Efficacy of mind‐body therapies for sleep disturbance in patients with early‐stage cancer: A systematic review and network meta‐analysis

Abstract

ObjectiveTo evaluate and compare the efficacy of different mind‐body therapies (MBTs) for sleep disturbance in patients with early‐stage cancer.MethodsRandomised controlled trials that included patients (aged ≥18 years) with early stage cancer who underwent MBTs (mindfulness, hypnosis, relaxation, yoga, and qigong) were searched in the CINAHL via the EBSCO Host, Cochrane Library, Embase, MEDLINE, PsycINFO, PubMed, and Scopus databases, from the date of database inception to October 2022. The outcomes were subjective sleep disturbance and objective sleep efficiency. Network meta‐analysis (NMA) and comparative effects ranking were performed using STATA (v14.0; STATACorp, College Station, TX, USA).ResultsForty‐seven studies investigating five MBTs were included in the NMA. For cancer patients receiving active treatment, mindfulness demonstrated the largest effect size in reducing subjective sleep disturbance (standardised mean difference [SMD]: 0.85; 95% confidence intervals [CI]: 0.20–1.50; Grading of Recommendations Assessment, Development, and Evaluation assessment: moderate), and had the highest cumulative probability compared to usual care or waitlist. For cancer patients who had completed active treatment, qigong demonstrated the largest effect size in reducing subjective sleep disturbance (SMD: 0.99; 95% CI: 0.35–1.63; GRADE: low), followed by hypnosis (SMD: 0.87; 95% CI: 0.32–1.42; GRADE: moderate), and mindfulness (SMD: 0.42; 95% CI: 0.24–0.59; GRADE: moderate). Qigong also demonstrated the largest effect size in improving objective sleep efficiency (weighted mean differences: 10.76; 95% CI: 2.01–19.50; GRADE: low); however, the effect of qigong was tested in only one study in this NMA. Among the eight different treatment conditions, cognitive behavioral therapy (CBT) showed the highest cumulative probability (surface under the cumulative ranking curve: 96.3%) in reducing subjective sleep disturbance and the second highest cumulative probability (SUCRA: 83.3%) in improving objective sleep efficiency.ConclusionThere is no evidence supporting the use of MBTs to replace or be comparable to CBT. Mindfulness can be recommended as an optional treatment for reducing sleep disturbance in patients with early‐stage cancer. Some support was observed for qigong and hypnosis in reducing sleep disturbances in patients with early‐stage cancer who had completed active treatment. More rigorous trials are warranted to confirm whether different forms of MBTs have different effects on sleep in patients with cancer.

Innovating in Mental Health: Metacognitive Psychotherapy

“…El modelo teórico explicativo de la TMC se denomina Modelo de autorregulación de la función ejecutiva (S-REF por sus siglas en inglés), y al patrón de respuesta frente a las experiencias internas que termina intensificando las emociones negativas, se lo denomina Síndrome Cognitivo Atencional (CAS por sus siglas en inglés), e incluye la preocupación, la rumiación, fijación atencional en las amenazas y conductas de afrontamiento disfuncionales. (42,43) Cuando se habla de la S-REF, nos estamos refiriendo al basamento en que se sustenta la terapia metacognitiva; este explica que no son las creencias autorreferenciales, como por ejemplo "soy un inútil" o "no valgo para nada", las que causan el cuadro psicopatológico sino las estrategias autorreguladoras comportamentales y cognitivas inadecuadas que el individuo pone en marcha y que terminan cronificando dichos contenidos Interdisciplinary Rehabilitation / Rehabilitación Interdisciplinaria. 2024;3:74 10 cognitivos e incrementando el malestar emocional asociado.…”