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  • 1.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Harvey, Allison G.
    Department of Psychology, Berkeley University of California, Berkley, USA.
    Lundh, Lars-Gunnar
    Psykologiska insitutionen, Lunds universitet, Lund, Sverige.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Psychometric properties of an insomnia-specific measure of worry: the anxiety and preoccupation about sleep questionnaire2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 1, p. 65-76Article in journal (Refereed)
    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.

  • 2.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work. Stockholm University, Stockholm, Sweden.
    Harvey, Allison G.
    Psychology Department, Berkeley University, San Francisco, USA.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Associations between psychological factors and night-time/daytime symptomatology in insomnia2012In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no Suppl. 1, p. 168-169Article in journal (Refereed)
    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.

  • 3.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Harvey, Allison G.
    Department of Psychology, University of California, Berkeley CA, United States.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Associations between psychological factors and nighttime/daytime symptomatology in insomnia2012In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 41, no 4, p. 273-287Article in journal (Refereed)
    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.

  • 4.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Granberg, Sarah
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Centre, Örebro University Hospital, Örebro, Sweden.
    Danermark, Berth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Audiological Research Centre, Örebro University Hospital, Örebro, Sweden.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Cognitive-behavioral therapy for insomnia co-morbid with hearing impairment: a randomized controlled trial2012In: Journal of clinical psychology in medical settings, ISSN 1068-9583, E-ISSN 1573-3572, Vol. 19, no 2, p. 224-234Article in journal (Refereed)
    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.

  • 5.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample2012In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, no 2, p. 103-110Article in journal (Refereed)
    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.

  • 6.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work. Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven
    Örebro University, School of Law, Psychology and Social Work.
    The role of emotion dysregulation in insomnia: longitudinal findings from a large community sample2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 133-134Article in journal (Other academic)
  • 7.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, Stockholm University, Stockholm, Sweden.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Linton, Steven J
    Örebro University, School of Law, Psychology and Social Work.
    The role of emotion dysregulation in insomnia: Longitudinal findings from a large community sample2016In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 21, no 1, p. 93-113Article in journal (Refereed)
    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.
  • 8.
    Norell, Annika. E. Clarke
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Nyander, Eva-Lotta
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work.
    Sleepless in Sweden: effects of cognitive therapy on youths with primary insomnia2009In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 32, p. A269-A270, article id 0824Article in journal (Other academic)
  • 9.
    Norell Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Harvey, Allison G.
    Lundh, Lars-Göran
    A psychometric investigation into two insomnia-specific measures of worry/rumination: the pre-sleep arousal scale and the anxiety and preoccupation about sleep questionnaire2010Conference paper (Other academic)
    Abstract [en]

    Introduction: The aim with this investigation was to psychometrically evaluate two insomnia-specific measures of worry/rumination: the Pre-Sleep Arousal Scale (PSAS; cognitive subscale) and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ).

    Methods: From a randomly selected sample from the general population (N = 5,000), 2,333 participants filled out a survey on sleep, daytime impairment, PSAS-C, and APSQ.

    Results: Exploratory factor analyses showed that for both PSAS-C and APSQ only one factor was retained (total variance: 64% and 69%). One of the PSAS-C items fitted less well in the solution (‘being distracted by sounds, noise in the environment’). The internal consistency for PSAS-C was .92 and for APSQ .95, and the two measures were highly correlated (r: .67). Both measures were correlated with sleep onset latency (r: .43-.50), wake time after sleep onset during night (r: .44-.46) and morning (r: .31-.34), sleep quality (r: .55-.60), and with sleep restoration (r: .51-.54). The two measures were correlated with daytime symptoms and function (r: .27-.57). On both measures, significant mean differences were noted between three groups with differing insomnia symptomatology; insomnia disorder group reported significantly higher scores than insomnia symptoms and normal sleep groups, and insomnia symptoms group had significantly higher levels than normal sleep group.

    Conclusions: In all, PSAS-C and APSQ are both psychometrically sound measures for assessing worry/rumination in insomnia.

  • 10.
    Norell Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Nyander, EvaLotta
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work.
    Effects of cognitive therapy on youths with primary insomnia2009Conference paper (Other academic)
  • 11.
    Norell Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Nyander, EvaLotta
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work.
    Sleepless in Sweden: a single subject study of effects of cognitive therapy for insomnia on three adolescents2011In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 39, p. 367-374Article in journal (Refereed)
    Abstract [en]

    Background: Sleeping difficulties are an increasing problem for youths, but there is a lack of treatment research for this age group.

    Aim: The aim of this study was to investigate the effects of Cognitive Therapy for Insomnia (CT-I) on youths with primary insomnia; this treatment has never been tested on youths before.

    Method: The study was conducted according to an AB single-case experimental phase design, with pre-tests and post-tests. After 7–10 days of baseline assessment, three youths aged 16–18 (2 male) with primary insomnia participated in a 7-week long treatment. A sleep diary was used throughout the treatment. A followup assessment including one week with a sleep diary was conducted 3 months later. Visual inspection was used to analyze outcome.

    Results: Insomnia severity was greatly reduced for all participants after treatment. Daily measures showed that sleep onset latency was reduced for two participants but no change in total sleep time was confirmed. Daytime symptoms fluctuated for the participants. The insomnia-specific psychological processes were reduced to varying extents. These results were maintained at the follow-up measure.

    Conclusions: CT-I may be a promising treatment for youths with insomnia and the treatment should be tested further in randomized controlled studies.

    Download full text (pdf)
    Sleepless in Sweden
  • 12. Norell-Clarke, A.
    et al.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Harvey, A. G.
    Lundh, L. G.
    Evaluating the cognitive model of insomnia: a general population approach2010Conference paper (Refereed)
  • 13.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Cogito, ergo insomnis: I think, therefore I am sleepless2014Doctoral 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.

    List of papers
    1. Sleepless in Sweden: a single subject study of effects of cognitive therapy for insomnia on three adolescents
    Open this publication in new window or tab >>Sleepless in Sweden: a single subject study of effects of cognitive therapy for insomnia on three adolescents
    2011 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 39, p. 367-374Article in journal (Refereed) Published
    Abstract [en]

    Background: Sleeping difficulties are an increasing problem for youths, but there is a lack of treatment research for this age group.

    Aim: The aim of this study was to investigate the effects of Cognitive Therapy for Insomnia (CT-I) on youths with primary insomnia; this treatment has never been tested on youths before.

    Method: The study was conducted according to an AB single-case experimental phase design, with pre-tests and post-tests. After 7–10 days of baseline assessment, three youths aged 16–18 (2 male) with primary insomnia participated in a 7-week long treatment. A sleep diary was used throughout the treatment. A followup assessment including one week with a sleep diary was conducted 3 months later. Visual inspection was used to analyze outcome.

    Results: Insomnia severity was greatly reduced for all participants after treatment. Daily measures showed that sleep onset latency was reduced for two participants but no change in total sleep time was confirmed. Daytime symptoms fluctuated for the participants. The insomnia-specific psychological processes were reduced to varying extents. These results were maintained at the follow-up measure.

    Conclusions: CT-I may be a promising treatment for youths with insomnia and the treatment should be tested further in randomized controlled studies.

    Place, publisher, year, edition, pages
    Cambridge University Press, 2011
    Keywords
    insomnia, cognitive therapy, single-case, adolescence
    National Category
    Applied Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-32221 (URN)10.1017/S1352465810000664 (DOI)000289726000010 ()21205358 (PubMedID)2-s2.0-79956156486 (Scopus ID)
    Available from: 2013-11-01 Created: 2013-11-01 Last updated: 2020-01-30Bibliographically approved
    2. Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population
    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
    Show others...
    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
    3. An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depression
    Open this publication in new window or tab >>An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depression
    Show others...
    (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.

    Keywords
    Insomnia, depression, cognitive behavioural therapy, dysfunctional beliefs, mediation
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-36103 (URN)
    Available from: 2014-08-25 Created: 2014-08-25 Last updated: 2020-01-30Bibliographically approved
    Download full text (pdf)
    Introductory chapter
    Download (pdf)
    Cover
    Download (pdf)
    Spikblad
  • 14.
    Norell-Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work. Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Harvey, Allison G.
    Dept Psychol, Univ Calif Berkeley, Berkeley, USA.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 38-48Article in journal (Refereed)
    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.

  • 15.
    Norell-Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    TIllfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden.
    Holländare, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depressionManuscript (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.

  • 16.
    Norell-Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work. Stockholm University, Stockholm, Sweden.
    Holländare, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiat Res Ctr, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiat Res Ctr, Örebro, Sweden.
    An investigation of dysfunctional beliefs as a mediator of cognitive behavioural therapy for insomnia in a sample with insomnia and depression2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 217-217Article in journal (Other academic)
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