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An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depression
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0003-2008-0784
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0002-9688-5805
Örebro University, School of Law, Psychology and Social Work. Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden.ORCID iD: 0000-0003-2059-1621
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0001-9500-7763
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: CBT for insomnia (CBT-I) seems to affect both insomnia and depression in comorbid samples but there is a gap in the knowledge about how the treatment works. The aim was to gain a greater understanding of the relationship between insomnia-specific cognitive processes, insomnia, depressive symptoms and CBT-I in sample with insomnia comorbid with depressive problems.

Methods: 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four sessions over seven weeks. Insomnia, depressive severity, and cognitive processes were measured pre-, mid- and post-treatment.

Results: All cognitive processes: sleep-related worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours, lowered over the course of treatment. CBT-I was associated with greater reductions of safety behaviours and dysfunctional beliefs about sleep compared to RT. Mid-treatment dysfunctional beliefs aboutsleep mediated between CBT-I and outcomes on insomnia and depression severity.

Conclusion: Dysfunctional beliefs may be a transdiagnostic process of both insomnia and depression. Clinical implications and further directions are discussed.

Keyword [en]
Insomnia, depression, cognitive behavioural therapy, dysfunctional beliefs, mediation
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-36103OAI: oai:DiVA.org:oru-36103DiVA: diva2:740446
Available from: 2014-08-25 Created: 2014-08-25 Last updated: 2017-10-17Bibliographically 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. 96 p.
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 30
Keyword
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, AnnikaTIllfors, MariaJansson-Fröjmark, MarkusHolländare, FredrikEngström, Ingemar
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School of Law, Psychology and Social WorkSchool of Health and Medical Sciences, Örebro University, Sweden
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