Mindfulness Meditation Targets Transdiagnostic Symptoms Implicated in Stress‐Related Disorders: Understanding Relationships between Changes in Mindfulness, Sleep Quality, and Physical Symptoms

Abstract

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study (n = 213) aimed to determine whether perseverative cognition, indicated by rumination and intrusive thoughts, and emotion regulation, measured by avoidance, thought suppression, emotion suppression, and cognitive reappraisal, partly accounted for the hypothesized relationship between changes in mindfulness and two health-related outcomes: sleep quality and stress-related physical symptoms. As expected, increased mindfulness following the MBSR program was directly correlated with decreased sleep disturbance (r = −0.21, p = 0.004) and decreased stress-related physical symptoms (r = −0.38, p < 0.001). Partial correlations revealed that pre-post changes in rumination, unwanted intrusive thoughts, thought suppression, experiential avoidance, emotion suppression, and cognitive reappraisal each uniquely accounted for up to 32% of the correlation between the change in mindfulness and change in sleep disturbance and up to 30% of the correlation between the change in mindfulness and change in stress-related physical symptoms. Results suggest that the stress-reducing effects of MBSR are due, in part, to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders.

Pre-sleep Cognitive Arousal Decreases Following a 4-Week Introductory Mindfulness Course

“…Participating in sleep research may also have triggered self-monitoring behavior and reactivity (Kazdin 1974) in both groups, which could account for the improvements seen in the waitlist participants (Todd and Mullan 2014). In the context of prior studies, the null finding in this experiment suggests that improving subjective sleep quality in a meaningful way may require longer (Black et al 2015;Britton et al 2010;Greeson et al 2018) or more targeted interventions (Ong et al 2014).…”

“…In the SENSE study, Blake et al (2017) showed that both somatic and cognitive arousal (measured by the PSAS) were mediators of change in four key outcome variables (objective SOL, subjective SE, PSQI global score, and anxiety). A recent study (Greeson et al 2018) showed that unwanted intrusive thoughts and thought suppression, both constructs related to cognitive arousal, each accounted for a significant portion of the negative correlation between change in mindfulness and change in sleep disturbance following an 8-week mindfulness intervention. Our own findings are well in line with these results.…”

“…High levels of pre-sleep cognitive arousal are associated with longer sleep onset latency, or the time taken to initiate sleep before getting into bed (Tang and Harvey 2004), and lower levels of arousal may help to reduce nighttime awakenings, and promote longer continuous episodes of nocturnal sleep (Chen et al 2011). Recent studies (Greeson et al 2018;Ong et al 2014) have shown that reduction in cognitive arousal prior to sleep correlates with improvements in sleep quality over 8week mindfulness-based interventions. Similarly, Blake et al (2017) reported that pre-sleep cognitive arousal mediated improvements in sleep quality in a study of mindfulness-based training for at-risk adolescents.…”

The Relationship between Mindfulness and Sleep Quality is Mediated by Emotion Regulation

“…Cognitive arousal has been associated with poor and disrupted sleep, and the coping behaviors people use to combat this arousal are important to a person's sleep quality [24]. Cognitive arousal can manifest into anxiety and depression, which is attributed to stress, and unmanaged stress can lead to sleep problems [12].…”

“…Emotion regulation is a process that occurs in stages and usually has genetic and biological components, but emotion regulation may be improved with practice or training [8][9][10][11]. One influential technique for promoting emotion regulation and self-awareness is mindfulness meditation and related therapies [10,12,13]. In a related study, Thompson & Waltz (2010) [14] surveyed 378 undergraduates on self-report measures of PTSD, mindfulness, experiential avoidance, thought suppression, and avoidance coping.…”