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Norell-Clarke, AnnikaORCID iD iconorcid.org/0000-0003-2008-0784
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Publications (10 of 16) Show all publications
Jansson-Fröjmark, M., Norell-Clarke, A. & Linton, S. J. (2016). The role of emotion dysregulation in insomnia: Longitudinal findings from a large community sample. British Journal of Health Psychology, 21(1), 93-113
Open this publication in new window or tab >>The role of emotion dysregulation in insomnia: Longitudinal findings from a large community sample
2016 (English)In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 21, no 1, p. 93-113Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The purpose of this longitudinal investigation was to examine the association between emotion regulation and future insomnia (incidence and persistence).

DESIGN: A longitudinal study in the general population.

METHODS: A survey was sent out to 5,000 individuals in the community. To those who returned the baseline questionnaire (n = 2,333), two follow-up surveys, 6 and 18 months later, were sent out and then completed by 1,887 and 1,795 individuals, respectively. The survey contained information about demographic factors, insomnia symptomatology, the Difficulties in Emotion Regulation Scale, anxiety, and depression.

RESULTS: The findings suggested that emotion regulation at baseline was not associated with the incidence or persistence of insomnia. Overall, the effect sizes were very small to medium. When examining changes in emotion regulation over time, a different pattern emerged. Partial support was established for the notion that decreases in emotion regulation were related to incident and persistent insomnia, as a decrease in emotion regulation was associated with a higher likelihood of future insomnia. Yet, the effect sizes were very small to small.

CONCLUSION: This study does partly point towards a longitudinal association between emotion dysregulation and insomnia. This might have implications for the conceptualization and management of insomnia as well as for future research.

Statement of contribution:

What is already known on this subject?

  • Previous research has indicated that emotion dysregulation might be enhanced in patients with insomnia.
  • A number of limitations have however hindered progress in understanding how emotion dysregulation is related to insomnia, such as limited research on the topic and relying solely on cross-sectional data.

What does this study add?

  • The current investigation showed that emotion dysregulation is a risk factor for the development of incident and persistent insomnia.
  • This study also shows that increased emotion dysregulation over time heightens the risk of incident and persistent insomnia.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
insomnia; sleep; epidemiology; emotion regulation; Difficulties in Emotion Regulation Scale, insomni, sömnproblem, emotionsreglering, emotioner
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-47055 (URN)10.1111/bjhp.12147 (DOI)000367827800006 ()26347204 (PubMedID)2-s2.0-84954374855 (Scopus ID)
Note

Funding Agency:

Swedish Council for Working Life and Social Research

Available from: 2015-12-11 Created: 2015-12-11 Last updated: 2020-01-30Bibliographically approved
Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F. & Engström, I. (2014). An investigation of dysfunctional beliefs as a mediator of cognitive behavioural therapy for insomnia in a sample with insomnia and depression. Paper presented at 22nd Congress of the European-Sleep-Research-Society, Tallinn, Estonia, September 16-20, 2014. Journal of Sleep Research, 23, 217-217
Open this publication in new window or tab >>An investigation of dysfunctional beliefs as a mediator of cognitive behavioural therapy for insomnia in a sample with insomnia and depression
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2014 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 217-217Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:oru:diva-43942 (URN)000349960600588 ()
Conference
22nd Congress of the European-Sleep-Research-Society, Tallinn, Estonia, September 16-20, 2014
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2020-01-30Bibliographically approved
Norell-Clarke, A. (2014). Cogito, ergo insomnis: I think, therefore I am sleepless. (Doctoral dissertation). Örebro: Örebro university
Open this publication in new window or tab >>Cogito, ergo insomnis: I think, therefore I am sleepless
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems.

The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2014. p. 96
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 30
Keywords
insomnia, CBT, cognitive therapy, worry, dysfunctional beliefs, arousal, selective attention, safety behaviours
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-35794 (URN)978-91-7529-035-5 (ISBN)
Public defence
2014-10-03, Långhuset, Hörsal 2, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-07-24 Created: 2014-07-24 Last updated: 2020-01-30Bibliographically approved
Norell-Clarke, A., Jansson-Fröjmark, M., Tillfors, M., Harvey, A. G. & Linton, S. J. (2014). Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population. Behaviour Research and Therapy, 54, 38-48
Open this publication in new window or tab >>Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population
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2014 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 38-48Article in journal (Refereed) Published
Abstract [en]

Aim: Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.

Methods: In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.

Results: Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.

Conclusions: The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Insomnia, Worry, Safety behaviours, Selective attention, Dysfunctional beliefs, Physiological arousal
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-34997 (URN)10.1016/j.brat.2014.01.002 (DOI)000334009000006 ()24513668 (PubMedID)2-s2.0-84893596229 (Scopus ID)
Available from: 2014-05-09 Created: 2014-05-09 Last updated: 2020-01-30Bibliographically approved
Jansson-Fröjmark, M., Norell-Clarke, A. & Linton, S. (2014). The role of emotion dysregulation in insomnia: longitudinal findings from a large community sample. Paper presented at 22nd Congress of the European-Sleep-Research-Society, Tallinn, Estonia, September 16-20, 2014. Journal of Sleep Research, 23, 133-134
Open this publication in new window or tab >>The role of emotion dysregulation in insomnia: longitudinal findings from a large community sample
2014 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 133-134Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:oru:diva-43941 (URN)000349960600346 ()
Conference
22nd Congress of the European-Sleep-Research-Society, Tallinn, Estonia, September 16-20, 2014
Available from: 2015-03-30 Created: 2015-03-30 Last updated: 2020-01-30Bibliographically approved
Jansson-Fröjmark, M., Harvey, A. G., Norell-Clarke, A. & Linton, S. J. (2012). Associations between psychological factors and night-time/daytime symptomatology in insomnia. Paper presented at 21th Congress of the European Sleep Research Society, Paris, France, September 4-8, 2012. Journal of Sleep Research, 21(Suppl. 1), 168-169
Open this publication in new window or tab >>Associations between psychological factors and night-time/daytime symptomatology in insomnia
2012 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no Suppl. 1, p. 168-169Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Objectives: Cognitive models of insomnia underscore cognitive mechanisms as important in the maintenance of insomnia. The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms with night-time and daytime symptoms.

Methods: In a cross-sectional examination, participants (n = 2327) from a randomly selected sample of the general population completed a survey on demographic parameters, night-time symptoms, daytime impairment, health outcomes, and psychological factors intended to index five cognitive processes (Harvey, 2002). Excluding those with a sleep disorder other than insomnia, the study sample consisted of 1890 participants.  

Results: Relative to poor and normal sleepers, the insomnia group scored higher on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviours relative to the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviours (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance).

Conclusion: The findings show that psychological factors discriminate those with insomnia from those with poor or normal sleep. The results also indicate that psychological factors are linked to insomnia-specific night-time and daytime symptomatology.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
National Category
Neurology
Research subject
Neurology
Identifiers
urn:nbn:se:oru:diva-26814 (URN)000307963200391 ()
Conference
21th Congress of the European Sleep Research Society, Paris, France, September 4-8, 2012
Available from: 2013-01-09 Created: 2013-01-09 Last updated: 2020-01-30Bibliographically approved
Jansson-Fröjmark, M., Harvey, A. G., Norell-Clarke, A. & Linton, S. J. (2012). Associations between psychological factors and nighttime/daytime symptomatology in insomnia. Cognitive Behaviour Therapy, 41(4), 273-287
Open this publication in new window or tab >>Associations between psychological factors and nighttime/daytime symptomatology in insomnia
2012 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 41, no 4, p. 273-287Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms and nighttime and daytime symptoms.

Methods: A cross-sectional examination in the general population was used. The study sample consisted of 1890 participants from the general population. The participants completed a survey on nighttime and daytime symptoms, health outcomes, and psychological factors.

Results: Relative to poor and normal sleepers, the insomnia group had higher scores on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviors than the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviors (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance).

Conclusion: The findings indicate that psychological factors are linked to nighttime and daytime symptomatology in insomnia.

Keywords
cognitions, epidemiology, health, insomnia, sleep
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-24851 (URN)10.1080/16506073.2012.672454 (DOI)22439741 (PubMedID)
Projects
Prospective Investigation on Psychological Processes for Insomnia (PIPPI)
Available from: 2012-08-23 Created: 2012-08-23 Last updated: 2020-01-30Bibliographically approved
Jansson-Fröjmark, M., Linton, S. J., Flink, I. K., Granberg, S., Danermark, B. & Norell-Clarke, A. (2012). Cognitive-behavioral therapy for insomnia co-morbid with hearing impairment: a randomized controlled trial. Journal of clinical psychology in medical settings, 19(2), 224-234
Open this publication in new window or tab >>Cognitive-behavioral therapy for insomnia co-morbid with hearing impairment: a randomized controlled trial
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2012 (English)In: Journal of clinical psychology in medical settings, ISSN 1068-9583, E-ISSN 1573-3572, Vol. 19, no 2, p. 224-234Article in journal (Refereed) Published
Abstract [en]

The purpose of the current study was to examine the effects of cognitive behavior therapy (CBT-I) for insomnia on patients with insomnia co-morbid with hearing impairment. A randomized controlled design was used with a 3-month follow-up. Thirty-two patients with insomnia co-morbid with hearing impairment were randomized to either CBT-I or a waitlist condition (WLC). The primary outcome was insomnia severity. Secondary outcomes were sleep diary parameters, dysfunction, anxiety, and depression. Compared to WLC, CBT-I resulted in lower insomnia severity at post-treatment and at follow-up (d = 1.18–1.56). Relative to WLC, CBT-I also led, at both assessment points, to reduced total wake time (d = 1.39) and increased sleep restoration (d = 1.03–1.07) and sleep quality (d = 0.91–1.16). Both groups increased their total sleep time, but no significant group difference emerged. Compared to WLC, CBT-I resulted in higher function (d = 0.81–0.96) and lower anxiety (d = 1.29–1.30) at both assessment points. Neither CBT-I nor WLC led to improvement on depression. Based on the Insomnia Severity Index, more CBT-I (53–77%) than WLC participants (0–7%) were treatment responders. Also, more CBT-I (24%) than WLC participants (0%) remitted. In patients with insomnia co-morbid with hearing impairment, CBT-I was effective in decreasing insomnia severity, subjective sleep parameters, dysfunction, and anxiety. These findings are in line with previous results on the effects of CBT-I in other medical conditions.

Place, publisher, year, edition, pages
New York, USA: Springer, 2012
Keywords
Insomnia, hearing impairment, tinnitus, cognitive behavior therapy, co-morbidity
National Category
Applied Psychology Other Health Sciences Otorhinolaryngology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-21660 (URN)10.1007/s10880-011-9275-y (DOI)000303866900009 ()22323041 (PubMedID)2-s2.0-84861481168 (Scopus ID)
Available from: 2012-02-15 Created: 2012-02-15 Last updated: 2020-01-30Bibliographically approved
Jansson-Fröjmark, M. & Norell-Clarke, A. (2012). Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample. Journal of Psychosomatic Research, 72(2), 103-110
Open this publication in new window or tab >>Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample
2012 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, no 2, p. 103-110Article in journal (Refereed) Published
Abstract [en]

Objective: The purpose was to examine the psychometric properties of the Pre-Sleep Arousal Scale.

Methods: From a randomly selected sample of the general population (N = 5000), 2327 participants completed a survey on nighttime symptoms, daytime symptoms, health outcomes, and psychological processes. The study sample consisted of 1890 participants who did not fulfill criteria for a sleep disorder other than insomnia.

Results: Findings indicated that the PSAS did not produce an adequate factorial solution. When three problematic items were removed, the solution, accounting for 48.5% of the variance, improved (PSAS-13). One subscale, cognitive arousal (alpha = .88), consisted of five items (37.1%), and one subscale, somatic arousal (alpha = .72), of eight items (11.4%). The two factors were significantly inter-correlated (rho = .51) and associated with the PSAS-13 (rho = .91, rho = .80). Among those with insomnia, a shortened PSAS (PSAS-14) was established, which consisted of a cognitive and a somatic subscale (48.6% of the variance). The PSAS-13 and the two subscales showed discriminant validity between three sleep groups (normal sleep, poor sleep, and insomnia disorder) (R-2 = .24-.34). The PSAS-13 and the subscales demonstrated convergent validity with measures on sleep-related worry, sleep-related beliefs, anxiety, and depression. The PSAS-13 and the two subscales were significantly correlated with sleep parameters and daytime impairment.

Conclusion: Though acceptable psychometric properties were established for the PSAS, the cognitive sub-scale's focus upon general pre-sleep arousal and the relatively low variance accounted for calls for further work on and a possible re-conceptualization of the PSAS.

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
Insomnia, Sleep, Arousal, Scale
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-21824 (URN)10.1016/j.jpsychores.2011.10.005 (DOI)000299856800003 ()22281450 (PubMedID)2-s2.0-84856222611 (Scopus ID)
Projects
Prospective Investigation on Psychological Processes for Insomnia (PIPPI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2012-02-27 Created: 2012-02-27 Last updated: 2020-01-30Bibliographically approved
Jansson-Fröjmark, M., Harvey, A. G., Lundh, L.-G., Norell-Clarke, A. & Linton, S. J. (2011). Psychometric properties of an insomnia-specific measure of worry: the anxiety and preoccupation about sleep questionnaire. Cognitive Behaviour Therapy, 40(1), 65-76
Open this publication in new window or tab >>Psychometric properties of an insomnia-specific measure of worry: the anxiety and preoccupation about sleep questionnaire
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2011 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 1, p. 65-76Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine the psychometric properties of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), with a focus on factorial validity and internal consistency as well as discriminative, convergent, and association with sleep parameters and daytime impairment. Among a randomly selected sample from the general population (N = 5,000), 2,333 participants completed a survey on nighttime symptoms, daytime symptoms, health outcomes, and psychological processes. The study sample consisted of 1800 participants who did not fulfill criteria for another sleep disorder than insomnia. A two-factor solution, accounting for 70.7% of the variance, was extracted from the 10 APSQ items. One six-item factor determined worries about the consequences of poor sleep (a = .91); the second factor, with four items, assessed worries about the uncontrollability of sleep (a = .86). The two factors were significantly intercorrelated (ρ = .65) and significantly associated with the total APSQ (ρs = .97 and .76, respectively). The APSQ and the two subscales showed discriminant validity between three sleep status groups (normal sleep, poor sleep, and insomnia disorder; R2 = .33-.41). The APSQ and the subscales demonstrated convergent validity with measures on cognitive arousal, sleep-related beliefs, anxiety, and depression. They also were significantly correlated with sleep parameters and daytime impairment. The findings suggest that the APSQ is a psychometrically sound instrument for assessing worry in insomnia.

Keywords
insomnia, sleep, worry, scale
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-13462 (URN)10.1080/16506073.2010.538432 (DOI)
Available from: 2011-01-12 Created: 2011-01-12 Last updated: 2020-01-30Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2008-0784

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