Garland, S.N., Rouleau, C.R., Campbell, T., Samuels, C., & Carlson, L.E. (2015). The comparative impact of mindfulness-based cancer recovery (MBCR) and cognitive behavior therapy for insomnia (CBT-I) on sleep and mindfulness in cancer patients. Explore, 11, 445–454. 

To compare the impact of a mindfulness-based cancer recovery (MBCR) intervention versus cognitive behavioral therapy for insomnia (CBT-I) on mindfulness and dysfunctional sleep beliefs, to examine associations of insomnia severity and changes in mindfulness and dysfunctional sleep beliefs, and to compare changes in insomnia severity between treatment groups

MBCR was used on-site at weekly 90-minute group classes with one six-hour silent retreat between weeks 6 and 7 as an opportunity for extended practice. The program consists of several types of mindfulness practices and didactic instruction on application of mindfulness attitudes. The facilitator was a nurse with more than 10 years of experience delivering MBCR. The CBT-I program consisted of eight weekly 90-minutes sessions, including stimulus control, sleep restriction, relaxation, cognitive strategies aimed at dysfunctional sleep beliefs, and sleep hygiene. The facilitator for the CBT-I program was a doctoral level trainee in a nationally accredited clinical psychology program and was supervised by a PhD-level Clinical Health Psychologist.

• N = 72  
• MEAN AGE: No sample mean
• AGE RANGE: 36–88 years
• MALES: 27.8%, FEMALES: 72.2%
• KEY DISEASE CHARACTERISTICS: The study included patients with breast, prostate, blood/lymph, female genitourinary, lung, head/neck, or colorectal cancers; and survivors with non-metastatic disease who had completed treatment at least one month prior to study participation.
• OTHER KEY SAMPLE CHARACTERISTICS: 64% were married and 58% were employed.

• SITE: Single site
• SETTING TYPE: Outpatient  
• LOCATION: University of Calgary/Alberta Health Services

• PHASE OF CARE: Late effects and survivorship

• Secondary analysis of randomized, controlled trail data
• Parent study compared MBCR with CBT-I for treatment of insomnia in patients with cancer

• Five Facet Mindfulness Questionnaire (FFMQ)
• Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16)
• Insomnia Severity Index (ISI)

Mindfulness outcomes not reported. There were significant group, time, and group X time effects on overall and subscale scores for the DBAS with large effect sizes. The CBT-I group had more improvements than the MBCR group. Baseline to post-program improvements were noted that persisted at three-month follow-up. Associations between DBAS subscale and total scores and insomnia severity were not reported. Aspects of mindfulness were negatively correlated with a number of DBAS subscales and total score. Insomnia severity was negatively correlated with mindfulness non-judging. Insomnia severity (severe, moderate, mild, none) was not significantly different at baseline, post-program, and follow-up between MBCR and CBT-I groups.

CBT-I has a greater impact on DBAS measures than MBCR, but both have large effect sizes on DBAS. Aspects of mindfulness account for some variability in DBAS scores. Both MBCR and CBT-I have a positive impact on insomnia severity over time.

• Small sample (less than 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Key sample group differences that could influence results
• Findings not generalizable
• A number of risks for bias are unknown. The parent study is not referenced; therefore, the number of people who refused to participate or the attrition rate or allocation sequence and concealment is unknown. Analysis was per protocol. Results should be taken with caution.

Both CBT-I and MBCR may improve insomnia in survivors. CBT-I has a greater impact in decreasing dysfunctional beliefs about sleep.