Non-pharmacological treatment of insomnia in cancer patients: a randomized, controlled, non-inferiority trial investigating mindfulness-based and cognitive-behavioral approaches.
Date
2012-08-16
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Abstract
Patients who are diagnosed and treated for cancer are three times more likely than the general population to experience disturbed sleep and insomnia. The presence of persistent insomnia places patients at a higher risk for psychological and physical morbidity and reduced quality of life. This dissertation examined the use of non-pharmacological interventions to address insomnia in a heterogeneous sample of cancer patients. Cognitive-Behavioral Therapy for insomnia (CBT-I) is considered a well-established intervention, however a substantial proportion of people do not experience a treatment response or complete insomnia remittance. Mindfulness-Based Stress Reduction (MBSR) is generating a considerable amount of research interest in the area of insomnia due to its demonstrated effectiveness in reducing cognitive and physiological arousal, factors associated with disturbed sleep. We employed a non-inferiority design to determine whether MBSR performs to the same standard as CBT-I for insomnia, while providing additional benefits such as improved mood and lower appraisals of stress. MBSR was non-inferior to CBT-I for improving sleep when assessed three months after treatment completion, but not immediately post-program. This result is attributed to MBSR producing slower but continual improvements over time while CBT-I generated rapid effects that were largely maintained. While both groups demonstrated the ability to reduce stress symptoms and mood disturbance, those receiving CBT-I uniquely improved sleep quality and dysfunctional sleep beliefs. Secondary analyses were performed on the full sample (N=111) to examine associations between dispositional mindfulness, sleep and psychological outcomes. Mindfulness facets of acting with awareness, non-judging and non-reacting were associated with better sleep and psychological outcomes, but mindfulness was not predictive of fewer sleep disturbances above and beyond the influence of symptoms of stress and mood disturbance. We then focused specifically on the MBSR group (n=32) to examine whether improvements in mindfulness were associated with sleep and psychological outcomes. This sub-study suggests that one of the mechanisms by which MBSR may improve sleep outcomes is through a reduction in dysfunctional sleep-related beliefs. This body of work emphasizes the need to conduct patient-centered research and expands potential treatment options for patients with insomnia.
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Psychology--Clinical
Citation
Garland, S. N. (2012). Non-pharmacological treatment of insomnia in cancer patients: a randomized, controlled, non-inferiority trial investigating mindfulness-based and cognitive-behavioral approaches. (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/27123