I-CAN SLEEP: rationale and design of a non-inferiority RCT of Mindfulness-based Stress Reduction and Cognitive Behavioral Therapy for the treatment of Insomnia in CANcer survivors

Effects of mindfulness-based stress reduction therapy for sleep quality and perceived stress in patients with spinal cord injury

OBJECTIVE

To explore the effect of the mindfulness-based stress reduction (MBSR) practice on sleep quality and perceived stress in patients with spinal cord injury (SCI).

METHOD

A total of 104 patients with SCI (diagnosed via imaging and clinical symptoms) admitted to our hospital between January 2020 and December 2022 were selected as the study participants. The patients were randomly divided into two groups: the MBSR (observation) group and the control group. The observation group received MBSR therapy and routine nursing, and the control group received music training therapy and routine nursing. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and the perceived stress score was used to evaluate stress experienced by the patients at three timepoints: before intervention, 4 weeks and 8weeks after intervention.

RESULTS

Compared with before intervention, the PSQI scores of both the control group and intervention group participants significantly decreased after intervention(P < 0.01). Compared with the 4 weeks after intervention, the PSQI scores of both groups of participants decreased in the 8 weeks after intervention(P < 0.01). There was a significant difference in PSQI scores between the two groups of participants at 4 and 8 weeks after intervention(P < 0.01). Compared with before intervention, the average perceived stress score of both the control group and intervention group participants significantly decreased after intervention(P < 0.05). Compared with the 4 weeks after intervention, the average perceived stress score of both groups of participants decreased in the 8 weeks after intervention(P < 0.01). There was a significant difference in average perceived stress score between the two groups of participants at 4(P < 0.05) and 8 weeks(P < 0.01) after intervention(P < 0.01).

CONCLUSION

The use of MBSR therapy could effectively improve patient sleep quality and reduce perceived stress.

The Effect of Mindfulness-Based Stress Reduction on Posttraumatic Stress of Mothers With Premature Neonates Admitted to a Neonatal Intensive Care Unit

Mothers experience posttraumatic stress disorder with the birth of a premature neonate. The purpose of this study was to determine the effect of mindfulness-based stress reduction on posttraumatic stress of mothers with premature neonates in Iran. Sixty mothers with premature neonates were selected by using convenience sampling and stratified random allocation. Mindfulness-based stress reduction was trained and mean posttraumatic stress disorder was measured. Mean posttraumatic stress scores of the 2 groups were statistically significant immediately and 1 month after the intervention (independent t test, P < .05). Posttraumatic stress of both groups reduced over time, but this reduction was more significant in the intervention group (repeated-measures analysis of variance, P < .05). Concerning the positive role of mindfulness-based stress reduction in posttraumatic stress disorder of mothers, it is recommended to use this approach in care programs of mothers with premature neonates.

Sleep Disorders in Cancer-A Systematic Review

INTRODUCTION

Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment.

METHODS

A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis.

RESULTS

The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%.

DISCUSSION

Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.

The Effect of Mindfulness-Based Stress Reduction Group Counseling on Psychological and Inflammatory Responses of the Women With Breast Cancer

Introduction: Breast cancer is common among women and reduces their quality of life. The current study aimed to investigate the effectiveness of mindfulness-based stress reduction group counseling in alleviating psychological responses such as anxiety, depression, stress, and regulating laboratory tests including cortisol and C-reactive protein (CRP) in women with breast cancer. Methods: This randomized clinical trial was conducted based on convenience sampling. Participants were divided into 2 groups (control and intervention groups) with block randomization. The intervention group received mindfulness-based stress reduction group counseling during 8 weeks. The participants completed the Beck anxiety inventory, Beck-II depression inventory, and perceived stress scale before and after the intervention and their blood samples were taken to check their cortisol and CRP. Results: After the intervention, the MBSR group had significantly lower anxiety compared with the control group (P < .001). No significant difference was found between the 2 groups in the reduction of perceived stress and depression (P < .05). In addition, no significant difference was found between the 2 groups in CRP and cortisol levels after the intervention (P > .05). Conclusion: The present study showed the effectiveness of mindfulness-based cognitive therapy in improving anxiety rather than the stress, depression, and inflammatory laboratory factors such as cortisol and CRP in women with breast cancer. Therefore, the psychological symptoms of these patients can be improved at different stages of treatment by providing this type of training.

Yoga into Cancer Care: A Review of the Evidence-based Research

To cope with cancer and its treatment-related side effects and toxicities, people are increasingly using complementary and alternative medicine (CAM). Consequently, integrative oncology, which combines conventional therapies and evidence-based CAM practices, is an emerging discipline in cancer care. The use of yoga as a CAM is proving to be beneficial and increasingly gaining popularity. An electronic database search (PubMed), through December 15, 2016, revealed 138 relevant clinical trials (single-armed, nonrandomized, and randomized controlled trials) on the use of yoga in cancer patients. A total of 10,660 cancer patients from 20 countries were recruited in these studies. Regardless of some methodological deficiencies, most of the studies reported that yoga improved the physical and psychological symptoms, quality of life, and markers of immunity of the patients, providing a strong support for yoga's integration into conventional cancer care. This review article presents the published clinical research on the prevalence of yoga's use in cancer patients so that oncologists, researchers, and the patients are aware of the evidence supporting the use of this relatively safe modality in cancer care.

Calibrating actigraphy to improve sleep efficiency estimates

Actigraphy (ACT) can enhance treatment for insomnia by providing objective estimates of sleep efficiency; however, only two studies have assessed the accuracy of actigraphy-based estimates of sleep efficiency (ACT-SE) in sleep-disordered samples studied at home. Both found poor correspondence with polysomnography-based estimates (PSG-SE). The current study tested that concordance in a third sample and piloted a method for improving ACT-SE. Participants in one of four diagnostic categories (panic disorder, post-traumatic stress disorder, comorbid post-traumatic stress and panic disorder and controls without sleep complaints) underwent in-home recording of sleep using concurrent ambulatory PSG and actigraphy. Precisely synchronized PSG and ACT recordings were obtained from 41 participants. Sleep efficiency was scored independently using conventional methods, and ACT-SE/PSG-SE concordance examined. Next, ACT data recorded initially at 0.5 Hz were resampled to 30-s epochs and rescaled on a per-participant basis to yield optimized concordance between PSG- and ACT-based sleep efficiency estimates. Using standard scoring of ACT, the correlation between ACT-SE and PSG-SE across participants was statistically significant (r = 0.35, P < 0.025), although ACT-SE failed to replicate a main effect of diagnosis. Individualized calibration of ACT against a night of PSG yielded a significantly higher correlation between ACT-SE and PSG-SE (r = 0.65, P < 0.001; z = 1.692, P = 0.0452, one-tailed) and a significant main effect of diagnosis that was highly correspondent with the effect on PSG-SE. ACT-based estimates of sleep efficiency in sleep-disordered patients tested at home can be improved significantly by calibration against a single night of concurrent PSG.

Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease?

There is increasing awareness of the role of sleep disturbance as an important factor in health and disease. Although sub-clinical sleep disturbances (insufficient sleep duration or inadequate sleep quality) may be difficult to assess with conceptual and/or methodological clarity, this review attempts to summarize and synthesize these findings. First, the concept of sleep disturbance in a public health context is introduced, to provide context and rationale. Second, operational definitions of 'cardiometabolic disease' and 'sleep disturbance' are offered, to address many unclear operationalizations. Third, the extant literature is summarized regarding short or long sleep duration and/or insufficient sleep, insomnia and insomnia symptoms, general (non-specific sleep disturbances), circadian rhythm abnormalities that result in sleep disturbances, and, briefly, sleep-disordered breathing. Fourth, the review highlights the social/behavioural context of sleep, including discussions of sleep and race/ethnicity, socio-economic position, and other social/environmental factors, in order to place these findings in a social-environmental context relevant to public health. Fifth, the review highlights the issue of sleep as a domain of health behaviour and addresses issues regarding development of healthy sleep interventions. Finally, a research agenda of future directions is proposed.

Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial

PURPOSE

Our study examined whether mindfulness-based stress reduction (MBSR) is noninferior to cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia in patients with cancer.

PATIENTS AND METHODS

This was a randomized, partially blinded, noninferiority trial involving patients with cancer with insomnia recruited from a tertiary cancer center in Calgary, Alberta, Canada, from September 2008 to March 2011. Assessments were conducted at baseline, after the program, and after 3 months of follow-up. The noninferiority margin was 4 points measured by the Insomnia Severity Index. Sleep diaries and actigraphy measured sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency. Secondary outcomes included sleep quality, sleep beliefs, mood, and stress.

RESULTS

Of 327 patients screened, 111 were randomly assigned (CBT-I, n = 47; MBSR, n = 64). MBSR was inferior to CBT-I for improving insomnia severity immediately after the program (P = .35), but MBSR demonstrated noninferiority at follow-up (P = .02). Sleep diary-measured SOL was reduced by 22 minutes in the CBT-I group and by 14 minutes in the MBSR group at follow-up. Similar reductions in WASO were observed for both groups. TST increased by 0.60 hours for CBT-I and 0.75 hours for MBSR. CBT-I improved sleep quality (P < .001) and dysfunctional sleep beliefs (P < .001), whereas both groups experienced reduced stress (P < .001) and mood disturbance (P < .001).

CONCLUSION

Although MBSR produced a clinically significant change in sleep and psychological outcomes, CBT-I was associated with rapid and durable improvement and remains the best choice for the nonpharmacologic treatment of insomnia.

Reduction in salivary α-amylase levels following a mind-body intervention in cancer survivors--an exploratory study

OBJECTIVE

The main aim of this exploratory study was to assess whether salivary α-amylase (sAA) and salivary cortisol levels would be positively modulated by sleep-focused mind-body interventions in female and male cancer survivors.

METHODS

We conducted a randomized controlled trial in which 57 cancer survivors with self-reported sleep disturbance received either a Sleep Hygiene Education (SHE; n=18) control, or one of two experimental mind-body interventions, namely, Mind-Body Bridging (MBB; n=19) or Mindfulness Meditation (MM; n=20). Interventions were three sessions each conducted once per week for three consecutive weeks. Saliva cortisol and sAA were measured at baseline and 1 week after the last session. Participants also completed a sleep scale at the same time points when saliva was collected for biomarker measurement.

RESULTS

Our study revealed that at post-intervention assessment, mean sAA levels upon awakening ("Waking" sample) declined in MBB compared with that of SHE. Mean Waking cortisol levels did not differ among treatment groups but declined slightly in SHE. Self-reported sleep improved across the three interventions at Post-assessment, with largest improvements in the MBB intervention.

CONCLUSION

In this exploratory study, sleep focused mind-body intervention (MBB) attenuated Waking sAA levels, suggesting positive influences of a mind-body intervention on sympathetic activity in cancer survivors with sleep disturbance.

Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial

Purpose

After completing treatment, cancer survivors may suffer from a multitude of physical and mental health impairments, resulting in compromised quality of life. This exploratory study investigated whether two mind–body interventions, i.e., Mind–Body Bridging (MBB) and Mindfulness Meditation (MM), could improve posttreatment cancer survivors’ self-reported sleep disturbance and comorbid symptoms, as compared to sleep hygiene education (SHE) as an active control.

Methods

This randomized controlled trial examined 57 cancer survivors with clinically significant self-reported sleep disturbance, randomly assigned to receive MBB, MM, or SHE. All interventions were conducted in three sessions, once per week. Patient-reported outcomes were assessed via the Medical Outcomes Study Sleep Scale and other indicators of psychosocial functioning relevant to quality of life, stress, depression, mindfulness, self-compassion, and well-being.

Results

Mixed effects model analysis revealed that mean sleep disturbance symptoms in the MBB (p = .0029) and MM (p = .0499) groups were lower than in the SHE group, indicating that both mind–body interventions improved sleep. In addition, compared with the SHE group, the MBB group showed reductions in self-reported depression symptoms (p = .040) and improvements in overall levels of mindfulness (p = .018), self-compassion (p = .028), and well-being (p = .019) at postintervention.

Conclusions

This study provides preliminary evidence that brief sleep-focused MBB and MM are promising interventions for sleep disturbance in cancer survivors. Integrating MBB or MM into posttreatment supportive plans should enhance care of cancer survivors with sleep disturbance. Because MBB produced additional secondary benefits, MBB may serve as a promising multipurpose intervention for posttreatment cancer survivors suffering from sleep disturbance and other comorbid symptoms.

Implications for Cancer Survivors

Two brief sleep-focused mind–body interventions investigated in the study were effective in reducing sleep disturbance and one of them further improved other psychosocial aspects of the cancer survivors’ life. Management of sleep problems in survivors is a high priority issue that demands more attention in cancer survivorship.

The durability of cognitive behavioral therapy for insomnia in patients with chronic pain

The purpose of this study was to assess the long-term (six months) effects of cognitive behavioral therapy for insomnia (CBT-I) in patients with chronic pain. The results of the pre-post treatment effects have been reported previously. The therapy was delivered by an advanced practice nurse in a research setting using a parallel-group, randomized, single blind trial of CBT-I with a contact/measurement control condition. Outcomes included sleep diary, the Insomnia Severity Index, the Multidimensional Pain Inventory, the Beck Depression Inventory, the Profile of Mood States-short form, and the Pain Disability Index. Measurement time points were end-of-treatment, three-month and six-month posttherapy. Subjects receiving CBT-I (n = 19), as compared to control subjects (n = 9), did not exhibit any significant group by visit effects on measures of sleep, pain, mood, or function after end of treatment. However, subjects in the treatment group exhibited statistically (P = 0.03) and clinically significant improvement in total sleep time (23 minutes) over the six months following treatment. In this paper, cognitive behavioral therapy directed to improve insomnia was successfully delivered to patients with moderate-to-severe chronic pain and the positive effects of CBT-I continued to improve despite the presence of continued moderate-to-severe pain.

Clinical trials in integrative therapies

OBJECTIVES

To review clinical trials in natural products and mind-body therapies for oncology symptom management, to discuss issues related to developing clinical trials in this area, and outline examples of rigorous and innovative study design.

DATA SOURCES

Peer reviewed literature.

CONCLUSION

Most of the evidence for the integrative therapies reviewed is derived from phase II trials, and is considered preliminary. More research is needed in these therapies to clearly articulate their role in the management of oncology symptoms. Innovative strategies and methodologies for studying integrative therapies have been demonstrated.

IMPLICATIONS FOR NURSING PRACTICE

It is necessary to critically evaluate the literature to be able to educate patients about integrative therapies. Investigators should expand on well-designed studies that demonstrate clinically important effects. Dissemination trials may be a good strategy, once data exists, to move integrative therapies into the care of patients.

Improving psychotherapy research: The example of mindfulness based interventions

The increasing number and sophistication of available psychotherapies suggests that a critical appraisal of the methodological issues of psychotherapy studies is highly needed. Several key questions regarding the efficacy of a given intervention, the understanding of whether positive effects observed following the delivery of a psychotherapeutic intervention are specifically attributable to the intervention itself or to other "non specific" factors, such as benefit expectations, therapist attention and support, and the possibility of improving psychotherapy research need an answer. This, in turn, could provide clinicians with more rigorous information about psychotherapy outcomes and could properly address several shortcomings that are frequently observed in current psychotherapy studies. Accordingly, in this editorial I will highlight some of the most important critical issues that a well designed psychotherapy study should take into account, including the need for appropriate control groups, appropriate randomization and blinding procedures, and the importance of performing appropriately powered studies that include a sufficiently long follow-up period. Finally, I will build on my expertise in the field of mindfulness based interventions, in particular mindfulness based stress reduction and mindfulness based cognitive therapy, to show how such issues have been and can be successfully implemented in the design of future psychotherapy studies.