Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia

Abstract

While there is an accumulating evidence to suggest that therapies using mindfulness and acceptance-based approaches have benefits for improving the symptoms of insomnia, it is unclear how these treatments work. The goal of this paper is to present a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. The existing cognitive and behavioral models of insomnia are first reviewed and a two-level model of cognitive (primary) and metacognitive (secondary) arousal is presented in the context of insomnia. We then focus on the role of metacognition in mindfulness and acceptance-based therapies, followed by a review of these therapies in the treatment of insomnia. A conceptual framework is presented detailing the mechanisms of metacognition in the context of insomnia treatments. This model proposes that increasing awareness of the mental and physical states that are present when experiencing insomnia symptoms and then learning how to shift mental processes can promote an adaptive stance to one's response to these symptoms. These metacognitive processes are characterized by balanced appraisals, cognitive flexibility, equanimity, and commitment to values and are posited to reduce sleep-related arousal, leading to remission from insomnia. We hope that this model will further the understanding and impact of mindfulness and acceptance-based approaches to insomnia.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Figures

Figure 1

Morin’s Cognitive-Behavioral Model of Insomnia, depicting the role of arousal, cognitions, behaviors, and perceived consequences in creating a cycle of insomnia.

Figure 2

Harvey’s Cognitive Model of Insomnia. This model describes how worry, selective attention monitoring, misperception of sleep, unhelpful beliefs, and safety behaviors at night and during the daytime are involved in insomnia.

Figure 3

Two-level model of sleep-related arousal. Primary arousal refers to the cognitive content and activity that is directly related to the inability to sleep. Secondary arousal refers to the attention and emotional bias towards sleep-related thoughts, the degree of attachment one has in believing these thoughts, and the interpretive value of the sleep-related thoughts.