Editing Insomnia (section)

==== Acceptance and commitment therapy ====

Treatments based on the principles of [[acceptance and commitment therapy]] (ACT) and [[metacognition]] have emerged as alternative approaches to treating insomnia.<ref>{{cite journal | vauthors = Ong JC, Ulmer CS, Manber R | title = Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia | journal = Behaviour Research and Therapy | volume = 50 | issue = 11 | pages = 651–60 | date = November 2012 | pmid = 22975073 | pmc = 3466342 | doi = 10.1016/j.brat.2012.08.001 }}</ref> ACT rejects the idea that behavioral changes can help insomniacs achieve better sleep since they require "sleep efforts" - actions which create more "struggle" and arouse the nervous system, leading to [[hyperarousal]].<ref name="meadows">Meadows, G. (2015) The sleep book: How to sleep well every night. London, UK: Orion Publishing Group, p.2-7</ref> The ACT approach posits that acceptance of the negative feelings associated with insomnia can, in time, create the right conditions for sleep. [[Mindfulness]] practice is a key feature of this approach, although mindfulness is not practiced to induce sleep (this in itself is a ''sleep effort'' to be avoided) but rather as a longer-term activity to help calm the nervous system and create the internal conditions from which sleep can emerge.

A key distinction between CBT-I and ACT lies in the divergent approaches to time spent awake in bed. Proponents of CBT-i advocate minimizing time spent awake in bed, on the basis that this creates a cognitive association between being in bed and wakefulness. The ACT approach proposes that avoiding time in bed may increase the pressure to sleep and arouse the nervous system further.<ref name=meadows/>

Research has shown that "ACT has a significant effect on primary and comorbid insomnia and sleep quality, and ... can be used as an appropriate treatment method to control and improve insomnia".<ref name="Salari_2020">{{cite journal | vauthors = Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Ghasemi H, Mohammadi M, Shohaimi S | title = The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review | journal = BMC Neurology | volume = 20 | issue = 1 | pages = 300 | date = August 2020 | pmid = 32791960 | pmc = 7425538 | doi = 10.1186/s12883-020-01883-1 | doi-access = free }}</ref>