Advertisement
Review Article| Volume 18, ISSUE 1, P59-71, March 2023

Mindfulness as an Adjunct or Alternative to CBT-I

  • Jason C. Ong
    Correspondence
    Corresponding author: Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Dr, Chicago, IL 60625.
    Affiliations
    Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Dr, Chicago, IL 60625, USA

    Behavioral Sleep Medicine, Nox Health, 5000 Research Court, Suite 500, Suwanee, GA 30024, USA
    Search for articles by this author
  • David A. Kalmbach
    Affiliations
    Thomas Roth Sleep Disorders Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, Detroit, MI 48377, USA

    Department of Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
    Search for articles by this author

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Sleep Medicine Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ohayon M.M.
        Epidemiology of insomnia: what we know and what we still need to learn.
        Sleep Med Rev. 2002; 6: 97-111
        • Morin C.M.
        • LeBlanc M.
        • Daley M.
        • Gregoire J.P.
        • Merette C.
        Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.
        Sleep Med. 2006; 7 (S1389-9457(05)00195-4 [pii]): 123-130
        • Morin C.M.
        • Vallières A.
        • Guay B.
        • et al.
        Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial.
        JAMA. 2009; 301: 2005-2015
        • Wu J.Q.
        • Appleman E.R.
        • Salazar R.D.
        • Ong J.C.
        Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis.
        JAMA Intern Med. 2015; 175https://doi.org/10.1001/jamainternmed.2015.3006
        • Buysse D.J.
        • Germain A.
        • Moul D.E.
        • et al.
        Efficacy of brief behavioral treatment for chronic insomnia in older adults.
        Arch Intern Med. 2011; 171: 887-895
        • Kabat-Zinn J.
        Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness.
        Bantam Books, New York2003
        • Shapiro S.L.
        • Carlson L.E.
        • Astin J.A.
        • Freedman B.
        Mechanisms of mindfulness.
        J Clin Psychol. 2006; 62: 373-386
        • Ong J.C.
        • Ulmer C.S.
        • Manber R.
        Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia. Article.
        Behav Res Ther. 2012; 50: 651-660
        • Segal Z.V.
        • Williams J.M.G.
        • Teasdale J.D.
        Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse.
        The Guilford Press, New York2013
        • Bowen S.
        • Chawla N.
        • Witkiewitz K.
        Mindfulness-based relapse prevention for addictive behaviors. Mindfulness-based treatment approaches.
        Elsevier, New York2014: 141-157
        • Garcia M.C.
        • Kozasa E.H.
        • Tufik S.
        • Mello L.E.A.
        • Hachul H.
        The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study.
        Menopause. 2018; 25: 992-1003
        • Khoury B.
        • Lecomte T.
        • Fortin G.
        • et al.
        Mindfulness-based therapy: a comprehensive meta-analysis.
        Clin Psychol Rev. 2013; 33: 763-771
        • Hofmann S.G.
        • Sawyer A.T.
        • Witt A.A.
        • Oh D.
        The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review.
        J consulting Clin Psychol. 2010; 78: 169
        • Goyal M.
        • Singh S.
        • Sibinga E.M.S.
        • et al.
        Meditation programs for psychological stress and well-being: a systematic review and meta-analysis.
        JAMA Intern Med. 2014; 174: 357-368
        • Ong J.C.
        • Manber R.
        • Segal Z.
        • Xia Y.
        • Shapiro S.
        • Wyatt J.K.
        A randomized controlled trial of mindfulness meditation for chronic insomnia. Article.
        Sleep. 2014; 37: 1553-1563
        • Ong J.C.
        • Manber R.
        Mindfulness-based therapy for insomnia. Handbook of Mindfulness-Based Programmes, Itai Ivtzan. ed., 1st edn. Imprint Routledge, London2019
        • Garcia M.C.
        • Kozasa E.H.
        • Tufik S.
        • Mello L.E.A.M.
        • Hachul H.
        The effects of mindfulness and relaxation training for insomnia (mrti) on postmenopausal women: a pilot study.
        Menopause. 2018; 25https://doi.org/10.1097/GME.0000000000001118
        • Huberty J.L.
        • Green J.
        • Puzia M.E.
        • et al.
        Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: a randomized controlled trial.
        Plos one. 2021; 16: e0244717
        • Kennett L.
        • Bei B.
        • Jackson M.L.
        A randomized controlled trial to examine the Feasibility and preliminary efficacy of a digital mindfulness-based therapy for improving insomnia symptoms.
        Mindfulness. 2021; 12: 2460-2472
        • Barros V.V.
        • Opaleye E.S.
        • Demarzo M.
        • et al.
        Effects of mindfulness-based relapse prevention on the chronic use of hypnotics in treatment-seeking women with insomnia: a randomized controlled trial.
        Int J Behav Med. 2021; : 1-12
        • Bonnet M.H.
        • Arand D.L.
        Hyperarousal and insomnia: state of the science.
        Sleep Med Rev. 2010; 14: 9-15
        • Riemann D.
        • Spiegelhalder K.
        • Feige B.
        • et al.
        The hyperarousal model of insomnia: a review of the concept and its evidence.
        Sleep Med Rev. 2010; 14: 19-31
        • Bonnet M.H.
        • Arand D.L.
        Hyperarousal and insomnia.
        Sleep Med Rev. 1997; 1: 97-108
        • Espie C.A.
        Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adults.
        Annu Rev Psychol. 2002; 53: 215-243
        • Nofzinger E.A.
        • Buysse D.J.
        • Germain A.
        • Price J.C.
        • Miewald J.M.
        • Kupfer D.J.
        Functional Neuroimaging evidence for hyperarousal in insomnia.
        Am J Psychiatry. 2004; 161: 2126-2128
        • Spielman A.J.
        • Caruso L.S.
        • Glovinsky P.B.
        A behavioral perspective on insomnia treatment.
        Psychiatr Clin North Am. 1987; 10: 541-553
        • Shapiro S.L.
        • Carlson L.E.
        • Astin J.A.
        • Freedman B.
        Mechanisms of mindfulness.
        J Clin Psychol. 2006; 62: 373-386
        • Palagini L.
        • Ong J.C.
        • Riemann D.
        The mediating role of sleep-related metacognitive processes in trait and pre-sleep state hyperarousal in insomnia disorder. Article.
        J Psychosomatic Res. 2017; 99: 59-65
        • Fong T.C.
        • Ho R.T.
        Mindfulness facets predict quality of life and sleep disturbance via physical and emotional distresses in Chinese cancer patients: a moderated mediation analysis.
        Psycho-oncology. 2020; 29: 894-901
        • Hu Y.
        • Wang Y.
        • Sun Y.
        • Arteta-Garcia J.
        • Purol S.
        Diary study: the protective role of self-compassion on stress-related poor sleep quality.
        Mindfulness. 2018; 9: 1931-1940
        • Rakhimov A.
        • Ong J.
        • Realo A.
        • Tang N.K.Y.
        Being kind to self is being kind to sleep? A structural equation modelling approach evaluating the direct and indirect associations of self-compassion with sleep quality, emotional distress and mental well-being. Article.
        Curr Psychol. 2022; https://doi.org/10.1007/s12144-021-02661-z
        • Britton W.B.
        • Haynes P.L.
        • Fridel K.W.
        • Bootzin R.R.
        Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression.
        Psychosom Med. 2010; 72: 539-548
        • Goldstein M.R.
        • Turner A.D.
        • Dawson S.C.
        • et al.
        Increased high-frequency NREM EEG power associated with mindfulness-based interventions for chronic insomnia: preliminary findings from spectral analysis.
        J Psychosomatic Res. 2019; 120: 12-19
        • Wang Y.-Y.
        • Wang F.
        • Zheng W.
        • et al.
        Mindfulness-based interventions for insomnia: a meta-analysis of randomized controlled trials.
        Behav Sleep Med. 2020; 18: 1-9
        • Ong J.C.
        • Smith C.E.
        Using mindfulness for the treatment of insomnia. Review.
        Curr Sleep Med Rep. 2017; 3: 57-65
        • Ong J.C.
        • Moore C.
        What do we really know about mindfulness and sleep health? Review.
        Curr Opin Psychol. 2020; 34: 18-22
        • Gong H.
        • Ni C.X.
        • Liu Y.Z.
        • et al.
        Mindfulness meditation for insomnia: a meta-analysis of randomized controlled trials.
        J Psychosom Res. 2016; 89: 1-6
        • Rash J.A.
        • Kavanagh V.A.J.
        • Garland S.N.
        A meta-analysis of mindfulness-based Therapies for insomnia and sleep disturbance: Moving towards processes of change.
        Sleep Med Clin. 2019; 14: 209-233
        • Chen T.L.
        • Chang S.C.
        • Hsieh H.F.
        • Huang C.Y.
        • Chuang J.H.
        • Wang H.H.
        Effects of mindfulness-based stress reduction on sleep quality and mental health for insomnia patients: a meta-analysis.
        J Psychosom Res. 2020; 135: 110144
        • Garland S.N.
        • Carlson L.E.
        • Stephens A.J.
        • Antle M.C.
        • Samuels C.
        • Campbell T.S.
        Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial.
        J Clin Oncol : official J Am Soc Clin Oncol. 2014; 32: 449-457
        • Irwin M.R.
        • Olmstead R.
        • Carrillo C.
        • et al.
        Tai Chi Chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial.
        J Clin Oncol. 2017; 35: 2656-2665
        • Ong J.C.
        • Xia Y.
        • Smith-Mason C.E.
        • Manber R.
        A randomized controlled trial of mindfulness meditation for chronic insomnia: effects on daytime symptoms and cognitive-emotional arousal.
        Article Mindfulness. 2018; 9: 1702-1712
        • Wong M.Y.
        • Ree M.J.
        • Lee C.W.
        Enhancing CBT for chronic insomnia: a Randomised clinical trial of additive components of mindfulness or cognitive therapy.
        Clin Psychol Psychother. 2016; 23: 377-385
        • Watkins E.R.
        Constructive and unconstructive repetitive thought.
        Psychol Bull. 2008; 134: 163-206
        • Ong J.C.
        • Shapiro S.L.
        • Manber R.
        Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study. Article.
        Behav Ther. 2008; 39: 171-182
        • Espie C.A.
        • Kyle S.D.
        • Miller C.B.
        • Ong J.
        • Hames P.
        • Fleming L.
        Attribution, cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy.
        Sleep Med. 2014; 15: 913-917
        • Cheng P.
        • Kalmbach D.A.
        • Cuamatzi-Castelan A.
        • Muragan N.
        • Drake C.L.
        Depression prevention in digital cognitive behavioral therapy for insomnia: is rumination a mediator?.
        J Affective Disord. 2020; 273: 434-441
        • Kalmbach D.A.
        • Cheng P.
        • Arnedt J.T.
        • et al.
        Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education.
        Sleep Med. 2019; 55: 124-134
        • Kalmbach D.A.
        • Cheng P.
        • Roth T.
        • et al.
        Examining patient feedback and the role of cognitive arousal in treatment on-response to digital cognitive-behavioral therapy for insomnia during pregnancy.
        Behav Sleep Med. 2022; 20: 143-163
        • Jiang A.
        • Rosario M.
        • Stahl S.
        • Gill J.M.
        • Rusch H.L.
        The effect of virtual mindfulness-based interventions on sleep quality: a systematic review of randomized controlled trials.
        Curr Psychiatry Rep. 2021; 23https://doi.org/10.1007/s11920-021-01272-6
        • Bélanger L.
        • Belleville G.
        • Morin C.M.
        Management of hypnotic discontinuation in chronic insomnia.
        Sleep Med Clin. 2009/12/01/2009; 4: 583-592
        • Morin C.M.
        • Colecchi C.A.
        • Ling W.D.
        • Sood R.K.
        Cognitive behavior therapy to facilitate benzodiazepine discontinuation among hypnotic-dependent patients with insomnia.
        Behav Ther. 1995; 26: 733-745
        • Soeffing J.P.
        • Lichstein K.L.
        • Nau S.D.
        • et al.
        Psychological treatment of insomnia in hypnotic-dependant older adults.
        Sleep Med. 2008/01//2008; 9: 165-171
        • Pillai V.
        • Cheng P.
        • Kalmbach D.A.
        • Roehrs T.
        • Roth T.
        • Drake C.L.
        Prevalence and predictors of Prescription sleep Aid Use among individuals with DSM-5 insomnia: the role of hyperarousal.
        Sleep. 2016; 39: 825-832
        • Pearson N.J.
        • Johnson L.L.
        • Nahin R.L.
        Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data.
        Arch Intern Med. 2006; 166: 1775-1782
        • Hantsoo L.
        • Khou C.S.
        • White C.N.
        • Ong J.C.
        Gender and cognitive–emotional factors as predictors of pre-sleep arousal and trait hyperarousal in insomnia.
        J Psychosomatic Res. 2013; 74: 283-289
        • Martini J.
        • Asselmann E.
        • Einsle F.
        • Strehle J.
        • Wittchen H.-U.
        A prospective-longitudinal study on the association of anxiety disorders prior to pregnancy and pregnancy-and child-related fears.
        J anxiety Disord. 2016; 40: 58-66
        • Kalmbach D.A.
        • Cheng P.
        • Ong J.C.
        • et al.
        Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination.
        Sleep Med. 2020; 65: 62-73
        • Blackmore E.R.
        • Gustafsson H.
        • Gilchrist M.
        • Wyman C.
        • O’Connor T.G.
        Pregnancy-related anxiety: evidence of distinct clinical significance from a prospective longitudinal study.
        J Affective Disord. 2016; 197: 251-258
        • Manber R.
        • Bei B.
        • Simpson N.
        • et al.
        Cognitive behavioral therapy for prenatal insomnia: a randomized controlled trial.
        Obstet Gynecol. 2019; 133: 911
        • Felder J.N.
        • Epel E.S.
        • Neuhaus J.
        • Krystal A.D.
        • Prather A.A.
        Efficacy of digital cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: a randomized clinical trial.
        JAMA psychiatry. 2020; 77: 484-492
        • Kalmbach D.A.
        • Cheng P.
        • O'Brien L.M.
        • et al.
        A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women.
        Sleep Med. 2020; 72: 82-92
        • Kalmbach D.A.
        • Roth T.
        • Cheng P.
        • Ong J.C.
        • Rosenbaum E.
        • Drake C.L.
        Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy.
        Sleep Health. 2020; 6: 185-191
        • Guardino C.M.
        • Dunkel Schetter C.
        • Bower J.E.
        • Lu M.C.
        • Smalley S.L.
        Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy.
        Psychol Health. 2014; 29: 334-349
        • Goodman J.H.
        • Guarino A.
        • Chenausky K.
        • et al.
        CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety.
        Arch women's Ment Health. 2014; 17: 373-387
        • Dimidjian S.
        • Goodman S.H.
        • Felder J.N.
        • Gallop R.
        • Brown A.P.
        • Beck A.
        Staying well during pregnancy and the postpartum: a pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence.
        J consulting Clin Psychol. 2016; 84: 134
        • Lucena L.
        • Frange C.
        • Pinto A.C.A.
        • Andersen M.L.
        • Tufik S.
        • Hachul H.
        Mindfulness interventions during pregnancy: a narrative review.
        J Integr Med. 2020; 18: 470-477
        • Bacaro V.
        • Benz F.
        • Pappaccogli A.
        • et al.
        Interventions for sleep problems during pregnancy: a systematic review.
        Sleep Med Rev. 2020; 50: 101234
        • Beddoe A.E.
        • Lee K.A.
        • Weiss S.J.
        • Powell Kennedy H.
        • Yang C.-P.P.
        Effects of mindful yoga on sleep in pregnant women: a pilot study.
        Biol Res Nurs. 2010; 11: 363-370
        • Felder J.N.
        • Laraia B.
        • Coleman-Phox K.
        • et al.
        Poor sleep quality, psychological distress, and the buffering effect of mindfulness training during pregnancy.
        Behav Sleep Med. 2018; 16: 611-624
        • Tomfohr-Madsen L.M.
        • Campbell T.S.
        • Giesbrecht G.F.
        • et al.
        Mindfulness-based cognitive therapy for psychological distress in pregnancy: study protocol for a randomized controlled trial.
        Trials. 2016; 17: 1-12
        • Kantrowitz-Gordon I.
        • McCurry S.M.
        • Landis C.A.
        • Lee R.
        • Wi D.
        Online prenatal trial in mindfulness sleep management (OPTIMISM): protocol for a pilot randomized controlled trial.
        Pilot feasibility Stud. 2020; 6: 1-10
        • Carmody J.
        • Crawford S.
        • Salmoirago-Blotcher E.
        • Leung K.
        • Churchill L.
        • Olendzki N.
        Mindfulness training for coping with hot flashes: results of a randomized trial.
        Menopause (New York, NY). 2011; 18: 611
        • King D.E.
        • Xiang J.
        • Pilkerton C.S.
        Multimorbidity Trends in United States adults, 1988–2014.
        J Am Board Fam Med. 2018; 31: 503-513
        • Ong J.C.
        • Park M.
        Chronic headaches and insomnia: Working toward a biobehavioral model.
        Cephalalgia. 2012; 32: 1059-1070
        • Smith S.M.
        • Wallace E.
        • O'Dowd T.
        • Fortin M.
        Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.
        Cochrane Database Syst Rev. 2016; 3: Cd006560
        • Parekh A.K.
        • Goodman R.A.
        The HHS Strategic Framework on multiple chronic conditions: genesis and focus on research.
        J Comorb. 2013; 3: 22-29
        • Black D.S.
        • O’Reilly G.A.
        • Olmstead R.
        • Breen E.C.
        • Irwin M.R.
        Mindfulness meditation and improvement in sleep quality and daytime Impairment among older adults with sleep disturbances: a randomized clinical trial.
        JAMA Intern Med. 2015; 175: 494-501
        • Irwin M.R.
        • Olmstead R.
        • Carrillo C.
        • et al.
        Cognitive behavioral therapy vs. Tai Chi for late life insomnia and Inflammatory risk: a randomized controlled comparative efficacy trial.
        SLEEP. 2014; 37: 1543-1552
        • Perini F.
        • Wong K.F.
        • Lin J.
        • et al.
        Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial. Article.
        Psychol Med. 2021; https://doi.org/10.1017/S0033291721002476
        • Chick C.F.
        • Singh A.
        • Anker L.A.
        • et al.
        A school-based health and mindfulness curriculum improves children’s objectively measured sleep: a prospective observational cohort study.
        J Clin Sleep Med. 2021; 18: 2261-2271