A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia: Effects on Daytime Symptoms and Cognitive-Emotional Arousal
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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.
KeywordsMindfulness-based intervention Insomnia Non-inferiority Cognitions Hyperarousal Daytime symptoms
The authors would like to thank Shauna Shapiro, Zindel Segal, M. Isabel Crisostomo, and James Wyatt for the consultation and input in the development and design of the study. We would also like to thank David Sholtes and Christina Khou for their contributions as study coordinators, and Arthur Hoffman, Vered Hankin, Jamie Cvengros, Megan Hood, Jamie Jackson, Heather Gunn, and Liisa Hantsoo for serving as study therapists.
JCO: designed and executed the study, assisted with the data analyses, and wrote the paper. YX: conducted data analyses and collaborated in the writing and editing of the paper. CES: collaborated in the writing and editing of the final manuscript. RM: collaborated with the design and writing of the study, and collaborated in the writing and editing of the final manuscript.
This study was funded by a grant from the National Institutes of Health, National Center for Complementary and Alternative Medicine, awarded to the first author (K23AT003678). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with Ethical Standards
Conflict of Interests
Dr. Ong receives royalties from APA Books. This activity is unrelated to this manuscript. Dr. Xia, Dr. Manber, and Christine Smith declare that they have no conflict of interest.
All procedures performed in studies involved in human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is registered in clinicaltrials.gov, identifier NCT00768781, Mindfulness-Based Approaches to Insomnia.
Informed consent was obtained from all individual participants included in the study.
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