This treatment-development study is a Stage I evaluation of an intervention that combines mindfulness meditation with cognitive-behavior therapy for insomnia (CBT-I). Thirty adults who met research diagnostic criteria for Psychophysiological Insomnia (Edinger et al., 2004) participated in a 6-week, multi-component group intervention using mindfulness meditation, sleep restriction, stimulus control, sleep education, and sleep hygiene. Sleep diaries and self-reported pre-sleep arousal were assessed weekly while secondary measures of insomnia severity, arousal, mindfulness skills, and daytime functioning were assessed at pre-treatment and post-treatment. Data collected on recruitment, retention, compliance, and satisfaction indicate that the treatment protocol is feasible to deliver and is acceptable for individuals seeking treatment for insomnia. The overall patterns of change with treatment demonstrated statistically and clinically significant improvements in several nighttime symptoms of insomnia as well as statistically significant reductions in pre-sleep arousal, sleep effort, and dysfunctional sleep-related cognitions. In addition, a significant correlation was found between the number of meditation sessions and changes on a trait measure of arousal. Together, the findings indicate that mindfulness meditation can be combined with CBT-I and this integrated intervention is associated with reductions in both sleep and sleep-related arousal. Further testing of this intervention using randomized controlled trials is warranted to evaluate the efficacy of the intervention for this population and the specific effects of each component on sleep and both psychological and physiological arousal.
Insomnia is a highly prevalent problem with an estimated 10 percent of the general population experiencing both nighttime and daytime symptoms that would qualify for a diagnosis of insomnia (National Institutes of Health State of the Science Conference Statement, 2005). The current standard for non–pharmacological treatments of insomnia is a multi–component cognitive-behavior therapy for insomnia (CBT-I) which typically consists of one or more behavioral components such as sleep restriction, stimulus control, or relaxation training along with a cognitive component such as sleep education or cognitive restructuring (Morin, Bastein, & Savard, 2003). Treatment outcome studies have found that CBT-I is efficacious in reducing sleep onset latency (SOL) and wake time after sleep onset (WASO) and improving sleep efficiency (Edinger et al., 2001a, Jacobs et al., 2004, Morin et al., 1999 and Sivertsen et al., 2006). While these findings indicate the benefits of CBT-I on sleep parameters, the impact of CBT-I on other domains related to sleep, such as quality of life, daytime functioning, and sleep-related arousal are less clear.
One domain that merits further attention in insomnia treatment studies is sleep-related arousal. Although elevations in arousal have been identified as a contributing factor in the development and maintenance of insomnia, there is no consensus definition on this construct. Studies investigating psychological aspects of sleep-related arousal have found that people with insomnia report higher levels of pre-sleep rumination (Nicassio, Mendlowitz, Fussell, & Petras, 1985) and a more negative tone of sleep-related cognitions (Kuisk, Bertelson, & Walsh, 1989) relative to good sleepers. It has also been hypothesized that CBT-I reduces sleep-related arousal by changing maladaptive beliefs and attitudes that are believed to maintain the arousal (Morin, 1993). Collectively, the level of pre–sleep cognitive activity, the tone of these cognitions, and the content of these thoughts (e.g., beliefs and attitudes) might all represent aspects of sleep-related arousal. Therefore, there is a need for studies to include different measures to assess changes in arousal associated with treatment.
