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Associations Between Six Core Processes of Psychological Flexibility with Poor Sleep Outcomes: A Systematic Review and Meta-Analysis

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Abstract

Purpose of Review

While acceptance and commitment therapy (ACT) is one of the effective treatments for insomnia, one of the challenges in treating sleep disorders is unawareness of the role of the core processes of ACT. The present systematic review aimed to investigate the associations between the six core processes of psychological flexibility (i.e., acceptance, cognitive defusion, being at present or mindfulness, committed action, self as context, and values) and poor sleep outcomes including poor sleep quality (PSQ) and insomnia severity. PubMed and Scopus were searched to identify the academic articles published between 2000 and 2022 (PROSPERO- CRD42022381181).

Recent Findings

Pooled estimates of correlations were calculated using the random-effects method. The pooled effect sizes obtained from 28 studies showed significant correlations between four components of ACT and poor sleep outcomes. Meta-regression results showed that the negative correlation between acceptance and PSQ is significantly affected by the mean age of the samples across the studies (p = 0.042). Although the association between ACT components and PSQ was relatively stronger in studies with small sample sizes and those conducted only on women, none of these differences were statistically significant (p > 0.05).

Summary

It can be argued that four components of core processes of psychological flexibility are negatively correlated with poor sleep outcomes. Clinicians and therapists need to take into account these components when trying to treat insomnia and improve sleep quality.

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Data Availability

We did not use any original data and all data were extracted from publicly available records.

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Acknowledgements

The authors appreciate the cooperation of all the staff of the Sleep Disorders Research Center and Mind GPS Institute in facilitating this study.

Funding

This study did not receive financial support from any organization.

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Authors and Affiliations

  1. Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Ali Zakiei, Habibolah Khazaie, Masoumeh Rostampour, Mohammad-Taher Moradi & Leeba Rezaie

  2. Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran

    Saeid Komasi

  3. Faculdade de Medicina, Ambulatorio’ de SonoInstituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil

    Renatha El Rafihi-Ferreira

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  1. Ali Zakiei
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  2. Habibolah Khazaie
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  5. Leeba Rezaie
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  7. Renatha El Rafihi-Ferreira
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Contributions

AZ, HK, MR, MTM, LR, and SK collaboratively designed and conducted the study. The search process and analysis of the data were done by SK. Data were extracted by MR and MTM. The first draft was prepared by AZ with support from HK and LR, who supported the study with ideas and feedback. The critical review process and revisions were performed by RRF. All authors have seen and approved the manuscript.

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Correspondence to Saeid Komasi.

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Zakiei, A., Khazaie, H., Rostampour, M. et al. Associations Between Six Core Processes of Psychological Flexibility with Poor Sleep Outcomes: A Systematic Review and Meta-Analysis. Curr Sleep Medicine Rep (2024). https://doi.org/10.1007/s40675-024-00293-w

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