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Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0003-2008-0784
Örebro University, School of Law, Psychology and Social Work. Dept Psychol, Stockholm Univ, Stockholm, Sweden.ORCID iD: 0000-0003-2059-1621
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0002-9688-5805
Dept Psychol, Univ Calif Berkeley, Berkeley, USA.
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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. Vol. 54, p. 38-48
Keywords [en]
Insomnia, Worry, Safety behaviours, Selective attention, Dysfunctional beliefs, Physiological arousal
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-34997DOI: 10.1016/j.brat.2014.01.002ISI: 000334009000006PubMedID: 24513668Scopus ID: 2-s2.0-84893596229OAI: oai:DiVA.org:oru-34997DiVA, id: diva2:716355
Available from: 2014-05-09 Created: 2014-05-09 Last updated: 2018-06-07Bibliographically approved
In thesis
1. Cogito, ergo insomnis: I think, therefore I am sleepless
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: 2017-10-17Bibliographically approved

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Norell-Clarke, AnnikaJansson-Fröjmark, MarkusTillfors, MariaLinton, Steven J.

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