1
|
Yu H, Shi Z, Zhao M. The Relationship between Metacognition, Rumination, and Sleep in University Students with a Tendency toward Generalized Anxiety Disorder. Behav Sci (Basel) 2024; 14:444. [PMID: 38920776 PMCID: PMC11201180 DOI: 10.3390/bs14060444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/09/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
People with generalized anxiety disorder tend to have sleep problems, and studies have found correlations between metacognition, rumination, and sleep, but it is unclear how metacognition and rumination work in people with a tendency towards generalized anxiety disorder. The goal of this paper is to investigate the correlation between metacognition, rumination, and sleep in university students with a tendency towards generalized anxiety disorder, and the mediating role of rumination in the effect of metacognition on sleep. The Generalized Anxiety Disorder Scale (GAD-7), the Meta-Cognition Questionnaire (MCQ-30), the Ruminative Responses Scale (RRS), and the Insomnia Severity Index (ISI) were used to investigate and psychometrically measure 566 university students in Anyang Normal College. The results of correlation analysis showed significant positive correlations between metacognition and sleep, ruminative thinking and sleep, and metacognition and rumination in university students with a tendency towards generalized anxiety disorder. Mediation analysis showed that rumination partially mediated the effect of metacognition on sleep, with the mediating effect accounting for 51.1% of the total effect. There is a strong correlation between metacognition, rumination, and sleep in university students with a tendency towards generalized anxiety disorder, and both metacognition and rumination can predict sleep, while metacognition can affect sleep through the mediating effect of rumination.
Collapse
Affiliation(s)
| | - Zhanbiao Shi
- Institute of Psychology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Beijing 100101, China; (H.Y.); (M.Z.)
| | | |
Collapse
|
2
|
Pieroni I, Raffone A, Simione L. Sleep reactivity mediates the relationship between sensory-processing sensitivity and insomnia symptoms severity: A cross-sectional correlational study. Stress Health 2024; 40:e3297. [PMID: 37492995 DOI: 10.1002/smi.3297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
Sensory-processing sensitivity (SPS) is a temperamental trait that describes individual differences in sensitivity to environmental stimuli. Previous studies have shown that highly sensitive individuals are more vulnerable to stress and to sleep-related difficulties. In light of this evidence, we hypothesized that SPS is associated with an increase in insomnia symptoms and that this correlation would be mediated by increased perceived stress and sleep reactivity. To test this hypothesis, we conducted a cross-sectional study on 358 adults who completed a survey that included self-report measures of sensitivity, perceived stress, sleep reactivity, and insomnia symptoms. Correlation analysis revealed that SPS was positively related to both stress-related and sleep-related variables. We then conducted a mediation analysis, which revealed that SPS was positively related to insomnia symptoms and that this relationship was fully mediated by sleep reactivity but not mediated at all by perceived stress. The current findings suggest that sleep reactivity may contribute to the development of insomnia symptoms in highly sensitive individuals. Therefore, these results suggests that sleep reactivity should be assessed in highly sensitive individuals and that it could be important to evaluate and further study this relationship.
Collapse
Affiliation(s)
- Ilde Pieroni
- Department of Psychology, "Sapienza," University of Rome, Rome, Italy
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo (Pescara), Italy
| | - Antonino Raffone
- Department of Psychology, "Sapienza," University of Rome, Rome, Italy
- School of Buddhist Studies, Philosophy, and Comparative Religions, Nalanda University, Rajgir, India
| | - Luca Simione
- Institute of Cognitive Sciences and Technologies, Rome, Italy
- Faculty of Interpreting and Translation, UNINT Università degli Studi Internazionali, Rome, Italy
| |
Collapse
|
3
|
Uygur OF, Ahmed O, Bahar A, Hursitoglu O, Aydın EF, Chung S, Ozcan H, Drake CL. Adaptation and Validation of the Turkish Version of the Ford Insomnia Response to Stress Test in University Students. Nat Sci Sleep 2023; 15:139-149. [PMID: 37008595 PMCID: PMC10065018 DOI: 10.2147/nss.s398489] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
Objective We adapted the Ford Insomnia Response to Stress Test to Turkish (FIRST-T) and validated it. Methods We randomly divided 774 Turkish university students into two equal groups for exploratory (EFA) and confirmatory factor analysis (CFA). McDonald's omega and Cronbach's alpha values were utilized for reliability analyses. Item response theory (IRT) approach also used for psychometric properties on the full sample. For discriminant validity, study sample were classified into high and low sleep reactivity groups, and their sociodemographic and sleep data were compared. Results EFA results suggested a one-factor structure of the FIRST-T, which was confirmed by CFA results. The FIRST-T had solid internal reliability. Item analysis results showed that all the items could distinguish between low and high scorers. This scale showed the same construct (clinical insomnia vs good sleepers) across the sexes in multi-group CFA and differential item functioning results. In the high FIRST-T score group, sleep quality, severity of insomnia, and anxiety scores were higher. In this group, more participants had clinical insomnia according to the Insomnia Severity Index (ISI) and were poor sleepers according to the Pittsburg Sleep Quality Index (PSQI) (p < 0.01). Conclusion The FIRST-T has robust psychometric properties that assesses sleep reactivity among university students.
Collapse
Affiliation(s)
- Omer Faruk Uygur
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
- Correspondence: Omer Faruk Uygur, Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey, Tel +90 442 344 66 66, Email
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, Bangladesh
| | - Aynur Bahar
- Department of Psychiatric Nursing, Gaziantep University Faculty of Health Sciences, Gaziantep, Turkey
| | - Onur Hursitoglu
- Department of Psychiatry, Sular Academy Hospital, Kahramanmaras, Turkey
| | - Esat Fahri Aydın
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Halil Ozcan
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Christopher L Drake
- Henry Ford Hospital Sleep Disorders and Research Center, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, Wayne State College of Medicine, Detroit, MI, USA
| |
Collapse
|
4
|
Metacognition Mediates the Association Between Drug Dependence and Sleep Disturbances: Cross-Sectional Findings Among Khat-Chewing Polysubstance Users. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
5
|
Frøjd LA, Papageorgiou C, Munkhaugen J, Moum T, Sverre E, Nordhus IH, Dammen T. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med 2022; 18:779-787. [PMID: 34633284 PMCID: PMC8883089 DOI: 10.5664/jcsm.9712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease. METHODS A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale). RESULTS Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant. CONCLUSIONS Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia. CITATION Frøjd LA, Papageorgiou C, Munkhaugen J, et al. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.
Collapse
Affiliation(s)
- Lars Aastebøl Frøjd
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway,Address correspondence to: Lars Aastebøl Frøjd, StudMed, Department of Behavioural Medicine, Institute of Basic Medical Sciences, Institute of Medicine, University of Oslo. Postal address: Postboks 1111 Blindern 0317 Oslo, Norway;
| | - Costas Papageorgiou
- Priory Hospital Altrincham, Cheshire, United Kingdom,Department of Psychology, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway,Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Torbjørn Moum
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - Elise Sverre
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway,Department of Medicine, Drammen Hospital, Drammen, Norway
| | - Inger Hilde Nordhus
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway,Department of Clinical Psychology, University of Bergen, Bergen Norway
| | - Toril Dammen
- Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
6
|
Zamani E, Akbari M, Mohammadkhani S, Riskind JH, Drake CL, Palagini L. The Relationship of Neuroticism with Sleep Quality: The Mediating Role of Emotional, Cognitive and Metacognitive Factors. Behav Sleep Med 2022; 20:74-89. [PMID: 33618569 DOI: 10.1080/15402002.2021.1888730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Poor sleep quality is associated with a broad range of psychopathology and is a common problem among college students. This study aimed to investigate the mediating role of metacognitive beliefs related to sleep, emotion regulation and a negative cognitive style related to anxiety (looming cognitive style) in the relation between neuroticism and reported sleep quality. PARTICIPANTS Participants were 343 undergraduates from three universities in Tehran (56.3% females, Mean age = 22.01 ± 2.74 years). METHOD Data were gathered with a questionnaire packet that included the Pittsburgh Sleep Quality Index (PSQI), Metacognitions Questionnaire-Insomnia (MCQ-I), Emotion Regulation Questionnaire (ERQ), Looming Maladaptive Style Questionnaire (LMSQ) and Neuroticism subscale of NEO-PI-R. RESULTS Structural equation modeling analyses supported a proposed model (R2 = 37%) which proposed that neuroticism both directly and indirectly linked to reported sleep quality through metacognitions related to sleep, cognitive reappraisal and looming cognitive style (χ2 = 1194.87, p < .001; CFI = 0.93, NFI = 0.90, RMSEA = 0.065, GFI = 0.92, SRMR = 0.069, IFI = 0.93). CONCLUSIONS The results provide evidence for the impact of neuroticism on reported sleep quality through metacognitive, cognitive and emotional factors. The result suggest that special attention should be paid to these factors in the treatment and psychopathology of sleep quality.
Collapse
Affiliation(s)
- Elahe Zamani
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | | | - John H Riskind
- Department of Psychology, George Mason University, Fairfax, Virginia
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Laura Palagini
- Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Pisa, Italy
| |
Collapse
|
7
|
Galbiati A, Sforza M, Scarpellino A, Salibba A, Leitner C, D'Este G, Mombelli S, Ferini-Strambi L, Castronovo V. "Thinking About Thinking" in Insomnia Disorder: The Effect of Cognitive-Behavioral Therapy for Insomnia on Sleep-Related Metacognition. Front Psychol 2021; 12:705112. [PMID: 34566784 PMCID: PMC8458623 DOI: 10.3389/fpsyg.2021.705112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Metacognition is defined as the ability to reflect on one’s mental state and to govern thoughts and beliefs. Metacognitive dysfunctions are typical of several psychopathologic conditions, and also a feature of insomnia disorder, possibly playing a crucial role in its genesis and maintenance. In the context of insomnia, metacognition describes how individuals react to their own sleep-related thoughts and beliefs, boosting the hyperarousal state experienced by these patients. Up to now, no studies evaluated the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning. Therefore, the aim of our study was to evaluate the effect of CBT-I administered in group format in patients with insomnia disorder. As expected, all patients showed significant improvements in both insomnia and sleep diary parameters after treatment. Furthermore, an improvement was observed also in dysfunctional metacognitive levels, assessed by means of the Metacognitions Questionnaire-Insomnia (MCQ-I). However, 63% of patients still showed a MCQ-I score above the clinical cutoff after treatment. Dividing the sample on the basis of MCQ-I questionnaire scores after CBT-I, we found that patients, who still presented metacognitive impairment, received significant beneficial effects from CBT-I both on insomnia symptoms and on dysfunctional beliefs, but not on dysfunctional metacognitive functioning. These findings suggest that metacognition should be carefully evaluated in insomnia patients and further studies are needed to evaluate long-term implications of this remaining dysfunction.
Collapse
Affiliation(s)
- Andrea Galbiati
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Sforza
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Scarpellino
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salibba
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Leitner
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giada D'Este
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
8
|
Santoso AMM, Jansen F, Lissenberg-Witte BI, Baatenburg de Jong RJ, Langendijk JA, Leemans CR, Smit JH, Takes RP, Terhaard CHJ, van Straten A, Verdonck-de Leeuw IM. Sleep quality trajectories from head and neck cancer diagnosis to six months after treatment. Oral Oncol 2021; 115:105211. [PMID: 33581506 DOI: 10.1016/j.oraloncology.2021.105211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Patients with head and neck cancer (HNC) often report disturbances in their sleep quality, impairing their quality of life. This study aims to examine the trajectories of sleep quality from diagnosis up to 6-month after treatment, as well as the pre-treatment risk factors for poor sleep trajectories. MATERIALS AND METHODS Sleep quality (Pittsburgh sleep quality index) was measured shortly after diagnosis (pre-treatment), and at 3 and 6 months after finishing treatment. Patients were categorized into 5 trajectory groups. We examined the association of sleep quality trajectories with sociodemographic and clinical characteristics, coping style, HNC symptoms, and psychological distress. RESULTS Among 412 included patients, about a half either had a persistent good sleep (37.6%) or an improving (16.5%) trajectory. About a third had a persistent poor sleep (21.8%) or worsening (10.9%) sleep trajectory. The remaining patients (13.1%), alternated between good and poor sleep. Using persistent good sleep as a reference outcome, persistent poor sleepers were more likely to be woman (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.01-3.90), use painkillers prior to treatment (OR = 2.52, 95% CI 1.33-4.77), and have more pre-treatment anxiety symptoms (OR = 1.26, 95% CI 1.15-1.38). CONCLUSION Unfavorable sleep quality trajectories are prevalent among HNC patients from pre-treatment to 6-month after treatment. A periodic sleep evaluation starting shortly after HNC diagnosis is necessary to identify persistent sleep problems, especially among high-risk group.
Collapse
Affiliation(s)
- Angelina M M Santoso
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Femke Jansen
- Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology - Head and Neck Surgery, Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology - Head and Neck Surgery, Amsterdam, the Netherlands
| | - Johannes H Smit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology - Head and Neck Surgery, Amsterdam, the Netherlands.
| |
Collapse
|
9
|
Halsøy Ø, Johnson SU, Hoffart A, Ebrahimi OV. Insomnia Symptoms in the General Population During the COVID-19 Pandemic. Front Psychiatry 2021; 12:762799. [PMID: 34803771 PMCID: PMC8602186 DOI: 10.3389/fpsyt.2021.762799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
This empirical study aims to investigate factors associated with insomnia symptoms during the COVID-19 pandemic in 4,921 Norwegian adults. Participants were queried across two time-points, between March 31st and April the 7th 2020, and between June 22nd and July 13th, 2020. Relevant risk factors and psychological correlates at the first time-point and insomnia symptoms were measured 3 months later, allowing for the investigation of concurrent associations as well as associations across time. Insomnia symptoms were measured with the Bergen Insomnia Scale. The results revealed that individuals reported higher mean levels of insomnia symptoms during the COVID-19 lockdown, compared to pre-pandemic surveys from 2008 (p < 0.0001, Cohen's d = 0.29). Individuals who predominantly socially distanced reported higher mean levels of insomnia symptoms than those who did not predominantly distance. Females, individuals with lower education levels, individuals who had lost their job, and individuals who declared having been diagnosed with an unspecified pre-existing psychiatric disorder reported the most symptoms. The regression model (R2 = 0.44) showed that physical exercise, was associated with less symptoms of insomnia. Symptoms of health Anxiety, symptoms of depression, unhelpful coping strategies, worry about job and economy, and older age were all associated with higher levels of insomnia symptoms. These findings highlight particularly vulnerable subgroups, as well as providing clinicians with key areas of intervention to help individuals suffering from insomnia symptoms.
Collapse
Affiliation(s)
- Øyvind Halsøy
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway.,Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway.,Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Omid V Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway.,Modum Bad Psychiatric Hospital, Vikersund, Norway
| |
Collapse
|
10
|
Schneider MN, Kovas Y, Gregory AM. Dysfunctional beliefs about sleep and insomnia symptoms in early adulthood: A twin and sibling study. J Sleep Res 2019; 28:e12834. [DOI: 10.1111/jsr.12834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Yulia Kovas
- Department of Psychology Goldsmiths, University of London, New Cross London UK
| | - Alice M. Gregory
- Department of Psychology Goldsmiths, University of London, New Cross London UK
| |
Collapse
|
11
|
Chang J, Suh S. Validation of the Korean Ford Insomnia Response to Stress Test Questionnaire. SLEEP MEDICINE RESEARCH 2018. [DOI: 10.17241/smr.2018.00304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
12
|
Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res 2018; 27:e12710. [PMID: 29797753 PMCID: PMC7045300 DOI: 10.1111/jsr.12710] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
Abstract
Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.
Collapse
Affiliation(s)
- David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Jason R. Anderson
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | |
Collapse
|
13
|
Sella E, Cellini N, Miola L, Sarlo M, Borella E. The Influence of Metacognitive Beliefs on Sleeping Difficulties in Older Adults. Appl Psychol Health Well Being 2018; 11:20-41. [DOI: 10.1111/aphw.12140] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
14
|
Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, Tran KM, Anderson JR, Roth T, Drake CL. Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep 2018; 10:193-201. [PMID: 30046255 PMCID: PMC6054324 DOI: 10.2147/nss.s138823] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hyperarousal is a key component in all modern etiological models of insomnia disorder. Overall patterns in the literature suggest that over-active neurobiological and psychological systems contribute to difficulty sleeping. Even so, mixed results regarding the specific mechanisms linking hyperarousal to sleep disturbance limit current etiological conceptualizations. Similar basal arousal profiles between individuals with high vs low risk for insomnia in the absence of stress exposure suggest that dysregulated stress "response" rather than general hyperarousal may be a more pertinent marker of risk. In this report, we discuss evidence for hyperarousal in insomnia and explore the role of sleep reactivity. A trait characteristic, sleep reactivity is the degree to which stress disrupts sleep, manifesting as difficulty falling and staying asleep. Premorbid sleep reactivity has been shown to identify individuals at risk for future insomnia disorder, such as highly reactive sleepers (whose sleep systems are sensitive to stress) who are at elevated disease risk. Research points to genetics, family history of insomnia, gender, and environmental stress as factors that influence sleep reactivity. Importantly, stress-related cognitive-emotional reactivity (e.g., rumination, worry) may exploit the vulnerability of a highly reactive sleep system. We propose that sleep reactivity and cognitive-emotional reactivity may share a bidirectional relationship, conferring an insalubrious environment for sleep in response to stress. Future research on sleep reactivity is needed to identify its neurobiology, characterize its relationship with cognitive-emotional reactivity, and explore the potential clinical utility of sleep reactivity in treatment planning.
Collapse
Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | | | - Christine V Tonnu
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Kieulinh Michelle Tran
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Jason R Anderson
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| |
Collapse
|
15
|
Marques DR, Allen Gomes AC, Drake CL, Roth T, de Azevedo MHP. Assessing Stress-Induced Sleep Reactivity in College Students: The European Portuguese Version of the Ford Insomnia Response to Stress Test (FIRST). Behav Sleep Med 2018; 16:337-346. [PMID: 27712109 DOI: 10.1080/15402002.2016.1210151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE AND BACKGROUND Over the past few years, the comprehensive models of insomnia have exhibited impressive developments. However, there is scarce knowledge on predisposing or vulnerability factors for insomnia. One of the most promising constructs to aid in filling this gap is stress-induced sleep reactivity assessed through self-report. Our aim was to study the psychometric properties of the European Portuguese version of the Ford Insomnia Response to Stress Test (FIRST). PARTICIPANTS We recruited a large sample of students attending medical school (N = 699). METHODS Several analyses were carried out such as internal consistency, construct validity, and discriminant groups' analysis. RESULTS It was observed that FIRST-PT shows good internal consistency (Cronbach´s alpha = .81) and validity indicators. Interestingly, and contrary to what was observed in the previously published studies on psychometric properties of the FIRST, it was observed that a two-factor solution (Factor I = rumination, Factor II = worry) was the most adequate one to explain the correlation matrix, accounting for approximately 44% of the total variance. CONCLUSIONS The FIRST-PT proved to be a useful and reliable tool to measure stress-induced sleep reactivity. However, these results should be replicated in other groups, particularly clinical samples, in order to verify the stability of its factorial dimension.
Collapse
Affiliation(s)
- Daniel Ruivo Marques
- a Department of Education and Psychology , University of Aveiro , Aveiro , Portugal
| | | | | | - Thomas Roth
- b Sleep Center , Henry Ford Hospital , Detroit , Michigan , USA
| | | |
Collapse
|
16
|
Dieck A, Helbig S, Drake CL, Backhaus J. Validation of the German version of the Ford Insomnia Response to Stress Test. J Sleep Res 2017; 27:e12621. [DOI: 10.1111/jsr.12621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/06/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Arne Dieck
- Department of Psychology; University of Bonn; Bonn Germany
| | - Susanne Helbig
- Department of Psychology; University of Bonn; Bonn Germany
| | | | - Jutta Backhaus
- Department of Psychology; University of Bonn; Bonn Germany
| |
Collapse
|
17
|
Lichstein KL. Insomnia identity. Behav Res Ther 2017; 97:230-241. [PMID: 28858698 DOI: 10.1016/j.brat.2017.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 01/31/2023]
Abstract
Insomnia identity refers to the conviction that one has insomnia, and this sleep complaint can be measured independently of sleep. Conventional wisdom predicts that sleep complaints are synchronous with poor sleep, but crossing the presence or absence of poor sleep with the presence or absence of insomnia identity reveals incongruity with expected patterns. This review of existing research on insomnia identity processes and influence finds that about one-fourth of the population are uncoupled sleepers, meaning there is an uncoupling of sleep and sleep appraisal, and daytime impairment accrues more strongly to those who endorse an insomnia identity. Research supports the conclusion that there is a cost to pathologizing sleep. Individuals claiming an insomnia identity, regardless of sleep status, are at greater risk for a range of sequelae including self-stigma, depression, suicidal ideation, anxiety, hypertension, and fatigue. A broad research agenda is proposed with hypotheses about the sources, clinical mechanisms, and clinical management of insomnia identity.
Collapse
|
18
|
How Hyperarousal and Sleep Reactivity Are Represented in Different Adult Age Groups: Results from a Large Cohort Study on Insomnia. Brain Sci 2017; 7:brainsci7040041. [PMID: 28420079 PMCID: PMC5406698 DOI: 10.3390/brainsci7040041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 01/24/2023] Open
Abstract
Hyperarousal is a 24-h state of elevated cognitive and physiological activation, and is a core feature of insomnia. The extent to which sleep quality is affected by stressful events—so-called sleep reactivity—is a vulnerability factor for developing insomnia. Given the increasing prevalence of insomnia with age, we aimed to investigate how hyperarousal and sleep reactivity were related to insomnia severity in different adult age groups. Data were derived from a large cohort study investigating the natural history of insomnia in a population-based sample (n = 1693). Baseline data of the Arousal Predisposition Scale (APS) and Ford Insomnia Response to Stress Test (FIRST) were examined across age and sleep/insomnia subgroups: 25–35 (n = 448), 35–45 (n = 528), and 45–55 year olds (n = 717); good sleepers (n = 931), individuals with insomnia symptoms (n = 450), and individuals with an insomnia syndrome (n = 312). Results from factorial analyses of variance (ANOVA) showed that APS scores decreased with increasing age, but increased with more severe sleep problems. FIRST scores were not significantly different across age groups, but showed the same strong increase as a function of sleep problem severity. The findings indicate that though arousal predisposition and sleep reactivity increase with more severe sleep problems, only arousal decreases with age. How arousing events affect an individual during daytime thus decreases with age, but how this arousal disrupts sleep is equivalent across different adult age groups. The main implication of these findings is that treatment of insomnia could be adapted for different age groups and take into consideration vulnerability factors such as hyperarousal and stress reactivity.
Collapse
|