1. In this pilot randomized controlled trial, the Sleep Mood Intervention: Life Effectively (SMILE) intervention was associated with improvements in insomnia in university students.

Evidence rating level: 1 (Excellent)

Insomnia has a major burden on public health and can have serious long-term physical and mental health effects if left untreated. A population at a high risk for sleep problems include university students which may be due to specific challenges that arise during this phase in life as balancing stress and developing greater independence. There is much research to support the use of cognitive behavioural therapy for insomnia (CBT-I), involving changing negative attitudes through the use of cognitive restructuring. In addition to CBT-I, mindfulness interventions, promoting being present in the moment, have promising results, specifically on reducing stress and anxiety. To study the effectiveness of mindfulness counselling on insomnia in university students, a randomized controlled trial created the Sleep Mood Intervention: Life Effectively (SMILE) intervention. The participants were assigned to the SMILE intervention group and a waiting list control group is a 2:1 ratio. The participants completed the Insomnia Severity Index (ISI) and those with a score of ≥ 10 were eligible for further screening including a face-to-face diagnostic interview using the M.I.N.I Plus International Neuropsychiatric Interview. Several inclusion criteria were listed including self-reported sleep complaints (ISI score ≥ 10), university enrollment, 18 years or older, English proficiency, and willing to participate in a 4-week program. After randomization, 23 people were assigned to the SMILE group and 12 were assigned to the waitlist group. Outcomes were assessed at baseline and after five weeks. Insomnia was assessed using the ISI, while depression was assessed using the Beck Depression Inventory II, and anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS-A). The participants in the SMILE group had significantly lower severity levels of insomnia (M = 10.7, SD = 4.8) compared to the waitlist group (M = 14.7, SD = 4.9), post-test (t (33) = 2.33; p = .03, [95% CI: 0.51 to 7.52]. The impact of the SMILE intervention effects on insomnia severity was mediated by dysfunctional beliefs, with a reduction in dysfunctional beliefs associated with a decrease in insomnia severity, b = 1.12, [95% CI: -2.58 to -0.06]. There were no significant effects found for depression, d = 0.02 [95% CI: -0.35 tp 0.37], anxiety, d = 0.15 [95% CI: -0.16 to 0.53] and quality of life, d = 0.09 [95% CI: -0.25 to 0.42]. Overall, university students struggling with insomnia experienced improvements in their symptoms after participating in the four-week SMILE intervention.  

Click to read the study in BMC Psychology

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