The Effectiveness of Mindfulness-based Cognitive Therapy on Sleep Quality of Students with Social Anxiety Disorder
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Abstract
Background and Objective: Anxiety disorders are usually accompanied with sleep disorders. Since limited studies have focused on the effectiveness of mindfulness-based cognitive therapy (MBCT) on anxiety-related problems such as sleep disorders, the current research was conducted to investigate the effectiveness of this intervention on sleep problems.
Materials and Methods: This study was a clinical trial with control and treatment groups. The sample consisted of 24 university students diagnosed with social anxiety disorder (SAD). Social Interaction Anxiety Scale (SIAS) and Pitts-burgh Sleep Quality Index (PSQI) were used to assess the dependent variables. There were measurements during pre-test, post-test, and follow-up stages.
Results: The treatment could significantly improve the anxiety and sleeping problems in patients with social anxiety. Assessing the aspects of sleep quality showed that the intervention could improve the subjective aspects, latency, dis-turbance, and daily dysfunctions of sleep effectively; however, there was no significant effect on the duration of sleep, taking sleep medications, or sleep efficiency.
Conclusion: Mindfulness treatment could be used for improving sleep quality in patients with social anxiety. This treatment could also improve the aspects of sleep quality which are related to sleep threshold.
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3. Azadeh SM, Kazemi-Zahrani H, Besharat MA. Effectiveness of acceptance and commitment therapy on interpersonal problems and psychological flexibility in female high school students with social anxiety disorder. Glob J Health Sci 2015; 8: 131-8.
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6. Teo AR, Lerrigo R, Rogers MA. The role of social isolation in social anxiety disorder: A systematic review and meta- analysis. J Anxiety Disord 2013;27: 353-64.
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11. Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: Secondary symptom or core feature? Sleep Med Rev 2008; 12: 169-84.
12. Xie B, Chen XS, Xiao ZP, et al. Evaluation on the whole night polysomnography in patients with anxiety. J Shanghai Jiaotong Univ 2006; 4: 005.
13. Saletu-Zyhlarz GM, Anderer P, Berger P, et al.Nonorganic insomnia in panic Disorder: Comparative sleep laboratory studies with normal controls and placebo-controlled trials with alprazolam. Hum Psychopharmacol 2000; 15: 241-54.
14. Alfano CA, Reynolds K, Scott N, et al. Polysomnographic sleep patterns of non-depressed, nonmedicated children with generalized anxiety disorder. J Affect Disord 2013; 147: 379-84.
15. Horvath A, Montana X, Lanquart JP, et al. Effects of state and trait anxiety on sleep structure: A polysomnographic
study in 1083 subjects. Psychiatry Res 2016; 244: 279-83.
16. Bavafa A, Foroughi A, Khaledi-Paveh B, et al. The comparison of effects of state and trait anxiety on the components of sleep quality. Journal of Sleep Sciences 2018; 3: 95-101.
17. Gilbert P. The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice 2000; 7: 174-89.
18. Dalrymple KL, Herbert JD. Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study. Behav Modif 2007; 31: 543-68.
19. Twohig MP, Hayes SC, Masuda A. Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessivecompulsive disorder. Behav Ther 2006; 37: 3-13.
20. Eifert GH, Forsyth JP, Arch J, et al. Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cogn Behav Pract 2009; 16: 368-85.
21. Dindo L. One-day acceptance and commitment training workshops in medical populations. Curr Opin Psychol 2015; 2: 38-42.
22. Roemer L, Orsillo SM, Salters-Pedneault K. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. J Consult Clin Psychol 2008; 76: 1083-9.
23. Twohig MP, Woidneck MR, Crosby JM. Newer generations of CBT for anxiety disorders. In: Simos G, Hofmann SG, Editors. CBT for Anxiety Disorders: A Practitioner Book. Hoboken, NJ: John Wiley & Sons; 2013. p. 225-50.
24. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of be havioral and cognitive therapies-republished article.Behav Ther 2016; 47: 869-85.
25. Forghani Toroghi O, Javanbakht M, Bayazi MH, et al. The effectiveness of group cognitive-behavioral training and group reality therapy on self-esteem of high school students. J Fundam Ment Health 2012; 14: 172-80. [In Persian].
26. Eisendrath S, Chartier M, McLane M. Adapting mindfulness-based cognitive therapy for treatmentresistant
depression: A clinical case study. Cogn Behav Pract 2011; 18: 362-70.
27. Williams JM, Duggan DS, Crane C, et al. Mindfulness- based cognitive therapy for prevention of recurrence of suicidal behavior. J Clin Psychol 2006; 62: 201-10.
28. Pouyanfard S, Mohammadpour M, Parvizifard A, et al. The effectiveness of mindfulness-integrated cognitive-behavioral therapy on sleep quality, anxiety, and fatigue in patients with multiple sclerosis: A randomized clinical trial. J Sleep Sci 2019; 4: 1-8.
29. Ong JC, Shapiro SL, Manber R. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behav Ther 2008; 39: 171-82.
30. Simpson R, Booth J, Lawrence M, et al. Mindfulness based interventions in multiple sclerosis-a systematic review. BMC Neurol 2014; 14: 15.
31. Segal ZV, Williams MG, Teasdale JD. Mindfulness-based cognitive therapy for depression, first edition: A new approach to preventing relapse. New York, NY: Guilford Publications; 2002.
32. Brown TA, Barlow DH, DiNardo PA. Anxiety Disorders interview schedule adult version: Client interview schedule. Oxford, UK: Oxford University Press; 1994.
33. Mohammadi A, Birashk B, Gharraee B. Comparison of the effect of group transdiagnostic treatment and group cognitive therapy on emotion regulation. Iran J Psychiatry Clin Psychol 2014; 19: 187-94.
34. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
35. Farrahi Moghaddam J, Nakhaee N, Sheibani V, et al. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
36. Heimberg RG, Mueller GP, Holt CS, et al. Assessment of anxiety in social interaction and being observed by others: The social interaction anxiety scale and the Social Phobia Scale. Behav Ther 1992; 23: 53-73.
37. Tavoli A, Allahyari A, Azadfallah P, et al. Validity and reliability of the Farsi version of social interaction anxiety scale (SIAS). Iran J Psychiatry Clin Psychol 2012; 18: 227-32. [In Persian].
38. Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis. Psychiatry Res 2011; 187: 441-53.
39. Manicavasgar V, Parker G, Perich T. Mindfulnessbased cognitive therapy vs cognitive behaviour therapy as a reatment for non-melancholic depression. J Affect Disord 2011; 130: 138-44.
40. Kim B, Lee SH, Kim YW, et al. Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder. J Anxiety Disord 2010; 24: 590-5.
41. Ebrahiminejad S, Poursharifi H, Bakhshiour Roodsari A, et al. The effectiveness of mindfulnessbased cognitive therapy on Iranian female adolescents suffering from social anxiety. Iran Red Crescent Med J 2016; 18: e25116.
42. Belleville G, Cousineau H, Levrier K, et al. The impact of cognitive-behavior therapy for anxiety disorders on concomitant sleep disturbances: A meta-analysis. J Anxiety Disord 2010; 24: 379-86.
43. Harvey AG, Murray G, Chandler RA, et al. Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clin Psychol Rev 2011; 31: 225-35.
44. Doos Ali V, Gharraee B, Asgharnejad Farid AA, et al. The Effectiveness of transdiagnostic cognitive behavioral therapy for comorbid insomnia: A case report. Iran J Psychiatry 2018; 13: 154-9.
2. American Academy of Family Physicians, American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association; 1995.
3. Azadeh SM, Kazemi-Zahrani H, Besharat MA. Effectiveness of acceptance and commitment therapy on interpersonal problems and psychological flexibility in female high school students with social anxiety disorder. Glob J Health Sci 2015; 8: 131-8.
4. Wong QJJ, Rapee RM. The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. J Affect Disord 2016; 203: 84-100.
5. Kessler RC, Petukhova M, Sampson NA, et al.Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 2012; 21: 169-84.
6. Teo AR, Lerrigo R, Rogers MA. The role of social isolation in social anxiety disorder: A systematic review and meta- analysis. J Anxiety Disord 2013;27: 353-64.
7. Dams J, Konig HH, Bleibler F, et al. Excess costs of social anxiety disorder in Germany. J Affect Disord 2017; 213: 23-9.
8. Stuhldreher N, Leibing E, Leichsenring F, et al. The costs of social anxiety disorder: The role of symptom severity and comorbidities. J Affect Disord 2014; 165: 87-94.
9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013.
10. Steinert C, Hofmann M, Leichsenring F, et al. What do we know today about the prospective long-term course of social anxiety disorder? A systematic literature review. J Anxiety Disord 2013; 27: 692-702.
11. Spoormaker VI, Montgomery P. Disturbed sleep in post-traumatic stress disorder: Secondary symptom or core feature? Sleep Med Rev 2008; 12: 169-84.
12. Xie B, Chen XS, Xiao ZP, et al. Evaluation on the whole night polysomnography in patients with anxiety. J Shanghai Jiaotong Univ 2006; 4: 005.
13. Saletu-Zyhlarz GM, Anderer P, Berger P, et al.Nonorganic insomnia in panic Disorder: Comparative sleep laboratory studies with normal controls and placebo-controlled trials with alprazolam. Hum Psychopharmacol 2000; 15: 241-54.
14. Alfano CA, Reynolds K, Scott N, et al. Polysomnographic sleep patterns of non-depressed, nonmedicated children with generalized anxiety disorder. J Affect Disord 2013; 147: 379-84.
15. Horvath A, Montana X, Lanquart JP, et al. Effects of state and trait anxiety on sleep structure: A polysomnographic
study in 1083 subjects. Psychiatry Res 2016; 244: 279-83.
16. Bavafa A, Foroughi A, Khaledi-Paveh B, et al. The comparison of effects of state and trait anxiety on the components of sleep quality. Journal of Sleep Sciences 2018; 3: 95-101.
17. Gilbert P. The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice 2000; 7: 174-89.
18. Dalrymple KL, Herbert JD. Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study. Behav Modif 2007; 31: 543-68.
19. Twohig MP, Hayes SC, Masuda A. Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessivecompulsive disorder. Behav Ther 2006; 37: 3-13.
20. Eifert GH, Forsyth JP, Arch J, et al. Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cogn Behav Pract 2009; 16: 368-85.
21. Dindo L. One-day acceptance and commitment training workshops in medical populations. Curr Opin Psychol 2015; 2: 38-42.
22. Roemer L, Orsillo SM, Salters-Pedneault K. Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. J Consult Clin Psychol 2008; 76: 1083-9.
23. Twohig MP, Woidneck MR, Crosby JM. Newer generations of CBT for anxiety disorders. In: Simos G, Hofmann SG, Editors. CBT for Anxiety Disorders: A Practitioner Book. Hoboken, NJ: John Wiley & Sons; 2013. p. 225-50.
24. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of be havioral and cognitive therapies-republished article.Behav Ther 2016; 47: 869-85.
25. Forghani Toroghi O, Javanbakht M, Bayazi MH, et al. The effectiveness of group cognitive-behavioral training and group reality therapy on self-esteem of high school students. J Fundam Ment Health 2012; 14: 172-80. [In Persian].
26. Eisendrath S, Chartier M, McLane M. Adapting mindfulness-based cognitive therapy for treatmentresistant
depression: A clinical case study. Cogn Behav Pract 2011; 18: 362-70.
27. Williams JM, Duggan DS, Crane C, et al. Mindfulness- based cognitive therapy for prevention of recurrence of suicidal behavior. J Clin Psychol 2006; 62: 201-10.
28. Pouyanfard S, Mohammadpour M, Parvizifard A, et al. The effectiveness of mindfulness-integrated cognitive-behavioral therapy on sleep quality, anxiety, and fatigue in patients with multiple sclerosis: A randomized clinical trial. J Sleep Sci 2019; 4: 1-8.
29. Ong JC, Shapiro SL, Manber R. Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behav Ther 2008; 39: 171-82.
30. Simpson R, Booth J, Lawrence M, et al. Mindfulness based interventions in multiple sclerosis-a systematic review. BMC Neurol 2014; 14: 15.
31. Segal ZV, Williams MG, Teasdale JD. Mindfulness-based cognitive therapy for depression, first edition: A new approach to preventing relapse. New York, NY: Guilford Publications; 2002.
32. Brown TA, Barlow DH, DiNardo PA. Anxiety Disorders interview schedule adult version: Client interview schedule. Oxford, UK: Oxford University Press; 1994.
33. Mohammadi A, Birashk B, Gharraee B. Comparison of the effect of group transdiagnostic treatment and group cognitive therapy on emotion regulation. Iran J Psychiatry Clin Psychol 2014; 19: 187-94.
34. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
35. Farrahi Moghaddam J, Nakhaee N, Sheibani V, et al. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
36. Heimberg RG, Mueller GP, Holt CS, et al. Assessment of anxiety in social interaction and being observed by others: The social interaction anxiety scale and the Social Phobia Scale. Behav Ther 1992; 23: 53-73.
37. Tavoli A, Allahyari A, Azadfallah P, et al. Validity and reliability of the Farsi version of social interaction anxiety scale (SIAS). Iran J Psychiatry Clin Psychol 2012; 18: 227-32. [In Persian].
38. Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis. Psychiatry Res 2011; 187: 441-53.
39. Manicavasgar V, Parker G, Perich T. Mindfulnessbased cognitive therapy vs cognitive behaviour therapy as a reatment for non-melancholic depression. J Affect Disord 2011; 130: 138-44.
40. Kim B, Lee SH, Kim YW, et al. Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder. J Anxiety Disord 2010; 24: 590-5.
41. Ebrahiminejad S, Poursharifi H, Bakhshiour Roodsari A, et al. The effectiveness of mindfulnessbased cognitive therapy on Iranian female adolescents suffering from social anxiety. Iran Red Crescent Med J 2016; 18: e25116.
42. Belleville G, Cousineau H, Levrier K, et al. The impact of cognitive-behavior therapy for anxiety disorders on concomitant sleep disturbances: A meta-analysis. J Anxiety Disord 2010; 24: 379-86.
43. Harvey AG, Murray G, Chandler RA, et al. Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clin Psychol Rev 2011; 31: 225-35.
44. Doos Ali V, Gharraee B, Asgharnejad Farid AA, et al. The Effectiveness of transdiagnostic cognitive behavioral therapy for comorbid insomnia: A case report. Iran J Psychiatry 2018; 13: 154-9.
| Files | ||
| Issue | Vol 5 No 1 (2020): Winter | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jss.v5i1.4566 | |
| Keywords | ||
| Social anxiety; Sleep quality; Mindfulness-based cognitive therapy; Students | ||
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How to Cite
1.
Mohammadi S, Maleki M, Tashkeh M, Foroughi A, Goodarzi G. The Effectiveness of Mindfulness-based Cognitive Therapy on Sleep Quality of Students with Social Anxiety Disorder. J Sleep Sci. 2020;5(1):1-7.
