Rush University Medical Center, Chicago, IL 60612, USA.
Behav Res Ther. 2012 Nov;50(11):651-60. doi: 10.1016/j.brat.2012.08.001. Epub 2012 Aug 20.
While there is an accumulating evidence to suggest that therapies using mindfulness and acceptance-based approaches have benefits for improving the symptoms of insomnia, it is unclear how these treatments work. The goal of this paper is to present a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. The existing cognitive and behavioral models of insomnia are first reviewed and a two-level model of cognitive (primary) and metacognitive (secondary) arousal is presented in the context of insomnia. We then focus on the role of metacognition in mindfulness and acceptance-based therapies, followed by a review of these therapies in the treatment of insomnia. A conceptual framework is presented detailing the mechanisms of metacognition in the context of insomnia treatments. This model proposes that increasing awareness of the mental and physical states that are present when experiencing insomnia symptoms and then learning how to shift mental processes can promote an adaptive stance to one's response to these symptoms. These metacognitive processes are characterized by balanced appraisals, cognitive flexibility, equanimity, and commitment to values and are posited to reduce sleep-related arousal, leading to remission from insomnia. We hope that this model will further the understanding and impact of mindfulness and acceptance-based approaches to insomnia.
虽然有越来越多的证据表明，使用正念和接纳为基础的方法进行治疗对改善失眠症状有好处，但这些治疗方法的作用机制尚不清楚。本文的目的是基于正念和接纳的方法，提出一个失眠认知机制的概念框架。首先回顾了现有的失眠认知和行为模型，并在失眠的背景下提出了一个认知（主要）和元认知（次要）唤醒的两级模型。然后，我们专注于元认知在正念和接纳为基础的治疗中的作用，接着回顾这些治疗方法在失眠治疗中的应用。本文提出了一个详细阐述失眠治疗中元认知机制的概念框架。该模型提出，通过增加对体验失眠症状时的心理和生理状态的意识，并学习如何改变心理过程，可以促进对这些症状的适应态度。这些元认知过程的特点是平衡的评价、认知灵活性、平静和对价值观的承诺，被认为可以降低与睡眠相关的唤醒，从而从失眠中缓解。我们希望这个模型将进一步加深对正念和接纳为基础的失眠治疗方法的理解和影响。
