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This study aims to compare the efficacy of the Mahayana Buddhist Awareness Training Program (ATP) with a Qigong group in treating people with insomnia in Hong Kong. It also aims to investigate the underlying mechanisms, including changes in brain activity and heart rate variability during wakefulness, through which these two Eastern mind body interventions improve sleep quality. It is expected that ATP will be as efficacious as Qigong in enhancing sleep quality. Compared to the Qigong intervention, the more mind-based ATP will lead to more improvement in mental health and greater reductions in hyperarousal brain activity. Compared to ATP, the more body-based Qigong will lead to greater improvement in physical health and heart rate variability.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mahayana Buddhist Awareness Training Program (ATP) | Experimental | The 8-session ATP intervention consists of six 3-hour workshops plus two full day retreats. It will be delivered by instructors, who are trained by ATP co-founders. Participants will be guided to cultivate wisdom of non-attachment and compassion progressively by learning, contemplation, and practice. They will learn and memorize a core Buddhist mantra "Om mani padme hum," attend lectures, practice meditation, participate in experiential and reflective learning activities, and join the group discussions. Each workshop will typically begin with a sharing session followed by a Q&A segment to address participants' questions and concerns. To deepen their learning experience, revision exercises and corrections to revision exercises will be embedded at the end of each workshop. Participants will also receive guided meditation audio tracks, handouts, and weekly homework assignment to support their practice outside of workshop sessions. |
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| Qigong Intervention | Experimental | The 8-session Qigong intervention, with reference to the Five Elements Balance Qigong, will be delivered by instructors, who are trained by an experienced Daoist Qigong master teacher. It consists of six-3 hour workshops plus two full day retreats. Each workshop will typically begin with an introduction to some basic Traditional Chinese Medicine and Qigong concepts, or precautions in doing Qigong exercises and addressing participants' inquiries. Participants will progressively learn ten forms of simple Qigong movements that aim to enhance the flow of qi .The participants will also be asked to practice Qigong at home for 30 minutes at least three times per week and complete a practice log. Participants will also receive handouts to support their learning after each session. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Psychosocial intervention | Behavioral | Culturally relevant psychosocial intervention for people with insomnia |
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| Measure | Description | Time Frame |
|---|---|---|
| Changes over the measurement points in the 19-item Pittsburgh Sleep Quality Index | It measures sleep quality and disturbances experienced within a 1-month time frame. Scores range from 0 to 21, where a higher score represents poorer sleep quality. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the brain activity during wakefulness | Spectral power analysis for participants' theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), and gamma (30-50 Hz) bands during a 10-minute resting state wakefulness will be measured by the UMindSleep device (http://www.eegsmart.com/en/UMindSleep.html). | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the heart rate variability | This will be measured by the same wearable UMindSleep device. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Changes over the measurement points in the 7-item Insomnia Severity Index | It measures the nature, severity and impact of insomnia. Scores range from 0 to 28, where a higher score represents greater insomnia severity. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the 16-item Pre-Sleep Arousal Scale |
| Measure | Description | Time Frame |
|---|---|---|
| Demographics | Single items will be used to measure participants' age, education level, marital status, occupation, gender, presence of chronic illness, presence of life-threatening illness, and perceived energy levels throughout the day. | Baseline |
| Treatment Acceptance |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Victoria Ka-Ying Dr. HUI, PhD | College of Professional and Continuing Education Limited | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Division of Social Sciences, Humanities and Design | Hong Kong | Hong Kong |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Wu BWY, Gao J, Leung HK, Sik HH. A randomized controlled trial of Awareness Training Program (ATP), a group based Mahayana Buddhist intervention. Mindfulness. 2019;10:1280 1293. https://doi.org/10.1007/s12671-018-1082-1 | ||
| 34634445 | Background | Ng SM, Yin MXC, Chan JSM, Chan CHY, Fong TCT, Li A, So KF, Yuen LP, Chen JP, Chung KF, Chan CLW. Impact of mind-body intervention on proinflammatory cytokines interleukin 6 and 1beta: A three-arm randomized controlled trial for persons with sleep disturbance and depression. Brain Behav Immun. 2022 Jan;99:166-176. doi: 10.1016/j.bbi.2021.09.022. Epub 2021 Oct 8. | |
| 38248306 |
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D000083626 | Psychosocial Intervention |
| ID | Term |
|---|---|
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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It measures the symptoms of cognitive and somatic arousal experienced at bedtime. Scores range from 18 to 80, where a higher score represents greater pre-sleep arousal. |
| Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the 5-item item Santa Clara Brief Compassion Scale | It measures participants' perceived compassion towards others. Scores ranges from 5 to 35, where a higher score represents greater compassion towards others. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the PROMISĀ® 2-item Global Physical Health-2 Scale | It measures participants' perceived physical health. The raw total score will be converted to a T-score. T scores range from 23.4 to 63.3, where a higher score represents a higher perceived physical health. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the PROMISĀ® 2-item Global Mental Health-2 Scale | It measures participants' perceived mental health. The raw total score will be converted to a T-score. T Scores ranges from 25.8 to 64.6, where a higher score represents a higher perceived mental health. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the 6-item Qi Stagnation Scale | It measures participants' self-reported pathological qi status characterized by the slow and idle flow of qi. Scores range from 6 to 30, where a higher score represents greater qi stagnation. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the 6-item Qi Deficiency Scale | It measures participants' self-reported pathological qi status characterized by the lack of qi in one of the viscera or the whole body. Scores range from 6 to 30, where a higher score represents greater qi deficiency. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the 2-item Generalized Anxiety Disorder-2 Scale | It measures participants' anxiety level. Scores range from 0 to 6, where a higher score represents higher anxiety level. | Baseline, immediately after the intervention, 7 weeks after the intervention |
| Changes over the measurement points in the 2-item Patient Health Questionnaire-2 Scale | It measures participants' depression level. Scores range from 0 to 6, where a higher score represents higher depression level. | Baseline, immediately after the intervention, 7 weeks after the intervention |
This will be measured by two self-constructed items, namely, perceived helpfulness of the intervention and perceived appropriateness of the intervention content, on a 5-point Likert scale. Scores range from 2 to 10, where a higher score represents a higher treatment acceptance. |
| Immediately after the intervention |
| Background |
| Lee KCG, Gao J, Leung HK, Wu BWY, Roberts A, Thach TQ, Sik HH. Modulating Consciousness through Awareness Training Program and Its Impacts on Psychological Stress and Age-Related Gamma Waves. Brain Sci. 2024 Jan 17;14(1):91. doi: 10.3390/brainsci14010091. |
| 35936346 | Background | Gao J, Leung HK, Fan J, Wu BWY, Sik HH. The neurophysiology of the intervention strategies of Awareness Training Program on emotion regulation. Front Psychol. 2022 Jul 22;13:891656. doi: 10.3389/fpsyg.2022.891656. eCollection 2022. |
| 23983785 | Background | Chan JS, Ho RT, Wang CW, Yuen LP, Sham JS, Chan CL. Effects of qigong exercise on fatigue, anxiety, and depressive symptoms of patients with chronic fatigue syndrome-like illness: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:485341. doi: 10.1155/2013/485341. Epub 2013 Jul 31. |
| 37310329 | Background | Chan CS, Wong CYF, Yu BYM, Hui VKY, Ho FYY, Cuijpers P. Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial. Psychol Med. 2023 Apr;53(5):1799-1813. doi: 10.1017/S0033291721003421. Epub 2021 Aug 23. |
| D001523 |
| Mental Disorders |