Mindfulness-based therapy and cognitive therapy are equally effective at combating insomnia, according to new research from Australia. The study, published in the scientific journal Behaviour Change, also highlights the underlying cognitive mechanisms that lead to recovery from sleepless nights.

“Insomnia is common and carries with it a high disease burden and understanding how our most effective treatments work is an important priority for further refining and improving them,” explained study author Melissa J. Ree of the Marian Centre and Sleep Matters.

“One in three people regularly have difficulty with their sleep and approximately 10% of the adult population suffer from the clinical disorder of insomnia (American Psychiatric Association, 2013). Insomnia is miserable to live with and increases the risk of physical health problems, mood disorders, accidents, poorer quality of life, and it reduces occupational performance.

“Unfortunately, most people with insomnia who seek help only receive sleeping pills, which we know isn’t the best long term solution. (Cognitive-behavioral therapy is the recommended treatment of choice.) Better understanding how and why these most effective treatments work will help to improve them. What are the core things (processes) that need to shift in order to treat insomnia?” Ree said.

“For many years cognitive-behavioral therapy for insomnia (CBT-I) has been the recommended first line treatment – about 75% of people with insomnia respond well. We know in the long term that this approach is more effective than medication. More recent research has suggested that mindfulness-based approaches are also effective treatments for insomnia.

“In this study we compared mindfulness-based therapy (which involves meditation, acceptance, and not getting caught up in anxious thoughts or frustration), and cognitive therapy (which involves learning how to change unhelpful thinking patterns and beliefs about sleep into more productive, helpful thoughts and beliefs),” Ree told PsyPost.

Forty-seven participants received four sessions of CBT for insomnia before being randomly allocated to either another four sessions of cognitive therapy or four sessions of mindfulness-based therapy.

The researchers found that both treatments were equally effective. Even though the mindfulness-based therapy did not directly address unhelpful thoughts, it still appeared to change the thought patterns of the participants for the better.

“Interestingly, for the treatments to be effective, the content of peoples thoughts and beliefs needed to change — the more change in how people thought about their sleep, the better they responded to treatment,” Ree explained.

“For example, a person who believes that they cannot cope without 8 hours sleep each night will be more prone to worry about their sleep, and this worry may make their sleep worse — the belief about sleep is a self-fulfilling prophecy.”

“Further, they might change how they manage their day after a poor night of sleep — they might use extra caffeine, and may cancel meetings, or exercise, etc — these choices can also impact poorly on sleep the following night,” Ree said. “In contrast, a person who believes they will cope okay will be less likely to worry and more likely to achieve a sound slumber.”

“In essence, it appears that learning how to worry less about sleep is helpful in people with insomnia — and that this may be achieved through either cognitive therapy or mindfulness-based therapy.”

But the study — like all research — includes some limitations.

“It would be useful to replicate this study with a larger sample, and to look at the change in thoughts and beliefs in a purely behavioural treatment,” Ree said.

The study, “Effective Insomnia Treatments: Investigation of Processes in Mindfulness and Cognitive Therapy“, was authored by Christopher William Lee, Melissa J. Ree, and Mei Yin Wong.