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Insomnia: psychological mechanisms and early intervention: a cognitive-behavioral perspective
Örebro University, Department of Behavioural, Social and Legal Sciences.ORCID iD: 0000-0003-2059-1621
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

This dissertation focused on the role of psychological mechanisms in the development of insomnia and the effectiveness of an early cognitive-behavioral intervention for insomnia. The first aim was to examine whether distress, worry, and dysfunctional beliefs and attitudes about sleep were related to the development of insomnia. The findings from study I indicated that distress (anxiety and, to some extent, depression) was related to the development of insomnia. In study II, the relationship between sleep-related worry and subjective sleep perception was demonstrated to intensify over time, indicating that sleep-related worry was also linked to the development of insomnia. This indicates that both distress and sleep-related worry may be mechanisms that can be regarded as two of several pathways to insomnia. While distress was related to developing an onset of insomnia, worry was linked to the early development of insomnia. In study IV, dysfunctional beliefs and attitudes about sleep were not related to clinical improvement following cognitive behavior therapy for early insomnia. However, reductions in dysfunctional beliefs and attitudes about sleep were consistently linked to improvements in daytime symptoms, but not to sleep improvements. Instead of implying that such beliefs and attitudes are less important than distress and worry in the development of insomnia, it may rather suggest that dysfunctional beliefs and attitudes about sleep play a slightly different role in insomnia than previously envisioned.

The second aim of this dissertation was to compare the effects of cognitive-behavioral therapy for insomnia with self-help information in patients with a short history of insomnia. In study III, the results showed that an early cognitive-behavioral intervention was effective for individuals with insomnia. To the benefit of the patients with insomnia and to society, cognitive behavior therapy may have a deserving and vital role as an early intervention for patients with insomnia.

Taken together, the results in this dissertation indicate that psychological mechanisms play an important role in the development of insomnia. The findings might thus add to the elaboration of cognitive-behavioral models of insomnia. While most previous research has examined insomnia only in its persistent form, the focus of this dissertation was to study insomnia in its early phase. An approach where insomnia is studied in its early phase of development has not only heuristic value to the development of cognitive-behavioral models of the condition, but might also have implications for how cognitive-behavioral therapy for insomnia can be elaborated in future research and integrated in clinical settings.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2005. , p. 85
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 6
Keywords [en]
Psychology, insomnia, development, distress, worry, early intervention, cognitive-behavioral therapy, dysfunctional beliefs and attitudes about sleep
Keywords [sv]
Psykologi
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-175ISBN: 91-7668-449-0 (print)OAI: oai:DiVA.org:oru-175DiVA, id: diva2:135422
Public defence
2005-10-07, B-husets aula, Universitetssjukhuset, Örebro, 13:00
Opponent
Supervisors
Available from: 2005-09-16 Created: 2005-09-16 Last updated: 2017-10-18Bibliographically approved
List of papers
1. The role of anxiety and depression in the development of insomnia: cross-sectional and prospective analyses
Open this publication in new window or tab >>The role of anxiety and depression in the development of insomnia: cross-sectional and prospective analyses
2006 (English)In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321, Vol. 21, no 3, p. 383-397Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to examine the associations between anxiety, depression and insomnia, and to investigate whether anxiety and depression are related to future insomnia. This study employed a combination of a cross-sectional and a prospective design. From a randomly selected sample from the general population (N = 3600), 1936 participants filled out a baseline and 1-year follow-up survey on insomnia, anxiety and depression. Odds ratios (ORs) estimations were used to investigate the associations between anxiety, depression, and insomnia. In the cross-sectional study, anxiety (OR: 4.61) and depression (OR: 2.42) showed moderate to strong associations with insomnia. However, the prospective study showed that anxiety (OR: 3.35) was more strongly related than depression (OR: 1.96) to the development of insomnia 1 year later. While anxiety seems to play a key role in the development of insomnia, depression may be considered as a possible precipitating mechanism but even more likely as a consequence of insomnia.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-2888 (URN)10.1080/14768320500129015 (DOI)
Available from: 2005-09-16 Created: 2005-09-16 Last updated: 2017-12-14Bibliographically approved
2. The development of insomnia within the first year: a focus on worry
Open this publication in new window or tab >>The development of insomnia within the first year: a focus on worry
2006 (English)In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 11, no 3, p. 501-511Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this investigation was to study the relationships between sleep-related worry and subjective sleep perception as a function of stage of chronicity.

DESIGN: A cross-sectional study consisting of 136 individuals with a short history of insomnia was used.

METHODS: The 136 participants were grouped to form two different levels of chronicity based on their duration of insomnia: short (3-7 months; n=69) and long (>7-12 months; n=67). Two domains of sleep-related worry (sleeplessness and health) were used as predictors of subjective sleep perception (sleep onset latency, time awake after sleep onset, and total sleep time).

RESULTS: The association between worry for sleeplessness and subjective sleep perception was significantly different across the stages of chronicity. In the group with a short duration of insomnia, worry for sleeplessness was not related to subjective sleep perception. Worry for sleeplessness was however a significant predictor of subjective sleep perception in the group with a long duration of insomnia (unique variance: 33% on sleep onset latency, 19% on time awake after sleep onset, and 13% on total sleep time). Even if marked differences were observed between the two groups, worry for health was not significantly different across stages of chronicity on subjective sleep perception.

CONCLUSIONS: This suggests that the role of sleep-related worry to subjective sleep perception may increase over time. Given that worry was a mechanism with an increasingly stronger impact over time, this supports the idea that worry is a potential mechanism related to the development of insomnia.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-2889 (URN)10.1348/135910705X57412 (DOI)16870058 (PubMedID)
Available from: 2005-09-16 Created: 2005-09-16 Last updated: 2017-12-14Bibliographically approved
3. Cognitive-behavioral group therapy as an early intervention for insomnia: a randomized controlled trial
Open this publication in new window or tab >>Cognitive-behavioral group therapy as an early intervention for insomnia: a randomized controlled trial
2005 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 15, no 2, p. 177-190Article in journal (Refereed) Published
Abstract [en]

A randomized controlled design was used with a 1-yr follow-up. The purpose was to compare the effects of two early interventions, a cognitive-behavioral group intervention and a self-help information package, in patients with insomnia. In sum, 165 individuals seeking care for insomnia of 3–12 months duration were randomized to either a group receiving a CBT intervention or a group receiving a self-help information package. At the 1-yr follow-up, 136 participants had completed the entire study. At the 1-yr follow-up, the CBT group intervention was, compared with the control group, effective in producing reductions in dysfunctional beliefs and attitudes about sleep, negative daytime symptoms, as well as vital improvements in sleep (i.e. sleep onset latency, time awake after sleep onset, total sleep time, sleep quality, and sleep efficiency). In comparison with the control group, significantly more participants in the CBT group met criteria at the 1-yr follow-up for clinically meaningful improvements in sleep onset latency, time awake after sleep onset, and sleep efficiency. A CBT group intervention may well be a viable early intervention for patients with insomnia in a wide range of health services.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-2890 (URN)10.1007/s10926-005-1217-9 (DOI)
Available from: 2005-09-16 Created: 2005-09-16 Last updated: 2017-12-14Bibliographically approved
4. The role of dysfunctional beliefs about sleep to improvement in early cognitive-behavioral therapy for insomnia
Open this publication in new window or tab >>The role of dysfunctional beliefs about sleep to improvement in early cognitive-behavioral therapy for insomnia
(English)Manuscript (preprint) (Other academic)
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-2891 (URN)
Available from: 2005-09-16 Created: 2005-09-16 Last updated: 2017-10-18Bibliographically approved

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