*LITERATURE REVIEW* Abstract Background: Insomnia is an increasing public health epidemic, affecting healthy, sub-clinical and clinical populations. Cognitive Behaviour Therapy for insomnia (CBT-I) is the most evidence-based treatment endorsed by the National Institute of Clinical Excellence (NICE) which provides guidance to health and social services in England. Research has demonstrated, however, that CBT-I has low or uncertain efficacy within various populations including those with coexisting health problems and clinical diagnoses. Furthermore, CBT-I is not accessible to most people due to poor prioritisation within services and a paucity of clinicians skilled in insomnia treatment. There is an urgent need to develop alternative interventions for this persistent and highly debilitating complaint. Acceptance based approaches to insomnia including mindfulness-based stress reduction (MBSR) provide an alternative model for holistic treatment of sleep distress. Objectives: This review summarises and synthesises the available literature investigating the effectiveness of MBSR as a treatment for insomnia in community and clinical populations (with some specific populations excluded). Method: Systematic review of all relevant quantitative and qualitative literature to date using PsycINFO, PsycARTICLES and Web of Knowledge databases. Results: 13 relevant articles were included (3 abstracts): randomised control trials (RCTs), experimental, quasi-experimental and qualitative studies. Conclusions: Overall, the limited research in this area was assessed to be of moderate quality and to provide preliminary evidence that MBSR offers an effective intervention for insomnia symptoms and disorder in various populations. The review highlighted the paucity of research specifically MBSR AND INSOMNIA SYMPTOMS 10 investigating the acceptability of MBSR as an insomnia treatment, particularly for more complex presentations. It is possible that MBSR provides holistic and bi-directional benefits for sleep and emotional well-being, however, further research is required to determine how participants experience the course process in relation to their sleep. Keywords: Insomnia, CBT-I, MBSR. *EMPIRICAL PAPER* Abstract: There is an urgent need to improve the availability and acceptability of interventions for insomnia. Low-levels of help-seeking and high levels of functional impairment are often characteristic of individuals with unremitting complaints. Ambivalence about the significance of insomnia and/or a helpless resignation can be further compounded by lack of available treatments and socio-cultural attitudes towards sleep. Insomnia is often complicated with coexisting mental and physical health problems, a syndromal presentation. Theoretical and empirical evidence suggests that eight-week, mindfulness-based stress reduction (MBSR) programmes may offer a holistic intervention to relieve emotional disturbance that may underlie the complaint. This research sought to understand the experience of MBSR for individuals in the community with persistent insomnia, to gain insight into its acceptability. Methods: Holloway and Jefferson’s psychosocial method was used which posits the ‘defended subject’ as key to data construction and analysis (2013). Defences, free associations, researcher-interviewee dynamic, textual information, cultural and sociological knowledge all contributed to an understanding of the ‘whole’ of the experience of interviewees as communicated within Free Association Narrative Interviewing. Results: Results indicate that for highly defended individuals with insomnia, MBSR can be a challenging intervention to engage with and to embody. Barriers to acceptability included: limited insight into emotional distress, (unconscious) relational secondary gains to insomnia, limited understanding of sleep as a physiological process, restricted understanding or misconceptions about mindfulness prior to participation, resistance to acknowledging insomnia MBSR AND INSOMNIA SYMPTOMS 66 as a mental health complaint and practical issues of delivery. Researcher-interviewee dynamics suggested significant unmet relational needs of many interviewees. An exceptional case was discussed where relational distress was not understood to underlie insomnia and where significant benefits to sleep were reported from MBSR. Conclusion: The methodology enabled novel insights into the challenges for highly defended individuals with complex insomnia for accessing MBSR. By contrast, it is possible that for less complex but acute and recurrent insomnia, MBSR is more readily acceptable. Study limitations, future research needs and recommendations for improving the acceptability of MBSR for complex cases of insomnia are discussed.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:761744 |
| Date | January 2018 |
| Creators | Baker-Martins, Louise Diana |
| Contributors | Smithson, Janet |
| Publisher | University of Exeter |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/10871/34250 |
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