بهبود خواب با ذهن آگاهی و پذیرش: مدل فراشناختی بی خوابی

While there is an accumulating evidence to suggest that therapies using mindfulness and acceptance-based approaches have benefits for improving the symptoms of insomnia, it is unclear how these treatments work. The goal of this paper is to present a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. The existing cognitive and behavioral models of insomnia are first reviewed and a two-level model of cognitive (primary) and metacognitive (secondary) arousal is presented in the context of insomnia. We then focus on the role of metacognition in mindfulness and acceptance-based therapies, followed by a review of these therapies in the treatment of insomnia. A conceptual framework is presented detailing the mechanisms of metacognition in the context of insomnia treatments. This model proposes that increasing awareness of the mental and physical states that are present when experiencing insomnia symptoms and then learning how to shift mental processes can promote an adaptive stance to one’s response to these symptoms. These metacognitive processes are characterized by balanced appraisals, cognitive flexibility, equanimity, and commitment to values and are posited to reduce sleep-related arousal, leading to remission from insomnia. We hope that this model will further the understanding and impact of mindfulness and acceptance-based approaches to insomnia.

Novel treatments using mindfulness and acceptance-based approaches are a wave of rapidly emerging therapies. Many treatment studies and meta-analyses have demonstrated the benefits of these therapies on mental and physical health. A subset of these studies has examined the impact of mindfulness and acceptance-based therapies on sleep disturbance, collectively referred to here as metacognitive therapies for insomnia (MCTI). While there is an accumulating evidence to suggest that MCTIs have benefits for improving sleep, a conceptual model to explain their potential common mechanisms is lacking. This paper proposes a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. First, we review the existing cognitive and behavioral models of insomnia and present a re-conceptualization of sleep-related arousal to include metacognitive processes in addition to the cognitive processes that have been previously described. Second, we examine the literature on mindfulness and acceptance which has identified metacognitive processes as a potential target for emotion regulation and reducing second order distress. Third, we present a treatment model to explain how MCTIs target secondary distress and lead to remission from an insomnia disorder. Studies that support psychopathological processes relevant to the components of the model are presented along with clinical implications for assessment and intervention. Finally, we discuss potential implications of this model and offer an agenda for future research. We hope that these concepts provide a framework that can stimulate empirical testing of the treatment mechanisms in MCTIs.