Mindfulness-Based Therapy For Insomnia Research Articles

Mindful Night-to-Day: A Pilot Feasibility Trial of a Mindfulness-Based Insomnia and Symptom Management Intervention for Patients with Hematologic Cancer

ABSTRACT Objectives Patients with hematologic cancer experience severe symptoms (i.e. insomnia, fatigue, pain, distress). Few interventions addressing insomnia and other symptoms exist for this population. Mindfulness-Based Therapy for Insomnia (MBTI) may be appropriate but has only been tested in healthy outpatients. This study aimed to develop and test an adapted MBTI protocol for hematologic cancer patients. Methods Patient (n = 3) and clinician (n = 1) focus groups, and user-testing (N = 5) informed adaptation of Mindful Night-to-Day (MBTI+). A single-arm pilot trial (N = 32) evaluated feasibility (accrual, attrition, adherence), acceptability (intervention satisfaction), and changes to insomnia symptom severity (Insomnia Severity Index; primary outcome) and secondary outcomes (fatigue, pain, distress, pre-sleep arousal, mindfulness, symptom management self-efficacy) at baseline, post-intervention, and 1-month post-intervention. Descriptive statistics and paired sample t-tests were conducted. Results Qualitative feedback informed MBTI+ content, format, and delivery. Mindfulness was used to increase symptom awareness (sleepiness vs. fatigue). Meditations and behavioral skills were applied to inpatient treatment. MBTI+ met feasibility (N = 32/12 months; 8.1% attrition; 83.8% adherence) and acceptability (M = 3.52/4.00) benchmarks. Insomnia symptom severity decreased (d = 1.20) from baseline to post-intervention, as did most secondary outcomes. Conclusions MBTI+ was feasible, acceptable, and showed promise for benefits throughout inpatient and outpatient treatment. Findings warrant further evaluation in a randomized trial.

A Meta-analysis of Mindfulness and Sleep Quality

Mindfulness-based Therapies are an umbrella terminology for a group of interventions that is significantly efficient and effective in treating sleep disorders. To find out further research path of mindfulness-based stress reduction and mindfulness-based therapy for insomnia, a meta-analysis is conducted. Ten articles were included. The standardized mean difference is used as a measure to calculate this meta-analysis. Data in the analysis were processed using the random-effects model. The models effect size hedges g = -0.98 (95% CI: -1.69 to -0.27). Thus, significant difference from zero (z = -2.70, p = 0.007) was found in the average outcome. After subgroup analysis, when language served as moderator did the Q test results appeared to be homogeneous (Q (8) = 43.08, p < 0.001, tau= 0.30, I= 86.20%). This study guides a) Chinese researchers to dig more into the applications as well as mechanisms and differences between Chinese and western participants, especially more creatively and innovatively, b) Researching in online MBSR and MBT-I might lead another path towards refined and enhanced application in the future and c) more detailed control information or factors should be reported or controlled.

Mindfulness-based therapy for insomnia alleviates insomnia, depression, and cognitive arousal in treatment-resistant insomnia: A single-arm telemedicine trial

ObjectivesCognitive-behavioral therapy and pharmacotherapy are effective insomnia treatments, yet half of patients do not remit. Emerging evidence indicates refractory cognitive arousal is associated with poor insomnia treatment outcomes, giving rise to the concept that therapeutic approaches directly aimed at reducing cognitive arousal may benefit patients with a history of inadequate response to intervention. This proof-of-concept study examined the effects of mindfulness-based therapy for insomnia (MBTI) delivered individually via telemedicine on insomnia, depression, and cognitive arousal in patients with treatment-resistant insomnia.MethodsA single-arm trial wherein 19 patients whose insomnia did not remit with prior psychotherapy and/or pharmacotherapy received a course of MBTI as second-stage therapy, which included eight weekly 1-h sessions in an individual format via telemedicine video. Study outcomes included the 15-item version of the five-facet mindfulness questionnaire (FFMQ-15), insomnia severity index (ISI), Patient Health Questionnaire-9 to assess depression (PHQ-9), and three cognitive arousal indices: pre-sleep arousal scale's cognitive factor, perseverative thinking questionnaire, and the daytime insomnia symptom response scale.ResultsPatients reported increased mindfulness from pretreatment to posttreatment (FFMQ-15: 52.95 ± 8.30 to 57.47 ± 9.82, p = 0.008). Patients also reported large reductions in ISI (16.42 ± 3.95 to 8.37 ± 4.19, p < 0.001, Cohen's dz = 1.73; 57.9% remission), PHQ-9 (6.42 ± 3.47 to 3.32 ± 2.93, p = 0.001, Cohen's dz = 0.93), and all cognitive arousal indices (Cohen's dzs = 0.82–1.30) at posttreatment. Six months later, ISI scores and cognitive arousal levels remained significantly lower than pretreatment, although effect sizes decreased for ISI (Cohen's dz = 1.11) and cognitive arousal (Cohen's dzs = 0.63–0.68). Antidepressant effects were no longer significant at follow-up.ConclusionTreatment-resistant insomnia patients are engaged in MBTI, which produces large acute reductions in insomnia, depression, and cognitive arousal. MBTI effects on insomnia and cognitive arousal were moderate to large 6 months after treatment. These findings support the concept and feasibility of MBTI for treatment-resistant patients along with indication that longer-term strategies are needed to help maintain acute treatment gains.Clinical trial registrationClinicalTrials.gov, identifier NCT03724305.

Dissociable changes in sleep architecture with mindfulness and sleep hygiene intervention in older adults: Secondary and exploratory analysis of polysomnography data from the Mindfulness Sleep Therapy (MIST) trial

ObjectivesWe conducted a secondary analysis of the Mindfulness Sleep Therapy study, a randomized controlled trial testing Mindfulness-Based Therapy for Insomnia (MBTI) against a sleep hygiene education and exercise program (SHEEP). We investigated whether the interventions led to changes in sleep macroarchitecture (N2, N3 and REM), and microarchitecture (sleep fragmentation, slow wave activity, spectral band power) measured by ambulatory polysomnography (PSG). Methods48 MBTI and 46 SHEEP participants provided usable PSG and subjective sleep quality data both pre- and post intervention. The interventions consisted of 8 weekly 2-hour group sessions, and daily practice. PSG data were staged according to the American Academy of Sleep Medicine criteria by 2 technicians blind to time point and condition. Repeated-measures ANOVA and permutation analysis were used to test for differences over time and between the interventions. ResultsSelf-reported sleep quality improved in both study groups. We observed significant increases in N2 in MBTI but not SHEEP (p = .045), and significant increases in N3 in SHEEP but not MBTI (p = .012). No significant differences over time or between group were observed in N1, REM, or sleep fragmentation. Higher frequency non-REM EEG power decreased in SHEEP but not MBTI. Slow wave activity and slow wave activity dissipation did not differ over time or between groups. Among all variables, significant time by group interactions were observed in only N3 and non-REM alpha power. ConclusionsMBTI and sleep hygiene education had different effects on sleep macro and microarchitecture, suggesting that the underlying mechanisms of mindfulness training in improving sleep quality may differ from traditional interventions.

A Randomized Controlled Trial to Examine the Feasibility and Preliminary Efficacy of a Digital Mindfulness-Based Therapy for Improving Insomnia Symptoms.

ObjectivesInsomnia has widespread negative implications for health and well-being. Online delivery of mindfulness-based therapy for insomnia (MBTI) has not previously been evaluated. This study investigated the feasibility and preliminary efficacy of a digital MBTI program for improving insomnia symptoms. It was hypothesized that a 6-week digital MBTI program would reduce insomnia symptoms and pre-sleep arousal and improve mood, compared to a waitlist control condition.MethodsTwenty-seven participants (M = 29.44, SD = 11.97 years) experiencing insomnia symptoms (insomnia severity index [ISI] ≥ 8) were randomized to either a 6-week intervention or waitlist condition. Participants completed the ISI, pre-sleep arousal scale (PSAS), and the positive and negative affect schedule at baseline, mid-, and post-study. Feasibility was assessed across four domains (acceptability, implementation, practicality, and preliminary efficacy) using self-reports, attrition, program completions, and module completions.ResultsFeasibility data for the intervention indicated that there was 22% attrition, and 79% of the modules were completed. There were significantly greater reductions in the severity of insomnia symptoms (p < .001) and both cognitive (p = .03) and somatic (p = .02) subscales of the PSAS, at post-intervention compared to the waitlist group. There were no significant group differences in mood.ConclusionsThis study provides preliminary evidence of the feasibility and efficacy of a digital MBTI, which may assist in the broader dissemination of insomnia treatment.Trial RegistrationAustralian and New Zealand Clinical Trials Registry: ACTRN12620000398909

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

AbstractInsomnia 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 &lt; .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 &lt; .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.

MINDFULNESS INTERVENTIONS AND SLEEP DISTURBANCE: A MINI REVIEW

Background: Sleep disturbance is a growing medical and public health concern with insomnia increasing worldwide. In addition to exacerbating health problems, insomnia may increase psychological vulnerability and proneness to accidents this is a mini narrative review as to the evidence regarding the efficacy of mindfulness-based interventions in the treatment of sleep disturbances such as insomnia in clinical populations.  &#x0D; Method: A search of medical, health, and psychological databases was conducted for mindfulnessbased therapies and intervention variants thereof in the treatment of terms that included: mindfulness-based interventions, mindfulness-based stress reduction (MBSR), mindfulness therapies or treatments AND sleep disturbance, insomnia, poor sleep quality, or sleep disorder.  &#x0D; Results: Standard protocol mindfulness-based stress reduction (MBSR) interventions and the specific mindfulness-based therapy for insomnia (MBT-I) have been investigated as potential nonpharmacologic treatments for insomnia and sleep disturbance in clinical populations. Additionally, randomized controlled clinical trials have been conducted in this area to determine efficacy of such mindfulness treatment strategies. &#x0D; Conclusion: Accumulating data indicate that mindfulness treatment protocols produce significant sleep outcome benefits with long-term follow-up duration.

Increased high-frequency NREM EEG power associated with mindfulness-based interventions for chronic insomnia: Preliminary findings from spectral analysis

ObjectiveMindfulness-based interventions (MBI) have been shown to reduce subjective symptoms of insomnia but the effects on objective measures remain unclear. The purpose of this study was to examine sleep EEG microarchitecture patterns from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Therapy for Insomnia (MBTI). MethodsSleep EEG spectral analysis was conducted on 36 participants with chronic insomnia (>6 months) randomized to 8-week MBSR, MBTI, or self-monitoring control (SM). Overnight polysomnography with 6-channel EEG was conducted at baseline, post-treatment, and 6-month follow-up. Spectral power averaged from channels C3/C4 across NREM epochs (excluding N1) was examined for within-group changes and relationships with self-report measures. ResultsIncreases in absolute NREM beta (16–25 Hz) power were observed from baseline to post-treatment (p = .02, d = 0.53) and maintained at 6-month follow-up (p = .01, d = 0.57) in the combined MBI groups, and additionally in the gamma (25–40 Hz) range at follow-up for the MBTI group only. No significant changes in these frequency bands were observed for SM. Following mindfulness intervention, NREM beta was positively associated with Five-Facet Mindfulness (FFM) score (rho = 0.37, p = .091) and negatively associated with Insomnia Severity Index (rho = −0.43, p = .047). ConclusionThese results in people with insomnia corroborate prior reports of increased high-frequency sleep EEG power associated with mindfulness training. This change in beta EEG pattern merits further evaluation as a potential marker of the effects of mindfulness meditation on sleep, especially given the paradoxical findings in the context of insomnia. Clinical Trial Registrationclinicaltrials.gov, NCT00768781.

A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia: Effects on Daytime Symptoms and Cognitive-Emotional Arousal

Mindfulness-based interventions (MBI) have been shown to improve sleep quality among people with insomnia. However, much less is known about the effects of MBIs on other aspects of insomnia such as daytime symptoms and cognitive-emotional arousal. The purpose of this study was to examine the treatment effects on these domains for adults with chronic insomnia disorder who were randomized to mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or a delayed-treatment control consisting of sleep diary self-monitoring (SM) followed by behavior therapy (BT). Analyses were conducted on baseline to post-treatment changes with superiority comparisons for each MBI to SM followed by non-inferiority comparisons for each MBI to BT. The results revealed significant reductions from baseline in the MBTI group with large effect sizes on sleep effort, maladaptive sleep-related cognitions, and hyperarousal which were superior to the SM control (p < 0.05) and non-inferior to BT (p < 0.025). MBSR demonstrated a significant increase in positive affect with a large effect size which was non-inferior to BT (p < 0.025) but not statistically significant compared to SM. These findings indicate that MBTI, a new MBI which combines mindfulness practices with behavioral sleep components, can be effective at reducing cognitive-emotional arousal related to insomnia while MBSR, a general MBI, can increase positive affect at a level similar to a standard behavioral treatment for insomnia.

The value of mindfulness meditation in the treatment of insomnia.

Insomnia is the most common reported sleep disorder with limited treatment options including pharmacotherapy and cognitive behavioral therapy for insomnia. Pharmacotherapy can be complicated by tolerance and significant side-effects and cognitive behavioral therapy for insomnia providers are limited in number. This article reviews mindfulness meditation as an additional therapy for insomnia. Both mindfulness-based stress reduction (MBSR) and mindfulness-based therapy for insomnia (MBTI) have been studied in the treatment of insomnia. Randomized controlled studies of MBSR and MBTI have shown overall reduction in sleep latency and total wake time and increase in total sleep time after mindfulness therapy using both patient reported outcome and quantitative measures of sleep. Mindfulness techniques have been shown to be well accepted by patients with long-lasting effects. A three-arm randomized study with MBSR, MBTI, and self-monitoring showed similar improvement in insomnia between the MBSR and MBTI groups, with possibly longer duration of efficacy in the MBTI group. Recent data show that MBTI is also an effective and accepted treatment for insomnia in older patients. Increasing evidence shows that mindfulness meditation, delivered either via MBSR or MBTI, can be successfully used for the treatment of insomnia with good patient acceptance and durable results.

A randomized controlled trial of mindfulness meditation for chronic insomnia.

To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia. Three-arm, single-site, randomized controlled trial. Academic medical center. Fifty-four adults with chronic insomnia. Participants were randomized to either mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or an eight-week self-monitoring (SM) condition. Patient-reported outcome measures were total wake time (TWT) from sleep diaries, the pre-sleep arousal scale (PSAS), measuring a prominent waking correlate of insomnia, and the Insomnia Severity Index (ISI) to determine remission and response as clinical endpoints. Objective sleep measures were derived from laboratory polysomnography and wrist actigraphy. Linear mixed models showed that those receiving a meditation-based intervention (MBSR or MBTI) had significantly greater reductions on TWT minutes (43.75 vs 1.09), PSAS (7.13 vs 0.16), and ISI (4.56 vs 0.06) from baseline-to-post compared to SM. Post hoc analyses revealed that each intervention was superior to SM on each of the patient-reported measures, but no significant differences were found when comparing MBSR to MBTI from baseline-to-post. From baseline to 6-month follow-up, MBTI had greater reductions in ISI scores than MBSR (P < 0.05), with the largest difference occurring at the 3-month follow-up. Remission and response rates in MBTI and MBSR were sustained from post-treatment through follow-up, with MBTI showing the highest rates of treatment remission (50%) and response (78.6%) at the 6-month follow-up. Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia. Mindfulness-Based Approaches to Insomnia: clinicaltrials.gov, identifier: NCT00768781.

A mindfulness‐based approach to the treatment of insomnia

Mindfulness meditation has emerged as a novel approach to emotion regulation and stress reduction that has several health benefits. Preliminary work has been conducted on mindfulness-based therapy for insomnia (MBT-I), a meditation-based program for individuals suffering from chronic sleep disturbance. This treatment integrates behavioral treatments for insomnia with the principles and practices of mindfulness meditation. A case illustration of a chronic insomnia sufferer demonstrates the application of mindfulness principles for developing adaptive ways of working with the nocturnal symptoms and waking consequences of chronic insomnia.