title: [Contribution of mindfulness meditation in cognitive behavioral therapy for insomnia].
abstract: BACKGROUND
  Insomnia is considered to be a serious public health issue affecting approximately 10% of adults. Chronic insomnia may increase the risk of health problem, psychological vulnerability and proneness to accidents. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment. Even though CBT-I is widely considered as an effective therapy, 20 to 30% of patients do not respond to this treatment. Mindfulness therapy, known to reduce rumination and stress, could be an interesting complement to enhance CBT-I. The aim of this study is to evaluate the efficacy of therapy combining mindfulness meditation and CBT-I for the treatment of chronic insomnia.
  
  
  METHODS
  Thirty-three patients, diagnosed with chronic insomnia, aged 18 to 75 years (51±15 years) were recruited between October 2015 and June 2016 at the Sleep Center of Marseille. The patients were then divided into two groups according to their psychotherapy method: group CBT-I alone (17 patients) or a group therapy combining CBT-I and Mindfulness (16 patients). All participants were given five sessions of standard CBT during eight weeks. The patient-reported outcome measures were sleep onset latency, wake after sleep onset (WASO), total wake time, total sleep time, time in bed, sleep efficiency and number of awakening from sleep diaries before treatment (T0) and six weeks later (T1). Assessments were done using Pittsburgh Sleep quality index (PSQI), Insomnia severity Index (ISI), the Epworth sleepiness scale, the hospital anxiety and depression scale (HAD), the dysfunctional beliefs and attitude about sleep (DBAS-16); further, the use of sleeping pills was also recorded at T0 and T1.
  
  
  RESULTS
  Out of the 33 participants who began the treatment, 29 completed all sessions and were included in the analyses (4 dropouts in the group CBT-I alone). The data shows that each treatment yielded significant improvements over time in sleep variables from the diary, PSQI, ISI, anxiety (P=0.004), DBAS 16, sleeping pill use and vitality measured by SF36 health survey (P=0.004). Comparing the results of the two therapy groups, the meditation associated to CBT-I shows significantly greater rates of reduction in WASO relative to CBT-I group (P=0.009).
  
  
  CONCLUSIONS
  This study confirms the beneficial effects of CBT for patients suffering from insomnia on sleep parameters, anxiety symptoms and quality of life. Furthermore, this study suggests, for the first time, that combining CBT and mindfulness is a superior approach compared to that of only conventional CBT-I in improving sleep.
authors.affiliation: Service de neurophysiologie clinique, unité de sommeil, Aix-Marseille université, INS UMR_S 1106, CHU Timone, AP-HM, 13005 Marseille, France; Service de psychiatrie, hôpital Valvert, secteur 13G09, 78, boulevard des Libérateurs, 13011 Marseille, France. Electronic address: heloise.vanhuffel@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Vanhuffel
authors.affiliation: Service de neurophysiologie clinique, unité de sommeil, Aix-Marseille université, INS UMR_S 1106, CHU Timone, AP-HM, 13005 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Rey
authors.affiliation: Service de neurophysiologie clinique, unité de sommeil, Aix-Marseille université, INS UMR_S 1106, CHU Timone, AP-HM, 13005 Marseille, France.
authors.forename: I
authors.initials: I
authors.lastname: Lambert
authors.affiliation: Service de pédopsychiatrie, hôpital Salvator, 249, boulevard de Sainte-Marguerite, 13009 Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Da Fonseca
authors.affiliation: Service de pédopsychiatrie, hôpital Salvator, 249, boulevard de Sainte-Marguerite, 13009 Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Bat-Pitault
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D019122:Meditation / Q000379:methods*; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives
keywords: Chronic insomnia; Cognitive behavioral therapy; Insomnie chronique; Mindfulness; Pleine conscience; Sleep; Thérapie cognitive et comportementale