Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-20T04:22:51.607Z Has data issue: false hasContentIssue false
  • English
  • Français

Mindfulness and Behaviour Therapy for Insomnia: An Assessment of Treatment Effect in a Sleep Disorders Clinic Population with Insomnia

Published online by Cambridge University Press:  27 November 2020

Allie Peters ,
John Reece ,
Hailey Meaklim Open the ORCID record for Hailey Meaklim [Opens in a new window] ,
Moira Junge ,
David Cunnington ,
Jason C. Ong ,
Mervyn Jackson  and
Kenneth Mark Greenwood
Allie Peters
Affiliation:
Melbourne Sleep Disorders Centre, Melbourne, Victoria, Australia RMIT University, Melbourne, Victoria, Australia
John Reece*
Affiliation:
Australian College of Applied Psychology, Melbourne, Victoria, Australia
Hailey Meaklim
Affiliation:
Melbourne Sleep Disorders Centre, Melbourne, Victoria, Australia Monash University, Melbourne, Victoria, Australia
Moira Junge
Affiliation:
Melbourne Sleep Disorders Centre, Melbourne, Victoria, Australia
David Cunnington
Affiliation:
Melbourne Sleep Disorders Centre, Melbourne, Victoria, Australia
Jason C. Ong
Affiliation:
Department of Neurology, Centre for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Mervyn Jackson
Affiliation:
RMIT University, Melbourne, Victoria, Australia
Kenneth Mark Greenwood
Affiliation:
University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
*
*Corresponding author: John Reece, Australian College of Applied Psychology, Level 10, 123 Lonsdale Street, Melbourne, VIC3000, Australia. Email: [email protected]
Get access

Abstract

Insomnia is a common major health concern, which causes significant distress and disruption in a person's life. The objective of this paper was to evaluate a 6-week version of Mindfulness-Based Therapy for Insomnia (MBTI) in a sample of people attending a sleep disorders clinic with insomnia, including those with comorbidities. Thirty participants who met the DSM-IV-TR diagnosis of insomnia participated in a 6-week group intervention. Outcome measures were a daily sleep diary and actigraphy during pre-treatment and follow-up, along with subjective sleep outcomes collected at baseline, end-of-treatment, and 3-month follow-up. Trend analyses showed that MBTI was associated with a large decrease in insomnia severity (p < .001), with indications of maintenance of treatment effect. There were significant improvements in objective sleep parameters, including sleep onset latency (p = .005), sleep efficiency (p = .033), and wake after sleep onset (p = .018). Significant improvements in subjective sleep parameters were also observed for sleep efficiency (p = .005) and wake after sleep onset (p < .001). Overall, this study indicated that MBTI can be successfully delivered in a sleep disorders clinic environment, with evidence of treatment effect for both objective and subjective measures of sleep.

Keywords

mindfulnessinsomniatreatmentMBTIinterventionsleep
Type
Standard Paper
Information
Behaviour Change , Volume 38 , Issue 1 , April 2021 , pp. 25 - 39
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baer, R, Smith, G, Hopkins, J, Krietemeyer, J and Toney, L (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13, 27–45. doi: 10.1177/1073191105283504CrossRefGoogle ScholarPubMed
Bastien, C (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307. doi:10.1016/s1389-9457(00)00065-4.CrossRefGoogle ScholarPubMed
Black, DS, O'Reilly, GA, Olmstead, R, Breen, EC and Irwin, MR (2014). Mindfulness-based intervention for prodromal sleep disturbances in older adults: Design and methodology of a randomized controlled trial. Contemporary Clinical Trials, 39, 22–27. doi:10.1016/j.cct.2014.06.013.CrossRefGoogle ScholarPubMed
Black, DS, O'Reilly, GA, Olmstead, R, Breen, EC and Irwin, MR (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: A randomized clinical trial. JAMA Internal Medicine, 175, 494–501.10.1001/jamainternmed.2014.8081CrossRefGoogle ScholarPubMed
Britton, WB, Shapiro, SL, Penn, PE and Bootzin, RR (2003). Treating insomnia with mindfulness-based stress reduction. Sleep, 26, A309–A310.Google Scholar
Buysse, DJ, Reynolds, CF 3rd, Monk, TH, Berman, SR and Kupfer, DJ (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213. doi:10.1016/0165-1781(89)90047-4.CrossRefGoogle ScholarPubMed
Dong, Y and Yang, FM (2019). Insomnia symptoms predict both future hypertension and depression. Preventive Medicine, 123, 41–47. doi:10.1016/j.ypmed.2019.02.001.CrossRefGoogle ScholarPubMed
Garcia, MC, Kozasa, EH, Tufik, S, Mello, L and Hachul, H (2018). The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: A pilot study. Menopause, 25, 992–1003. doi:10.1097/GME.0000000000001118.CrossRefGoogle ScholarPubMed
Garland, SN, Carlson, LE, Stephens, AJ, Antle, MC, Samuels, C and Campbell, TS (2014). Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: A randomized, partially blinded, noninferiority trial. Journal of Clinical of Oncology, 32, 449–457. doi:10.1200/JCO.2012.47.7265.CrossRefGoogle ScholarPubMed
Garland, SN, Rouleau, CR, Campbell, T, Samuels, C and Carlson, LE (2015). The comparative impact of mindfulness-based cancer recovery (MBCR) and cognitive behavior therapy for insomnia (CBT-I) on sleep and mindfulness in cancer patients. Explore (NY), 11, 445–454. doi:10.1016/j.explore.2015.08.004.CrossRefGoogle ScholarPubMed
Gross, CR, Kreitzer, MJ, Reilly-Spong, M, Wall, M, Winbush, NY, Patterson, R, … Cramer-Bornemann, M (2011). Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: A randomized controlled clinical trial. Explore (NY), 7, 76–87. doi:10.1016/j.explore.2010.12.003.CrossRefGoogle ScholarPubMed
Heidenreich, T, Ströhle, G and Michalak, J (2006). Achtsamkeit: Konzeptuelle Aspekte und Ergebnisse zum Freiburger Achtsamkeitsfragebogen. Verhaltenstherapie, 16, 33–40. doi:10.1159/000091521.CrossRefGoogle Scholar
Hillman, D, Mitchell, S, Streatfeild, J, Burns, C, Bruck, D and Pezzullo, L (2018). The economic cost of inadequate sleep. Sleep, 41. doi:10.1093/sleep/zsy083.CrossRefGoogle ScholarPubMed
Hopkins, W (2002). A scale of magnitudes for effect statistics. A New View of Statistics. Retrieved from: http://www.sportsci.org/resource/stats/.Google Scholar
Johns, MW (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540–545. doi:10.1093/sleep/14.6.540.CrossRefGoogle ScholarPubMed
Johns, MW (1992). Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep, 15, 376–381. doi:10.1093/sleep/15.4.376.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J, Wheeler, E, Light, T, Skillings, A, Scharf, MJ, Cropley, TG, … Bernhard, JD (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine, 60, 625–632. doi:10.1097/00006842-199809000-00020.CrossRefGoogle Scholar
Kalmbach, DA, Cuamatzi-Castelan, AS, Tonnu, CV, Tran, KM, Anderson, JR, Roth, T and Drake, CL (2018). Hyperarousal and sleep reactivity in insomnia: Current insights. Nature and Science of Sleep, 10, 193–201. doi:10.2147/NSS.S138823.CrossRefGoogle ScholarPubMed
Krupp, LB, LaRocca, NG, Muir-Nash, J and Steinberg, AD (1989). The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123. doi:10.1001/archneur.1989.00520460115022.CrossRefGoogle ScholarPubMed
Morin, CM, Vallieres, A, Guay, B, Ivers, H, Savard, J, Merette, C, … Baillargeon, L (2009). Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: A randomized controlled trial. JAMA, 301, 2005–2015. doi:10.1001/jama.2009.682.CrossRefGoogle ScholarPubMed
Morin, CM, Belleville, G, Belanger, L and Ivers, H (2011). The Insomnia Severity Index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34, 601–608. doi:10.1093/sleep/34.5.601.CrossRefGoogle ScholarPubMed
Nakamura, Y, Lipschitz, DL, Kuhn, R, Kinney, AY and Donaldson, GW (2013). Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: A pilot randomized controlled trial. Journal of Cancer Survivorship, 7, 165–182. doi:10.1007/s11764-012-0252-8.CrossRefGoogle ScholarPubMed
Nicassio, PM, Mendlowitz, DR, Fussell, JJ and Petras, L (1985) The phenomenology of the pre-sleep state: The development of the pre-sleep arousal scale. Behaviour Research and Therapy 23, 263–271. doi: 10.1016/0005-7967(85)90004-xCrossRefGoogle ScholarPubMed
Ong, J and Manber, R (2011). Mindfulness-Based Therapy for Insomnia. Chicago, IL: Elsevier.Google Scholar
Ong, J and Sholtes, D (2010). A mindfulness-based approach to the treatment of insomnia. Journal of Clinical Psychology, 66, 1175–1184. doi:10.1002/jclp.20736.CrossRefGoogle ScholarPubMed
Ong, JC, Shapiro, SL and Manber, R (2008). Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behavior Therapy, 39, 171–182. doi:10.1016/j.beth.2007.07.002.CrossRefGoogle ScholarPubMed
Ong, JC, Shapiro, SL and Manber, R (2009). Mindfulness meditation and cognitive behavioral therapy for insomnia: A naturalistic 12-month follow-up. Explore (NY), 5, 30–36. doi:10.1016/j.explore.2008.10.004CrossRefGoogle ScholarPubMed
Ong, JC, Ulmer, CS and Manber, R (2012). Improving sleep with mindfulness and acceptance: A metacognitive model of insomnia. Behaviour Research Therapy, 50, 651–660. doi:10.1016/j.brat.2012.08.001.CrossRefGoogle ScholarPubMed
Ong, JC, Manber, R, Segal, Z, Xia, Y, Shapiro, S and Wyatt, JK (2014). A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep, 37, 1553–1563. doi:10.5665/sleep.4010.CrossRefGoogle ScholarPubMed
Ong, JC, Xia, Y, Smith-Mason, CE and Manber, R (2018). A randomized controlled trial of mindfulness meditation for chronic insomnia: Effects on daytime symptoms and cognitive-emotional arousal. Mindfulness 9, 1702–1712. doi: 10.1007/s12671-018-0911-6CrossRefGoogle Scholar
Rash, JA, Kavanagh, VAJ and Garland, SN (2019). A meta-analysis of mindfulness-based therapies for insomnia and sleep disturbance: Moving towards processes of change. Sleep Medicine Clinics, 14, 209–233. doi:10.1016/j.jsmc.2019.01.004.CrossRefGoogle ScholarPubMed
Shapiro, SL, Bootzin, RR, Figueredo, AJ, Lopez, AM and Schwartz, GE (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study. Journal of Psychosomatic Research, 54, 85–91. doi:10.1016/s0022-3999(02)00546-9.CrossRefGoogle Scholar
Substance Abuse and Mental Health Services Administration (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville, MD. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t36/.Google Scholar
Tang, NKY and Harvey, AG (2004) Correcting distorted perception of sleep in insomnia: A novel behavioural experiment?. Behaviour Research and Therapy 42, 27–39. doi: 10.1016/s0005-7967(03)00068-8CrossRefGoogle ScholarPubMed
Tousignant, OH, Taylor, ND, Suvak, MK and Fireman, GD (2019). Effects of rumination and worry on sleep. Behavior Therapy, 50, 558–570.10.1016/j.beth.2018.09.005CrossRefGoogle Scholar
Trauer, JM, Qian, MY, Doyle, JS, Rajaratnam, SM and Cunnington, D (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163, 191–204. doi:10.7326/M14-2841.CrossRefGoogle ScholarPubMed
Wu, JQ, Appleman, ER, Salazar, RD and Ong, JC (2015). Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: A meta-analysis. JAMA Internal Medicine, 175, 1461–1472. doi:10.1001/jamainternmed.2015.3006.CrossRefGoogle ScholarPubMed