Mindfulness-Based Stress Reduction Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia Comorbid With Cancer: A Randomized, Partially Blinded, Noninferiority Trial

Jan 8, 2014Journal of clinical oncology : official journal of the American Society of Clinical Oncology

Mindfulness-based stress reduction compared with cognitive behavioral therapy for treating insomnia in cancer patients: a randomized trial showing similar effectiveness

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Abstract

Of 327 patients screened, 111 were randomly assigned to either cognitive behavioral therapy for insomnia (CBT-I) or mindfulness-based stress reduction (MBSR).

MBSR was found to be inferior to CBT-I for improving insomnia severity immediately after the program.
At the 3-month follow-up, MBSR demonstrated noninferiority to CBT-I in terms of insomnia severity.
Sleep onset latency decreased by 22 minutes in the CBT-I group and by 14 minutes in the MBSR group at follow-up.
Total sleep time increased by 0.60 hours for CBT-I and 0.75 hours for MBSR.
CBT-I significantly improved sleep quality and dysfunctional sleep beliefs, while both groups experienced reduced stress and mood disturbance.

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PURPOSE: Our study examined whether mindfulness-based stress reduction (MBSR) is noninferior to cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia in patients with cancer.

PATIENTS AND METHODS: This was a randomized, partially blinded, noninferiority trial involving patients with cancer with insomnia recruited from a tertiary cancer center in Calgary, Alberta, Canada, from September 2008 to March 2011. Assessments were conducted at baseline, after the program, and after 3 months of follow-up. The noninferiority margin was 4 points measured by the Insomnia Severity Index. Sleep diaries and actigraphy measured sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency. Secondary outcomes included sleep quality, sleep beliefs, mood, and stress.

RESULTS: Of 327 patients screened, 111 were randomly assigned (CBT-I, n = 47; MBSR, n = 64). MBSR was inferior to CBT-I for improving insomnia severity immediately after the program (P = .35), but MBSR demonstrated noninferiority at follow-up (P = .02). Sleep diary-measured SOL was reduced by 22 minutes in the CBT-I group and by 14 minutes in the MBSR group at follow-up. Similar reductions in WASO were observed for both groups. TST increased by 0.60 hours for CBT-I and 0.75 hours for MBSR. CBT-I improved sleep quality (P < .001) and dysfunctional sleep beliefs (P < .001), whereas both groups experienced reduced stress (P < .001) and mood disturbance (P < .001).

CONCLUSION: Although MBSR produced a clinically significant change in sleep and psychological outcomes, CBT-I was associated with rapid and durable improvement and remains the best choice for the nonpharmacologic treatment of insomnia.

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Mindfulness-Based Stress Reduction Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia Comorbid With Cancer: A Randomized, Partially Blinded, Noninferiority Trial

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