation, exploratory factor analysis, and confirmatory factor analysis. Results: The Cronbach's α value of the Chinese version of B-MSCS was 0.920, and the Cronbach's α value of the dimensions ranged from 0.850 to 0.933. The split-half reliability and test-retest reliability were 0.770 and 0.723, respectively. Furthermore, the content validity index of the scale (S-CVI) was 0.946. The 6-factor structure, supported by the eigenvalues, total variance explained, and scree plot were obtained by using exploratory factor analysis. Moreover, as a result of the confirmatory factor analysis, the model fitting indexes were all in the acceptable range. Conclusion: The Chinese version of B-MSCS had suitable reliability and validity among hospice nurses. The developed scale will evaluate the level of mindful self-care of Chinese hospice nurses, providing an opportunity for development of targeted educational plans. Each item is a direct guide for hospice nurses to develop their mindful self-care practice.
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Affiliation(s)
- Zhen Yang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Fengmin Chen
- Department of Nursing, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Siqi Liu
- Department of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Ming Dai
- Department of Nursing, Jiamusi University, Jiamusi, China
| | - Huijun Zhang
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
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Canby NK, Eichel K, Peters SI, Rahrig H, Britton WB. Predictors of Out-of-Class Mindfulness Practice Adherence During and After a Mindfulness-Based Intervention. Psychosom Med 2021; 83:655-664. [PMID: 33038188 PMCID: PMC8024418 DOI: 10.1097/psy.0000000000000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Out-of-class mindfulness meditation practice is a health behavior that is considered to be a crucial ingredient in mindfulness-based interventions (MBIs), yet participant adherence to practice recommendations is often inconsistent. Furthermore, MBIs may enhance factors that lead to greater adherence to medical regimens in other contexts. This study examined baseline factors previously found to relate to adherence to medical regimen, MBI-related changes in these baseline factors, and treatment-related factors as predictors of meditation adherence in an 8-week MBI. METHODS Baseline traits (personality, depressive symptoms, and executive function) were entered into regression models (n = 96) to predict intervention and postintervention out-of-class meditation adherence. Trait changes and treatment-related factors were entered into models to predict postintervention meditation adherence. RESULTS Baseline conscientiousness (β = 0.33, p = .002), openness (β = 0.23, p = .019), and depressive symptoms (β = 0.19, p = .042) predicted intervention meditation adherence, whereas conscientiousness (β = 0.21, p = .044) and depressive symptoms (β = 0.22, p = .020) predicted postintervention meditation adherence. Although all trait variables except for agreeableness changed significantly pre-to-post intervention, these changes did not predict postintervention meditation adherence. Retreat attendance (β = 0.38, p = .029) and instructor/group-related therapeutic factors collectively predicted postintervention meditation adherence (R2 = 0.21, p = .019). CONCLUSIONS The identified baseline trait factors could be used to increase adherence in these interventions as a method of increasing their effectiveness. An emphasis on the MBI retreat and social factors during the intervention may be important for participant out-of-class practice postintervention.Trial Registration:ClinicalTrials.govNCT01831362.
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Affiliation(s)
- Nicholas K. Canby
- Department of Psychology, Clark University
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Kristina Eichel
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Sarah I. Peters
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Hadley Rahrig
- Department of Psychology, Virginia Commonwealth University
| | - Willoughby B. Britton
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
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Galante J, Friedrich C, Dawson AF, Modrego-Alarcón M, Gebbing P, Delgado-Suárez I, Gupta R, Dean L, Dalgleish T, White IR, Jones PB. Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials. PLoS Med 2021; 18:e1003481. [PMID: 33428616 PMCID: PMC7799763 DOI: 10.1371/journal.pmed.1003481] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is an urgent need for mental health promotion in nonclinical settings. Mindfulness-based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions. METHODS AND FINDINGS Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in-person, expert-defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk-of-Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well-being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta-regression and sensitivity analyses were prespecified. Pairwise random-effects multivariate meta-analyses and prediction intervals (PIs) were calculated. A total of 11,605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p-value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p-value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p-value < 0.001; 95% PI -1.04 to 0.14), and well-being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p-value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p-value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well-being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs' superiority. Only effects on distress remained when higher-risk trials were excluded. USA-based trials reported smaller effects. MBPs targeted at higher-risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials. CONCLUSIONS Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.
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Affiliation(s)
- Julieta Galante
- University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, United Kingdom
| | | | | | - Marta Modrego-Alarcón
- University of Zaragoza, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | | | - Irene Delgado-Suárez
- University of Zaragoza, Zaragoza, Spain
- Institute of Medical Research Aragón, Zaragoza, Spain
| | | | - Lydia Dean
- University of Cambridge, Cambridge, United Kingdom
| | - Tim Dalgleish
- University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Ian R White
- University College London, London, United Kingdom
| | - Peter B Jones
- University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
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Barrett B, Harden CM, Brown RL, Coe CL, Irwin MR. Mindfulness meditation and exercise both improve sleep quality: Secondary analysis of a randomized controlled trial of community dwelling adults. Sleep Health 2020; 6:804-813. [PMID: 32448712 DOI: 10.1016/j.sleh.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 04/04/2020] [Accepted: 04/05/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the benefits of training in mindfulness-based stress reduction (MBSR) or moderate intensity exercise (EX) for improving sleep quality. DESIGN Randomized controlled trial. SETTING Outpatient, community-based. PARTICIPANTS Healthy adults (n = 413) aged 30-69 who did not regularly exercise or practice meditation, and who had no known prior sleep problems. INTERVENTIONS 1) 8-weeks of MBSR training; 2) matched EX training; or 3) wait-list control. MEASUREMENTS The Pittsburgh Sleep Quality Index (PSQI) was administered at baseline and at 1, 3, 5, and 7-month follow-up visits. ANALYSIS Total PSQI scores and three PSQI factors (perceived sleep quality; daily disturbance, sleep efficiency) were assessed using linear mixed effects regression models for longitudinal data. RESULTS Compared to controls, PSQI global scores improved significantly for EX (mean change -0.98 points [95% CI -1.56, -0.41] p = 0.001) and marginally for MBSR (-0.53 [-1.10, 0.04] p = 0.07). The perceived sleep quality factor improved for both EX (-0.18 [-0.30, -0.07] p = 0.002) and MBSR (-0.12 [-0.24, -0.01] p = 0.035). The daily disturbance factor improved slightly more for MBSR (-0.13 [-0.22, -0.033] p = 0.008) than EX (-0.09 [-0.19, 0.004] p = 0.06). The sleep efficiency factor did not improve after MBSR (0.08 [-0.045, 0.21] p = 0.2) or EX (-0.07 [-0.20, 0.06] p = 0.3). Improvements in the sleep quality were sustained over 7 months for both groups. CONCLUSIONS Training in MBSR and EX produced small but statistically significant and sustained improvements in sleep quality. For EX participants, this improvement was due primarily to improvements in perceived sleep quality. For MBSR, the decrease in daily disturbance was more important.
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Affiliation(s)
- Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, Madison United States.
| | - Christine M Harden
- Department of Family Medicine and Community Health, University of Wisconsin, School of Medicine and Public Health, Madison United States
| | - Roger L Brown
- University of Wisconsin-Madison, School of Nursing, United States
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, United States
| | - Michael R Irwin
- David Geffen School of Medicine, Psychiatry, University of California - Los Angeles, United States
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