A Meta-Analysis of Mindfulness-Based Therapies for Insomnia and Sleep Disturbance: Moving Towards Processes of Change

https://doi.org/10.1016/j.jsmc.2019.01.004Get rights and content

Section snippets

Key points

  • •

    The Psychological Process Model of Sleep postulates that interventions such as mindfulness can influence sleep by altering psychological flexibility pertaining to sleep through process variables (eg, awareness, decentering, acceptance, defusion, values, readiness to change, and motivation).

  • •

    Mindfulness-based treatments are efficacious at reducing symptoms of insomnia and improving sleep quality among adults when compared with psychological placebos and waitlist control conditions.

  • •

Search Strategy

A thorough literature search was performed using 3 electronic databases—PubMed, Medline, and PsycInfo. Given the authors’ interest in recent literature, search dates were restricted to January 01, 2010 to August 31, 2018. Searches were enhanced by scanning bibliographies of identified articles.

Search terms were constructed to include the combination of keywords and controlled vocabulary for 3 search themes, including mindfulness (eg, mindfulness or acceptance), sleep disturbance (eg, insomnia,

Summary of Included Trials

The search of the literature yielded 16 publications reporting on 13 trials conducted since 2010 that reported on 864 adults (542 women and 304 men). Table 1 depicts the characteristics of included trials. Nine trials assessed the effect of MBTs on insomnia, with the remaining 4 investigating sleep disturbance more generally. Eight trials used an active control condition,51, 52, 53, 54, 55, 56, 57, 58, 59 3 an inactive control,60, 61, 62 and 2 included both active and inactive control

Summary

MBTs are increasingly being investigated as a viable treatment for insomnia or sleep disturbance. To date, 13 trials have been published since 2010 and suggest that MBTs are efficacious for improving symptoms of insomnia and sleep quality relative to psychological placebos and inactive control conditions with medium to large effects. Limited evidence suggests that these effects are sustained at 3-month follow-up. Despite this, limited data have been collected evaluating the empirically

First page preview

First page preview
Click to open first page preview
View PDF

References (84)

  • D.K. Thomsen et al.

    Rumination—relationship with negative mood and sleep quality

    Personality and Individual Differences

    (2003)
  • S.C. Hayes et al.

    Acceptance and commitment therapy: model, processes and outcomes

    Behav Res Ther

    (2006)
  • D. Riemann

    Insomnia and comorbid psychiatric disorders

    Sleep Med

    (2007)
  • H. Gong et al.

    Mindfulness meditation for insomnia: a meta-analysis of randomized controlled trials

    J Psychosom Res

    (2016)
  • R.D. Hays et al.

    Psychometric properties of the medical outcomes study sleep measure

    Sleep Med

    (2005)
  • D.J. Buysse et al.

    The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research

    Psychiatry Res

    (1989)
  • S.L. Yates et al.

    A scale for rating the quality of psychological trials for pain

    Pain

    (2005)
  • S.N. Garland et al.

    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)

    (2015)
  • C.R. Gross et al.

    Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial

    Explore (NY)

    (2011)
  • Y. Nakamura et al.

    Two sessions of sleep-focused mind-body bridging improve self-reported symptoms of sleep and PTSD in veterans: a pilot randomized controlled trial

    J Psychosom Res

    (2011)
  • J.X. Zhang et al.

    Mindfulness-based stress reduction for chronic insomnia in adults older than 75 years: a randomized, controlled, single-blind clinical trial

    Explore (NY)

    (2015)
  • V. Yeung et al.

    A systematic review and meta-analysis of placebo versus no treatment for insomnia symptoms

    Sleep Med Rev

    (2018)
  • S.D. Kyle et al.

    No pain, no gain: an exploratory within-subjects mixed-methods evaluation of the patient experience of sleep restriction therapy (SRT) for insomnia

    Sleep Med

    (2011)
  • H. Whittall et al.

    Daytime sleepiness, driving performance, reaction time and inhibitory control during sleep restriction therapy for Chronic Insomnia Disorder

    Sleep Med

    (2018)
  • N.A.S. Farb

    From retreat center to clinic to boardroom? Perils and promises of the modern mindfulness movement

    Religions

    (2014)
  • N.T. Van Dam et al.

    Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation

    Perspect Psychol Sci

    (2018)
  • R.J. Davidson et al.

    Conceptual and methodological issues in research on mindfulness and meditation

    Am Psychol

    (2015)
  • S. Dimidjian et al.

    Defining an agenda for future research on the clinical application of mindfulness practice

    Clin Psychol Sci Pract

    (2003)
  • J. Kabat-Zinn

    Full catastrophe living (revised version): using the wisdom of your body and mind to face stress, pain, and illness

    (2013)
  • A. Lutz et al.

    Investigating the phenomenological matrix of mindfulness-related practices from a neurocognitive perspective

    Am Psychol

    (2015)
  • A.A. Borbely et al.

    The two-process model of sleep regulation: a reappraisal

    J Sleep Res

    (2016)
  • C.A. Espie

    Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults

    Annu Rev Psychol

    (2002)
  • M.L. Perlis et al.

    Etiology and pathophysiology of insomnia

  • M.L. Perlis et al.

    Psychophysiological insomnia: the behavioural model and a neurocognitive perspective

    J Sleep Res

    (1997)
  • C.M. Morin et al.

    Insomnia: a clinical guide to assessment and treatment

    (2004)
  • C.M. Morin et al.

    Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints

    Psychol Aging

    (1993)
  • A.G. Harvey

    Pre-sleep cognitive activity: a comparison of sleep-onset insomniacs and good sleepers

    Br J Clin Psychol

    (2000)
  • L.A. Kuisk et al.

    Presleep cognitive hyperarousal and affect as factors in objective and subjective insomnia

    Percept Mot Skills

    (1989)
  • N.M. Broomfield et al.

    Towards a valid, reliable measure of sleep effort

    J Sleep Res

    (2005)
  • L.G. Lundh

    The role of acceptance and mindfulness in the treatment of insomnia

    J Cogn Psychother

    (2005)
  • A.G. Harvey

    I can't sleep, my mins is racing! an investigation of strategies of thought control in insomnia

    Behav Cogn Psychother

    (2001)
  • D.J. Taylor et al.

    Epidemiology of insomnia, depression, and anxiety

    Sleep

    (2005)

    • Cited by (0)

    Disclosure statement: The authors do not have any commercial or financial conflicts of interest.

    Funding: Dr S.N. Garland is funded by a New Investigator Award from the Beatrice Hunter Cancer Research Institute.

    View full text
    © 2019 Elsevier Inc. All rights reserved.