Effectiveness of a mindful nature walking intervention on sleep quality and mood in university students during Covid-19: A randomised control study

ObjectiveThe aim of this project was to conduct a randomised control study to examine whether outdoor mindful walking in nature can effectively improve university students’ sleep quality, mood, and mindfulness during the Covid-19 pandemic in the U.K.MethodsParticipants were measured at T₀ (pre-study baseline), T₁ (pre-intervention), T₂ (post-intervention), and T₃ (follow-up). A total of 104 participants (female = 94) who were experiencing sleep difficulties were randomly allocated to either an experimental (i.e., nature) or control (i.e., urban) walking environment. Participants in each walking condition independently undertook a daily 35-minute walk for a week (7 days). Subjective sleep quality, total mood disturbance, mindfulness, and degree of nature connectedness, and participants’ perspectives on the intervention, were collected.ResultsFindings suggest that both groups resulted in significant improvements in participants' trait mindfulness, sleep quality and mood after the intervention. However, mindful walking in nature did not bring additional mental health benefits to participants relative to those who walked an urban environment. Participants provided their perspectives about the intervention, which will assist with future intervention development.ConclusionsFindings contribute to the evidence-base on the effectiveness of outdoor mindful walking interventions for enhancing mental health. These findings contribute new knowledge on how mindful walking outdoors reduces university students’ mood disturbances and improves sleep quality and mindfulness level.     

Psychological interventions to improve sleep in college students: A meta‐analysis of randomized controlled trials

Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta‐analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta‐analysis was conducted with 10 randomized controlled trials with passive control conditions (N = 2,408). The overall mean effect size (Hedges’ g) of all sleep‐related outcomes within each trial was moderate to large (g = 0.61; 95% confidence interval: 0.41?0.81; numbers‐needed‐to‐treat = 3). Effect sizes for global measures of sleep disturbances were g = 0.79; 95% confidence interval: 0.52?1.06; and for sleep‐onset latency g = 0.65; 95% confidence interval: 0.36?0.94. The follow‐up analyses revealed an effect size of g = 0.56; 95% confidence interval: 0.45?0.66 for the combined sleep‐related outcomes based on three studies. No significant covariates were identified. These results should be interpreted cautiously due to an overall substantial risk of bias, and in particular with regard to blinding of participants and personnel. Nevertheless, they provide evidence that psychological interventions for improving sleep are efficacious among college students. Further research should explore long‐term effects and potential moderators of treatment efficacy in college students.     

Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia

OBJECTIVE: To describe the development and test the efficacy of a cognitive-behavioral intervention (CBT) for juvenile fibromyalgia. METHOD: Sixty-seven children with fibromyalgia and their parents were recruited to participate in an 8-week intervention that included modules of pain management, psychoeducation, sleep hygiene, and activities of daily living. Children were taught techniques of cognitive restructuring, thought stopping, distraction, relaxation, and self-reward. Additionally, they kept daily pain and sleep diaries. Children completed questionnaires of pre- and post-treatment measuring physical status and psychological functioning. RESULTS: Following CBT, children reported significant reductions (p < .006) in pain, somatic symptoms, anxiety, and fatigue, as well as improvements in sleep quality. Additionally, children reported improved functional ability and had fewer school absences. CONCLUSION: Children with fibromyalgia can be taught CBT strategies that help them effectively manage this chronic and disabling musculoskeletal pain disorder.     

Chronic sleep reduction is associated with academic achievement and study concentration in higher education students

Inadequate sleep impairs cognitive function and has been associated with worse academic achievement in higher education students; however, studies that control for relevant background factors and include knowledge on sleep hygiene are scarce. This study examined the association of chronic sleep reduction (i.e. symptoms of chronic sleep reduction such as shortness of sleep, sleepiness and irritation), subjective sleep quality and sleep hygiene knowledge with academic achievement (grades and study credits) and study concentration among 1378 higher education students (71% female, mean age 21.73 years, SD = 3.22) in the Netherlands. Demographic, health, lifestyle and study behaviour characteristics were included as covariates in hierarchical regression analyses. After controlling for significant covariates, only chronic sleep reduction remained a significant predictor of lower grades (last exam, average in current academic year). Better sleep quality and sleep hygiene knowledge were associated with better academic achievement, but significance was lost after controlling for covariates, except for a remaining positive association between sleep hygiene beliefs and grades in the current academic year. Moreover, better sleep quality and lower scores on chronic sleep reduction were associated with better study concentration after controlling for significant covariates. To conclude, chronic sleep reduction is associated with academic achievement and study concentration in higher education students. Inadequate sleep hygiene knowledge is moderately associated with worse academic achievement. Future research should investigate whether sleep hygiene interventions improve academic achievement in students of higher education.     

Determinants of sleep quality in college students: A literature review

PurposeTo review the various determinants of sleep quality among college students.MethodsThe PubMed, Web of Science and Cochrane Library databases were searched with the search string “sleep quality” AND “college students” for articles published between January 2007 and October 2017. Articles were excluded if they (1) examined sleep quality as a risk factor for other outcomes or (2) involved inpatients or participants under medical care.ResultsThe 112 identified studies were classified into categories according to the investigated determinants and their effect on sleep quality. Physical activity and healthy social relations improved sleep quality, while caffeine intake, stress and irregular sleep-wake patterns decreased sleep quality. Less consistent results were reported regarding eating habits and sleep knowledge, while proper napping during the day might improve overall sleep quality.ConclusionsCollege students are vulnerable to different risk factors for sleep quality. When designing interventions to improve sleep quality among college students, the main determinants need to be taken into consideration.     

A meta-analysis of imagery rehearsal for post-trauma nightmares: Effects on nightmare frequency, sleep quality, and posttraumatic stress

This meta-analysis evaluates the efficacy of imagery rehearsal as a treatment for nightmares, general sleep disturbance, and symptoms of post-traumatic stress. Bibliographic databases and cited references were searched to identify clinical trials of imagery rehearsal in individuals with post-trauma nightmares. Thirteen studies met inclusion criteria and reported sleep and post-traumatic stress outcomes in sufficient detail to calculate effect sizes. Results indicate that imagery rehearsal had large effects on nightmare frequency, sleep quality, and PTSD symptoms from the initial to post-treatment assessments. These effects were sustained through 6 to 12months follow-up. Furthermore, interventions that included both imagery rehearsal and cognitive behavioral therapy for insomnia resulted in greater treatment-related improvement in sleep quality than imagery rehearsal alone. Combined treatment did not improve outcomes for PTSD or nightmares. Notably, effect sizes were small in the single study that included an active-treatment control condition. Future research should identify necessary and sufficient components of interventions for trauma-related sleep disturbance and post-traumatic stress (e.g., exposure, cognitive reappraisal, sleep and circadian regulation).     

Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review

We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports. Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD.     

Psychological aspects of tinnitus and the application of cognitive-behavioral therapy

This article presents an overview of tinnitus (ringing or buzzing in the ears), its psychological effects, and the application of cognitive-behavioral therapy (CBT) for its treatment. Several studies have confirmed an association between psychological factors, such as anxiety and depression, and severe tinnitus and preliminary reports suggest that a proportion of tinnitus patients suffer from mental illness. Assessment strategies used in CBT for tinnitus include structured interviews, daily diary ratings, and validated self-report questionnaires. The treatment approach described in this article includes applied relaxation, imagery and distraction techniques, advice regarding environmental sounds, management of sleep, cognitive restructuring of thoughts and beliefs associated with tinnitus, and relapse prevention. The literature pertinent to CBT approaches to treating tinnitus is reviewed, and it is concluded that CBT shows promise as a treatment of tinnitus-related distress. Future research directions are discussed.     

Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions

There is growing evidence that mindfulness and acceptance-based interventions have positive consequences for psychological and physical health. The most well-established of these interventions typically involve relatively large resource commitments, in terms of both the provider and participant. A number of recent studies have begun to explore whether the benefits of such interventions can be generalised to less intensive methods. Methods include pure and guided self-help utilising resources such as books and workbooks, computer programmes and applications and audio-visual materials. This paper presents a systematic review and meta-analysis of studies that have evaluated the effectiveness and acceptability of low-intensity interventions including mindfulness and acceptance-based components. Fifteen RCTs (7 ACT-based, 4 mindfulness-based and 4 multi-component interventions including elements of mindfulness and/or acceptance) were identified and reviewed. Interventions that included mindfulness and/or acceptance-based components produced significant benefits in comparison to control conditions on measures of mindfulness/acceptance, depression and anxiety with small to medium effect sizes. Engagement with the self-help interventions varied but on average two-thirds of participants completed post-intervention measures. Emerging research into low-intensity mindfulness and acceptance-based interventions is hopeful. Recommendations for research and practice are presented.     

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

BACKGROUND: While there is a growing body of evidence on the efficacy of psychological interventions for schizophrenia, this meta-analysis improves upon previous systematic and meta-analytical reviews by including a wider range of randomized controlled trials and providing comparisons against both standard care and other active interventions. METHOD: Literature searches identified randomized controlled trials of four types of psychological interventions: family intervention, cognitive behavioural therapy (CBT), social skills training and cognitive remediation. These were then subjected to meta-analysis on a variety of outcome measures. This paper presents results relating to the first two. RESULTS: Family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication compliance. CBT produced higher rates of 'important improvement' in mental state and demonstrated positive effects on continuous measures of mental state at follow-up. CBT also seems to be associated with low drop-out rates. CONCLUSIONS: Family intervention should be offered to people with schizophrenia who are in contact with carers. CBT may be useful for those with treatment resistant symptoms. Both treatments, in particular CBT, should be further investigated in large trials across a variety of patients, in various settings. The factors mediating treatment success in these interventions should be researched.     

催眠疗法对大学生考试焦虑水平的影响

目的 探讨催眠疗法与放松训练对于缓解学生考试焦虑的效果.方法 对随机抽取的我校204名大学生进行<学生自我效能感问卷>及<考试焦虑问卷>调查,将考试焦虑评分在20分以上的26名学生随机分为3组分别进行对照、催眠和放松训练干预,在治疗前和治疗后6个时间点共进行了6次调查,运用多变量统计分析方法 进行不同疗法间的比较.结果...     

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT‐I) should be the first‐line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT‐I Academy that would enable a Europe‐wide system of standardized CBT‐I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT‐I, preconditions for health professionals to teach CBT‐I, the way in which CBT‐I should be taught, who should be taught CBT‐I and to whom CBT‐I should be administered. Furthermore, diverse aspects of CBT‐I care and delivery were discussed and incorporated into a stepped‐care model for insomnia.     

A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus

We conducted a randomized clinical trial to examine the relative effectiveness of two psychological interventions for treating tinnitus. People with tinnitus were initially offered a single session of psychoeducation about tinnitus, followed 2 months later by six weekly sessions of either mindfulness or relaxation training. Results indicated benefits from psychoeducation in reducing negative emotions, rumination and psychological difficulties of living with tinnitus. These effects were maintained or enhanced by mindfulness training that also emphasized acceptance, although they were eroded in the relaxation condition over the follow-up. Mediating processes are discussed, and suggestions for refining clinical interventions for this population are offered. KEY PRACTITIONER MESSAGE: The present results suggest that mindfulness training might constitute a useful addition to psychoeducation for interventions targeting the psychological consequences of tinnitus.     

Relationship of sleep hygiene awareness,sleep hygiene practices,and sleep quality in university students

College students are known for their variable sleep schedules. Such schedules, along with other common student practices (e.g., alcohol and caffeine consumption), are associated with poor sleep hygiene. Researchers have demonstrated in clinical populations that improving sleep hygiene knowledge and practices is an effective treatment for insomnia. However, researchers who have examined relationships between sleep hygiene and practices in nonclinical samples and overall sleep quality have produced inconsistent findings, perhaps because of questionable measures. In this study, the authors used psychometrically sound instruments to examine these variables and to counter the shortcomings in previous investigations. Their findings suggest that knowledge of sleep hygiene is related to sleep practices, which, in turn, is related to overall sleep quality. The data from their regression modeling indicated that variable sleep schedules, going to bed thirsty, environmental noise, and worrying while falling asleep contribute to poor sleep quality.     

Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial

This pilot, randomized controlled trial analyzed the effects of a cognitive behavioral therapy (CBT, n = 20) for insomnia vs a sleep hygiene (SH, n = 20) program on the three attentional networks (alertness, orienting, and executive function) and other additional outcome measures (sleep, pain, depression, anxiety, and daily functioning) of fibromyalgia patients. The CBT group showed significant improvement in alertness (F(1, 28) = 11.84, p = .0018), executive functioning (F(1, 28) = 15.76, p = .00059), sleep quality ( F(1, 38) = 6.33, p = .016), and a trend to improvement in daily functioning (p > .06), as compared with the SH group. The improvement in executive functioning was significantly related to the changes in sleep (r = 0.40, p = .026). A CBT for insomnia represents a useful intervention in fibromyalgia patients not only regarding sleep disturbance but also attentional dysfunction and probably daily functioning.     

Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice

STUDY OBJECTIVES: Persistent insomnia, although very common in general practice, often proves problematic to manage. This study investigates the clinical effectiveness and the feasibility of applying cognitive behavior therapy (CBT) methods for insomnia in primary care. DESIGN: Pragmatic randomized controlled trial of CBT versus treatment as usual. SETTING: General medical practice. PARTICIPANTS: Two hundred one adults (mean age, 54 years) randomly assigned to receive CBT (n = 107; 72 women) or treatment as usual (n = 94; 65 women). INTERVENTION: CBT comprised 5 sessions delivered in small groups by primary care nurses. Treatment as usual comprised usual care from general practitioners. MEASUREMENTS AND RESULTS: Assessments were completed at baseline, after treatment, and at 6-month follow-up visits. Sleep outcomes were appraised by sleep diary, actigraphy, and clinical endpoint. CBT was associated with improvements in self-reported sleep latency, wakefulness after sleep onset, and sleep efficiency. Improvements were partly sustained at follow-up. Effect sizes were moderate for the index variable of sleep efficiency. Participants receiving treatment as usual did not improve. Actigraphically estimated sleep improved modestly after CBT, relative to no change in treatment as usual. CBT was also associated with significant positive changes in mental health and energy/vitality. Comorbid physical and mental health difficulties did not impair sleep improvement following CBT. CONCLUSION: This study suggests that trained and supervised nurses can effectively deliver CBT for insomnia in routine general medical practice. Treatment response to small-group service delivery was encouraging, although effect sizes were smaller than those obtained in efficacy studies. Further research is required to consider the possibility that CBT could become the treatment of first choice for persistent insomnia in primary healthcare.     

正念冥想训练对大学生心理健康和睡眠质量的干预作用

目的:本研究主要考察正念冥想训练对大学生心理健康及睡眠质量的干预作用。方法:对40名自认为睡眠质量较差或期望通改善自身焦虑水平或学习压力的大学生进行为期8周每周1次的正念冥想训练。同时由40名同学校的学生组成控制组。在干预前后及干预测量干预组和对照组的学生的正念觉知量表、SCL-90的焦虑、抑郁和强迫症状分量表及匹兹堡睡眠质量量表,正念干预组在干预结束6个月后进行第三次测量。结果:1通过8周的正念冥想训练,干预组的焦虑(F=4.68,P0.05,η2=0.061,珚x前测=20.94;(珚x)后测=19.49)、抑郁(F=19.02,P0.01,η2=0.209,珚x前测=24.43,珚x后测=21.49)和强迫症状(F=4.27,P0.05,η2=0.056,珚x前测=30.06,珚x后测=28.11)均显著降低,而对照组前后测的焦虑(珚x前测=19.13,珚x后测=18.68)、抑郁(珚x前测=23.23,珚x后测=22.74)和强迫症状(珚x前测=28.13,珚x后测=28.67)均无显著变化;2正念冥想组的大学生的睡眠质量在干预后有显著的改善(F=6.67,P0.05,η2=0.09),而对照组无明显变化(珚x前测=5.41,珚x后测=5.26);36个月追踪显示,正念组的心理健康水平和睡眠质量在干预6个月后恢复到干预前的水平。结论:正念冥想训练可以在短期内改善大学生的心理健康和睡眠质量。     

Preventing sleep deficit in adolescents: Long‐term effects of a quasi‐experimental school‐based intervention study

Adolescents are at risk of sleep deficit, which has serious consequences for their daytime functioning. However, school‐based interventions to improve sleep have shown limited success. This might be due to the content of the programmes (e.g., not targeting central factors such as daytime stress and technology use) or because changes have not been captured due to a lack of long‐term follow‐ups. Hence, the aim of this study was to evaluate the long‐term effects of a school‐based sleep education curriculum including time‐management training. The study used a quasi‐experimental design. Participants were 3,622 adolescents (mean age 13.7, 48% girls); 286 were in the intervention group and 3,336 were followed as a natural control group. Data were collected before the intervention and at a 1‐year follow‐up. We divided participants into three groups according to baseline sleep duration (calculated from self‐reported bed‐ and wake times, minus sleep onset latency): insufficient (<7 hr), borderline (7–8 hr) and adequate (>8 hr). Adolescents in the intervention group were ~2 times less likely to report insufficient sleep at follow‐up as compared to controls. Sleep knowledge improved significantly in the intervention group but there were no changes in emotional sleep hygiene (e.g., bedtime worry) and perceived stress. Surprisingly, technology use increased and behavioural sleep hygiene worsened in the intervention group. Although the mechanisms of change need further investigation, the results of this study point to potential long‐term benefits of school‐based sleep programmes.     

A Mixed-Methods Pilot Study of the Acceptability and Effectiveness of a Brief Meditation and Mindfulness Intervention for People with Diabetes and Coronary Heart Disease

Mindfulness-based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long-term conditions is uncertain. We therefore pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility, and user experience with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. Positive impacts of mindfulness-based interventions on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.     

Cognitive‐Behavioral School‐Based Interventions for Anxious and Depressed Youth: A Meta‐Analysis of Outcomes

A meta‐analysis of school‐based interventions for anxious and depressed youth using QUORUM guidelines was conducted. Studies were located by searching electronic databases, manual effort, and contact with expert researchers. Analyses examined 63 studies with 8,225 participants receiving cognitive‐behavioral therapy (CBT) and 6,986 in comparison conditions. Mean pre–post effect sizes indicate that anxiety‐focused school‐based CBT was moderately effective in reducing anxiety (Hedge's g = 0.501) and depression‐focused school‐based CBT was mildly effective in reducing depression (Hedge's g = 0.298) for youth receiving interventions as compared to those in anxiety intervention control conditions (Hedge's g = 0.193) and depression intervention controls (Hedge's g = 0.091). Predictors of outcome were explored. School‐based CBT interventions for youth anxiety and for youth depression hold considerable promise, although investigation is still needed to identify features that optimize service delivery and outcome.