Evaluation of the effectiveness of mindfulness-based cognitive therapy to treat chronic insomnia

Can mindfulness-based interventions improve outcomes in cognitive-behavioural therapy for chronic insomnia disorder in the general population? Systematic review and meta-analysis

Cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first-line therapy for adults with chronic insomnia disorder (ID), which is characterized by hyperarousal. Mindfulness-based interventions (MBIs) are protocols aimed at stress reduction based on non-judgmental attention control in the present moment. However, MBIs have been increasingly used without a clear scientific basis. The objective of this analysis was to examine if MBIs could be useful as a component of the CBT-I therapeutic system through a systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies (NRS) searched in PubMed, PsycINFO, Cochrane and WoS. The Insomnia Severity Index (ISI) was the primary outcome, while the Pittsburgh Sleep Quality Index (PSQI) and a composite sleep variable (CSV) were secondary outcomes. Thirteen articles corresponding to nine studies (three pragmatic RCTs, three explanatory RCTs and three NRS) were included. The omnibus test found that MBIs had a small to medium effect size on ISI nearing signification when comparing active control groups in the pretest-posttest period [Δ = 0.44, p = 0.07], a medium, non-significant, effect size on PSQI [Δ = 0.52, p = 0.18], and a significant though small effect size on CSV [Δ = 0.05, p < 0.01]. No heterogeneity was found. The analysis could not demonstrate that MBIs, combined with CBT-I components in some studies, positively affected ID in the general adult population. This was probably due to the lack of pragmatic designs and suitable measuring instruments. Recommendations are made for designing further studies to address these issues.

Mindfulness and burnout among Chinese college students: mediation through sleep quality and perceived stress

College students often face challenges and obstacles which leads them vulnerable to burnout. Though numerous studies have supported an association between mindfulness and burnout, yet little is known about the potential mediating role of mindfulness exerts its effect in this link. This study aimed to explore the relationship between mindfulness and burnout among Chinese college students and investigated the sleep quality and perceived stress as two potential mediators of that relationship. A total of 536 college students (mean age = 21.93, 66.2% female) were investigated and completed the Five Facet of Mindfulness Questionnaire, Pittsburgh Sleep Quality Index, Perceived Stress Scale and Academic Burnout Scale of College Students. Path analyses were employed to examine the mediating effect. Results indicated that mindfulness had significant negative correlation with burnout (r=-.584, p < 0.001). Sleep quality and perceived stress were significant mediators of the observed relationship between mindfulness and burnout. These findings shed light upon the mediating role of sleep quality and perceived stress, and suggest that college students' mindfulness may facilitate their sleep quality and decrease perceived stress, which, in turn, may help prevent and reduce burnout.

Bedtime procrastination mediates the relation between anxiety and sleep problems

The prevalence of sleep problems is high in primary care patients and in anxious individuals. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems. We predicted higher anxiety would be negatively associated with total sleep time and positively associated with bedtime procrastination and sleep problems, and these variables would statistically mediate the association between anxiety and sleep problems. Participants were 308 adult primary care patients, predominantly female (non-Hispanic White = 158, Latinx = 111, mean age = 33.30), who initiated behavioral health services at an integrated primary care clinic. Patients completed a questionnaire regarding psychological health and sleep behaviors. Using structural equation modeling, we found higher anxiety related to higher sleep problems, partially mediated by bedtime procrastination but not total sleep time. This study highlights related factors like anxiety and prebedtime behaviors that may be effective treatment targets for sleep challenges.

A Qualitative Study of Use of Mindfulness to Reduce Long-Term Use of Habit-Forming Prescription Drugs

Objective: The aim of this study was to study how participants used a mindfulness-based program-Mindfulness Based Relapse Prevention to reduce use of habit-forming prescription drugs after long-term use. We explored participants' descriptions of their post-intervention strategies for controlling medication intake. Method: Eighteen participants provided semi-structured qualitative interviews shortly after completion of the program and 13 participants were also interviewed 1 year after completion. Participants were asked about the conditions that originally led to use of medication, how they had attempted prior to the course to cope with problems associated with these conditions and their prescription drug-use, and whether and how their coping strategies had changed after participation in the program. Thematic analysis was performed within the framework of a realist epistemology, with an emphasis on researcher reflexivity. Results: The following themes were identified in the material: Increased present-moment sensory awareness, Observing without controlling, Self-acceptance, Making conscious choices, Non-judgmental self-guidance, Sense of control, and Challenges of learning and using mindfulness. Although these findings are closely related to the specific needs of our sample-mainly coping with tapering use of prescription drugs-they are largely in line with existing research on mindfulness interventions. An exception is the theme "Non-judgmental self-guidance," which encompasses change in individuals' inner dialogue and practical self-care. Conclusions: Analyses suggested that mindfulness might increase individuals' control over medication intake by shifting individuals' attention toward present-moment sensory awareness of concrete stimuli, thereby facilitating other kinds of control, such as non-judgmental inner self-guidance and more adaptive ways of reducing distress. We suggest that it is the moment-to-moment sensory awareness and non-controlling observation of distress, together with inner self-guidance, that differentiates mindful control from dysfunctional attempts at direct, top down control of medication-use.

Integrative Medicine for Insomnia

Difficulty initiating and/or maintaining sleep is a common issue. Patients experiencing insomnia symptoms frequently self-treat their symptoms with sleep medications. However, there remains concern regarding the short- and long-term health impacts of sleep medications. This article discusses the evidence supporting integrative approaches to insomnia treatment, including cognitive-behavioral therapy and mind-body therapies (mindfulness meditation, yoga, tai chi), as well as emerging data for use of other less well supported approaches (dietary supplements, acupuncture).

[Contribution of mindfulness meditation in cognitive behavioral therapy for insomnia]

INTRODUCTION

Insomnia is considered to be a serious public health issue affecting approximately 10% of adults. Chronic insomnia may increase the risk of health problem, psychological vulnerability and proneness to accidents. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment. Even though CBT-I is widely considered as an effective therapy, 20 to 30% of patients do not respond to this treatment. Mindfulness therapy, known to reduce rumination and stress, could be an interesting complement to enhance CBT-I. The aim of this study is to evaluate the efficacy of therapy combining mindfulness meditation and CBT-I for the treatment of chronic insomnia.

METHODS

Thirty-three patients, diagnosed with chronic insomnia, aged 18 to 75 years (51±15 years) were recruited between October 2015 and June 2016 at the Sleep Center of Marseille. The patients were then divided into two groups according to their psychotherapy method: group CBT-I alone (17 patients) or a group therapy combining CBT-I and Mindfulness (16 patients). All participants were given five sessions of standard CBT during eight weeks. The patient-reported outcome measures were sleep onset latency, wake after sleep onset (WASO), total wake time, total sleep time, time in bed, sleep efficiency and number of awakening from sleep diaries before treatment (T0) and six weeks later (T1). Assessments were done using Pittsburgh Sleep quality index (PSQI), Insomnia severity Index (ISI), the Epworth sleepiness scale, the hospital anxiety and depression scale (HAD), the dysfunctional beliefs and attitude about sleep (DBAS-16); further, the use of sleeping pills was also recorded at T0 and T1.

RESULTS

Out of the 33 participants who began the treatment, 29 completed all sessions and were included in the analyses (4 dropouts in the group CBT-I alone). The data shows that each treatment yielded significant improvements over time in sleep variables from the diary, PSQI, ISI, anxiety (P=0.004), DBAS 16, sleeping pill use and vitality measured by SF36 health survey (P=0.004). Comparing the results of the two therapy groups, the meditation associated to CBT-I shows significantly greater rates of reduction in WASO relative to CBT-I group (P=0.009).

CONCLUSIONS

This study confirms the beneficial effects of CBT for patients suffering from insomnia on sleep parameters, anxiety symptoms and quality of life. Furthermore, this study suggests, for the first time, that combining CBT and mindfulness is a superior approach compared to that of only conventional CBT-I in improving sleep.

The Quest for Mindful Sleep: A Critical Synthesis of the Impact of Mindfulness-Based Interventions for Insomnia

Mindfulness-Based Interventions (MBIs) for insomnia and sleep disturbances are receiving increasing clinical and research attention. This paper provides a critical appraisal of this growing area investigating the application of MBIs for people with insomnia and sleep disturbance. First, we discuss the theoretical justification for how mindfulness meditation practice may affect sleep processes. Second, we provide a focused review of literature published between January 1, 2012 and April 1, 2016 examining the impact of MBIs on sleep, broken down by whether insomnia or sleep disturbance was a primary or secondary outcome. Recommendations for future research are discussed.