Sick and Tired: Understanding and Managing Sleep Difficulties in ...

intervention for people with FMS in the USA. These intensive interventions may be
difficult to implement in clinical practice however, due to the high costs of delivery and
the difficulties of being able to travel long distances to attend the group sessions faced
by FMS participants. These feasibility issues are of particular importance in countries
such as New Zealand and the UK where many people live in remote areas and are
unable to access such specialist professionals and group based programmes. Therefore
an intervention that could be delivered within the community or at a person‟s home is
likely to have greater clinical utility for FMS patients.
The Mindfulness Approach
The mindfulness approach, which focuses on increasing acceptance of thoughts and
focusing attention on the present moment in a non-judgemental way (Kabat-Zinn, 1982,
1990), may provide one such approach to address the high cognitive arousal, perceived
levels of stress, dysfunctional beliefs and poor sleep quality in people with FMS.
The practice of mindfulness emerged from eastern Buddhist traditions where it was
recognised that mindfulness can improve well-being and self awareness. Mindfulness
approaches are now being increasingly used in medical settings, with structured
mindfulness programmes being developed, which specifically focus on application to
patient groups. The Mindfulness Based Stress Reduction (MBSR) programme was
developed by Kabat-Zinn (1982, 1990) for patients with chronic pain and stress related
medical conditions. The programme involves eight weekly group sessions, lasting two
and a half hours (often including a whole day session towards the end of the
programme). Components of the programme include meditation, (sitting quietly and
focusing attention on a specific stimulus for prolonged periods); a body scan, (directing
attention to different parts of the body); and hatha yoga, (directing attention to the body
through a series of postures and movements). In addition to the group training sessions,
patients are encouraged to practice the techniques at home. An important principle of
mindfulness is that it does not aim to reduce physical symptoms, but intends only to
increase patient‟s awareness and acceptance of their thoughts and physical sensations,
without trying to interpret or challenge them. Developing acceptance of symptoms has
been associated with lower perceived pain and enables patients to continue to engage in
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