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| 3. |
- Danielsson, Nanette S.
(författare)
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Disturbed sleep and emotion : a developmental perspective
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep disturbances are not only defining features, but also diagnostic criteria for most psychiatric disorders. Recently, researchers have proposed a theoretic role for sleep disturbances in emotion dysregulation, subsequently linking neurobiological processes and psychopathology. Most prior research examining the potential role for sleep disturbance in emotion dysregulation is from a neurophysiological or clinical perspective, or primarily focused on maintaining processes. Less well understood are how sleep disturbances may be involved at the levels of predisposition, precipitation, and perpetuation of emotion dysregulation concurrently and over time.This dissertation presents findings from three studies that were designed to expand on what is known about sleep disturbance in the predisposition, precipitation, and perpetuation of emotion dysregulation. Study 1 examined the long-term relation between sleep-onset problems and neuroticism over twenty-years. Adolescent sleep-onset posed risk (predisposition) for neuroticism in midlife, not vice versa. Study 2 investigated the effects of 3-nights partial sleep deprivation (5-hours total time in bed) on the positive and negative affect and emotions of otherwise healthy adults. Following partial sleep deprivation, people reported significant reductions in positive affect and emotions compared to rested people (precipitation). The only impact on negative emotions was on the discrete level. Sleep deprived peo-ple reported significantly more irritability, loathing, hostility, and shakiness compared to controls. Study 3 measured adolescent sleep disturbances, depressive symptoms, and catastrophic worry. In addition to direct risk, sleep disturbances posed a non-gender specific risk for depressive symptoms one-year later through catastrophic worry (perpetuation). Overall, the results provide support for the role of sleep disturbances in the predis-position, precipitation, and perpetuation of emotion dysregulation. An implication is that sleep disturbances and catastrophic worry are two po-tentially modifiable markers of risk for emotion dysregulation.
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| 5. |
- Danielsson, Nanette S., et al.
(författare)
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Neuroticism and sleep-onset : What is the long-term connection?
- 2010
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Ingår i: Personality and Individual Differences. - Oxford, United Kingdom : Elsevier BV. - 0191-8869 .- 1873-3549. ; 48:4, s. 463-468
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Tidskriftsartikel (refereegranskat)abstract
- People with sleep-onset problems often experience neuroticism. To what extent the one problem leads to the other is unknown. We used self-reported data from a Swedish longitudinal project to examine developmental links between neuroticism and sleep-onset problems. A sample of 212 people, followed from birth to midlife, was part of a cohort study spanning 37 years. Adolescent neuroticism was measured at age 16 with the High School Personality Questionnaire (HSPQ, Form A) and in midlife at age 37 with the Eysenck Personality Questionnaire (EPQ). Sleep-onset problems were measured at ages 15 to 17, 25, and 37 with items developed for the Solna Project. Adolescent neuroticism failed to predict sleep-onset problems. Instead, sleep-onset problems in adolescence and young adulthood predicted midlife neuroticism. We found that sleep-onset problems during adolescence were a direct risk for midlife neuroticism, as well as, an indirect risk through continuance of sleep-onset problems into adulthood. This study provides longitudinal support for adolescent sleep-onset problems as a potent risk factor for heightened neuroticism in midlife. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)
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| 6. |
- Danielsson, Nanette S., 1967-, et al.
(författare)
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Sleep Disturbance and Depressive Symptoms in Adolescence : The Role of Catastrophic Worry
- 2013
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Ingår i: Journal of Youth and Adolescence. - : Springer Science and Business Media LLC. - 0047-2891 .- 1573-6601. ; 42:8, s. 1223-1233
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Tidskriftsartikel (refereegranskat)abstract
- Depression is a common and debilitating disorder in adolescence. Sleep disturbances and depression often co-occur with sleep disturbances frequently preceding depression. The current study investigated whether catastrophic worry, a potential cognitive vulnerability, mediates the relationship between adolescent sleep disturbances and depressive symptoms, as well as whether there are gender differences in this relationship. High school students, ages 16-18, n = 1,760, 49 % girls, completed annual health surveys including reports of sleep disturbance, catastrophic worry, and depressive symptoms. Sleep disturbances predicted depressive symptoms 1-year later. Catastrophic worry partially mediated the relationship. Girls reported more sleep disturbances, depressive symptoms, and catastrophic worry relative to boys. The results, however, were similar regardless of gender. Sleep disturbances and catastrophic worry may provide school nurses, psychologists, teachers, and parents with non-gender specific early indicators of risk for depression. Several potentially important practical implications, including suggestions for intervention and prevention programs, are highlighted.
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| 7. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Associations between psychological factors and night-time/daytime symptomatology in insomnia
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell. - 0962-1105 .- 1365-2869. ; 21:Suppl. 1, s. 168-169
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 8. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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Associations between psychological factors and nighttime/daytime symptomatology in insomnia
- 2012
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 41:4, s. 273-287
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 9. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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Attentional bias in insomnia : the dot-probe task with pictorial stimuli depicting daytime fatigue/malaise
- 2013
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Ingår i: Cognitive Therapy and Research. - : Springer Science and Business Media LLC. - 0147-5916 .- 1573-2819. ; 37:3, s. 534-546
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to examine whether individuals with primary insomnia (PI) have an attentional bias towards insomnia-specific stimuli, relative to normal sleepers (NS). Also, the aim was to determine if the attentional bias was characterized by vigilance or disengagement. A between-groups, matched design was employed. Forty-two individuals completed the study (PI = 21; NS = 21). Participants completed a dot-probe task with stimuli comprising insomnia-specific (fatigue/malaise) and neutral pictures. It was hypothesized that individuals with PI would show greater attentional bias to insomnia-specific stimuli compared with NS. An overall bias effect was noted. This effect was however not due to vigilance; taking into account the reaction times on neutral trials, the PI group and the NS group did not display significantly different results in reaction times to insomnia-specific pictures. On the contrary, the results suggest that the overall bias effect was due to disengagement; the PI group had significantly longer reaction times than the NS group when shifting away from the insomnia-specific pictures, relative to neutral-neutral picture presentations. The findings suggest that individuals with insomnia are not more vigilant than normal sleepers to insomnia-specific stimuli, but instead have greater difficulties in shifting away from such stimuli.
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| 10. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Bidirectionality between pain and insomnia symptoms : a prospective study
- 2012
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Ingår i: British Journal of Health Psychology. - : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 17:2, s. 420-431
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to investigate whether there is a bidirectional relationship between pain and insomnia symptoms over the course of a year.Design: A longitudinal design with a 1-year follow-up was used. Methods. From a randomly selected sample of the adult general population (N = 3,000), 1,746 individuals filled out a baseline and 1-year follow-up survey on pain, insomnia symptoms, anxiety symptoms, and depressive symptoms.Results: Pain (OR = 1.64) and anxiety symptoms increased the risk for the incidence of insomnia symptoms (R-2 =.125) and pain (OR = 1.98), anxiety symptoms and depressive symptoms were related to the persistence of insomnia symptoms (R-2 =.212). Gender and anxiety symptoms increased the risk for the incidence of pain (R-2 =. 073); and age, insomnia symptoms (OR= 1.49), anxiety symptoms, and depressive symptoms were associated with the persistence of pain (R-2 =.187).Conclusion: While pain was linked to future insomnia symptoms and insomnia symptoms to the persistence of pain over the course of a year, insomnia symptoms was not associated with the incidence of pain. The results, thus, partly argue against bidirectionality between pain and insomnia symptoms.
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| 11. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Cognitive-behavioral therapy for insomnia co-morbid with hearing impairment : a randomized controlled trial
- 2012
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Ingår i: Journal of clinical psychology in medical settings. - New York, USA : Springer. - 1068-9583 .- 1573-3572. ; 19:2, s. 224-234
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 12. |
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| 13. |
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| 14. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Don't worry, be constructive : a randomized controlled feasibility study comparing behaviour therapy singly and combined with constructive worry for insomnia
- 2012
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Ingår i: British Journal of Clinical Psychology. - : Wiley-Blackwell. - 0144-6657 .- 2044-8260. ; 51:2, s. 142-157
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry (CW) intervention adds to the effects of behaviour therapy (BT).Design: A randomized, controlled design was used. The design included a 2-week baseline, a 4-week intervention phase (sleep restriction and stimulus control [BT] or sleep restriction and stimulus control plus constructive worry [BT + CW]), and a 2-week follow-up.Methods: Twenty-two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index (ISI), and the Work and Social Adjustment Scale (WSAS).Results: Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time (TWT) and total sleep time (TST). Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT + CW led to a larger decrease in insomnia severity at all three time points (controlled d= 1.101.68). In comparison with BT, BT + CW resulted in a larger reduction in worry at two of the time points (controlled d= 0.761.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT + CW (80100%) than in the BT condition (1827%), none of the participants remitted.Conclusions: The findings suggest that, compared to BT alone, CW might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow-up, future studies are warranted.
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| 15. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Is there a bidirectional link between insomnia and burnout? : a prospective study in the Swedish workforce
- 2010
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Ingår i: International Journal of Behavioral Medicine. - : Springer. - 1070-5503 .- 1532-7558. ; 17:4, s. 306-313
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Tidskriftsartikel (refereegranskat)abstract
- Background: Insomnia and burnout has been suggested to form a bidirectional association.Purpose: The aim of this study was to investigate whether there is a bidirectional relationship between insomnia and burnout over the course of a year among individuals in the workforce.Method: This study employed a prospective design, where a randomly selected sample from the general population (20-60 year; N = 1,812) filled out a survey on insomnia and burnout. In employed participants (n = 1,258), the associations between insomnia and three dimensions of burnout (Maslach Burnout Inventory - General Survey) were examined, while controlling for age, gender, anxiety, and depression.Results: The bivariate correlations between insomnia and the three burnout dimensions were significant at a low level (η: .12-.29). The longitudinal analyses demonstrated that insomnia was not associated with the incidence of burnout and vice versa. However, insomnia was demonstrated to increase the risk for the persistence of emotional exhaustion (OR = 3.02). Further, insomnia was not associated with the persistence of professional efficacy and cynicism, and burnout was not related to the persistence of insomnia.Conclusion: In summary, this investigation demonstrated that insomnia and burnout are not bidirectionally related in the working population. While insomnia was linked to the maintenance of the central part of burnout, burnout was not related to future insomnia.
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| 16. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Psychometric properties of an insomnia-specific measure of worry : the anxiety and preoccupation about sleep questionnaire
- 2011
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 40:1, s. 65-76
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 17. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Psychometric properties of the Insomnia Catastrophizing Scale
- 2012
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell. - 0962-1105 .- 1365-2869. ; 21:Suppl. 1, s. 168-168
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Few questionnaires have been developed and validated to specifically index insomnia-specific cognitive mechanisms. The purpose of this study was to investigate the psychometric properties of a newly developed instrument, the Insomnia Catastrophising Scale (ICS). We seek to examine the factorial validity and internal consistency, discriminative and convergent validity along with associations with anxiety, depression, sleep parameters, and daytime impairment.Methods: Participants (n = 1803) from a randomly selected sample of the general population completed a survey that probed demographics, night-time symptoms, daytime impairment, anxiety and depression. The ICS was also administered. Excluding those with a sleep disorder other than insomnia, the study sample consisted of 1558 participants. Results: Of the twenty original ICS items, three were removed due to low communality. Exploratory factor analysis of the eleven items indexing night-time catastrophising indicated a one-factor solution (59.1% variance), strong primary loadings, and high internal consistency (α = .92). Analysis of the six items indexing daytime catastrophising indicated a one-factor solution (70.1% variance), strong primary loadings, and high internal consistency (α = .91). The internal consistency for the total ICS was .95. At scale-, subscale-, and item-levels significant mean differences were noted between three groups which differed on insomnia symptomatology; the insomnia disorder group (n = 113) reported significantly higher scores than the poor sleep (n = 247) and normal sleep groups (n = 1157), and the poor sleep group exhibited significantly higher scores than the normal sleep group. Receiver operating characteristics analyses indicated that when using an optimal cut-off for the ICS, the sensitivity was 84.1% (detecting those with insomnia disorder) and specificity was 81.5% (detecting those with normal sleep). The ICS was significantly associated with anxiety and depression (ρ = .44-.54), total wake time (η = .38), total sleep time (η = .29), sleep quality (ρ = .49), and daytime impairment (ρ = .57).Conclusion: The ICS can be considered as a reliable and valid questionnaire for indexing insomnia-specific catastrophising. The use of the ICS is recommended in research and clinical settings for assessing insomnia-related catastrophising.
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| 18. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample
- 2012
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Ingår i: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 72:2, s. 103-110
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 19. |
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| 20. |
- Jansson-Fröjmark, Markus
(författare)
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The Work and Social Adjustment Scale as a Measure of Dysfunction in Chronic Insomnia : Reliability and Validity
- 2014
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Ingår i: Behavioural and Cognitive Psychotherapy. - New York : Cambridge University Press. - 1352-4658 .- 1469-1833. ; 42:2, s. 186-198
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dysfunction is an integral part of chronic insomnia. Despite this, very little effort has yet been made to design and psychometrically validate an insomnia-specific measure of dysfunction. Aims: The purpose was to examine the psychometric properties of the Work and Social Adjustment Scale (WSAS) as a measure of dysfunction in chronic insomnia. Method: Seventy-three patients with chronic insomnia from three subsamples participated. All the patients completed the WSAS, the Insomnia Severity Index (ISI), and sleep diaries over one week. Results: An exploratory factor analysis suggested a one-factor solution for the WSAS, determining dysfunction, accounting for 73.7% of the variance. The internal consistency of the WSAS was alpha = .91. The test-retest reliability for the WSAS items was high at .90-.99 and for the entire scale .99. A cut-off at 17 points was established, discriminating those with subclinical versus moderate or severe clinical insomnia (88% sensitivity and 78% specificity). Evidence of convergent and criterion validity was documented via (1) a significant, positive association between the WSAS and ISI and (2) a higher WSAS score among those with severe clinical insomnia, relative to those with moderate clinical and subthreshold insomnia, as well as a higher WSAS score among those with moderate clinical insomnia relative to those with subthreshold insomnia. The WSAS was also shown to be a treatment-sensitive measure for insomnia patients. Conclusions: The WSAS appears as a reliable and valid measure of dysfunction in chronic insomnia. Additional advantages are its shortness, easiness, and treatment-sensitivity.
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| 21. |
- Lundh, Lars-Gunnar, et al.
(författare)
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Sömnstörningar
- 2013
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Ingår i: KBT inom psykiatrin. - 9789127135604 ; 2 rev. & utökade utgåvan, s. 265-282
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Bokkapitel (refereegranskat)
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| 22. |
- Lundh, Lars-Gunnar, et al.
(författare)
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Sömnstörningar
- 2013. - 2
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Ingår i: KBT inom psykiatrin. - Stockholm : Natur och kultur. - 9789127135604 ; , s. 265-282
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 23. |
- MacDonald, Shane, et al.
(författare)
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Cognitive vulnerability in the development of concomitant pain and sleep disturbances
- 2010
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Ingår i: British Journal of Health Psychology. - Malden, USA : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 15:2, s. 417-434
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The present study uses a cognitive behavioural framework to explore the idea that people with pain and sleep disturbances share a common cognitive vulnerability. Design: A longitudinal classification of people (N=592) in a community sample reporting on symptoms of pain and sleep at baseline, 3 and 12 months after the initial survey. Method: Cluster analysis was used to classify people reporting different degrees of symptoms, and their endorsement of cognitive behavioural processes, and consequences at each time point. Groups in similar clusters were linked at adjacent time points to document patterns of stability and change. The clusters are described at baseline on a range of indices not used to form them (problem duration, problem frequency, anxiety, and depression). Reliable change in reports of symptom-related interference was cross tabulated with reliable change in cognitive behavioural processes and consequences.Results: Cluster analyses resulted in six homogenous and distinct profiles at each time point. Linking the clusters over time showed partial individual stability in cluster membership at adjacent time points. Reliable change in symptom-related interference was associated with reliable change in endorsement of cognitive behavioural processes and consequences on the short term.Conclusion: The character and partial individual stability of symptom cluster membership suggests that problems with pain and sleep may share mutually maintaining cognitive behavioural processes and consequences. Future research should examine the utility of identifying mutually maintaining factors in the treatment of concomitant pain and sleep disturbances.
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| 24. |
- Maroti, Daniel, et al.
(författare)
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Does treating insomnia with cognitive-behavioural therapy influence comorbid anxiety and depression? : An exploratory multiple baseline design with four patients
- 2011
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Ingår i: Behaviour change. - : Australian Academic Press. - 0813-4839 .- 2049-7768. ; 28:4, s. 195-205
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Although cognitive–behaviour therapy for insomnia (CBT-I) has been shown to be effective for primary insomnia, the impact of CBT-I on insomnia comorbid with psychiatric conditions is largely unknown.Design: A multiple baseline design with 2–3 weeks of baseline, 6 weeks of CBT-I, and a 3-week follow-up was employed.Methods: Four patients with insomnia comorbid with both anxiety and depressive disorders participated. Sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), the Insomnia Severity Index (ISI), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI-II) were used as outcome measures.Results: Improvements in SOL, WASO, and TST were observed for all the four patients. Based on ISI, there were reductions for all the patients (32–92%), three patients responded to treatment, and two patients remitted. Based on BAI, reductions on anxiety were observed for all the patients (40–76%), three patients were treatment responders, and two patients remitted. Based on BDI-II, all the patients experienced reductions in depression (36–53%), three patients responded to treatment, and one patient remitted.Conclusions: CBT-I was able to reduce insomnia and co-morbid anxiety and depression, thus providing preliminary evidence for using CBT-I on insomnia co-morbid with psychiatric conditions.
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| 25. |
- Norell Clarke, Annika, 1979-, et al.
(författare)
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A psychometric investigation into two insomnia-specific measures of worry/rumination : the pre-sleep arousal scale and the anxiety and preoccupation about sleep questionnaire
- 2010
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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| 26. |
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| 27. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Are different sleep trajectories characterized by differences in psychological processes at baseline?
- 2011
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Models of chronic insomnia suggest that cognitive and behavioural processes may maintain and worsen sleep problems. Our aim was to investigate if the degree of psychological processes at baseline would differ between three groups of stable sleep categories over 1.5 years, defined as having “insomnia disorder”, “poor sleep” or “normal sleep” at both times. Another aim was to investigate if groups with trajectories to worsened sleep (e.g. poor sleep to insomnia) would differ from groups with stable or improved sleep regarding the psychological processes.Method: A survey with sleep-related questionnaires was sent to the general population. A multivariate analysis of variance was performed to investigate differences in psychological processes between sleep category groups. The dependent variables were safety behaviours, sleep related worry, selective attention, somatic arousal, and dysfunctional beliefs about sleep. The independent variable (1-9) consisted of nine possible combinations of development between the categories insomnia disorder, poor sleep, and normal sleep from time one until time two, 1.5 years later.Results: There was a difference between the groups on the combined psychological processes F (5, 1238) = 19.36, p = .0001, with the groups explaining between 16-38 % of the variance of the five processes. Further analyses revealed that there were significant differences between the stable sleep groups on all psychological processes, where “stable insomnia” reported higher scores than “stable poor sleep” which in turn reported higher scores than “stable normal sleep” (p = .0001). “Poor sleep to insomnia” had significantly higher means on safety behaviours and worry compared with “stable poor sleep” and “poor sleep to normal sleep” (p = .0001).Conclusion: The results suggest that the psychological processes are associated with different sleep trajectories over time, with worry and safety behaviours as possible risk factors for insomnia for people with poor sleep.
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| 28. |
- Norell-Clarke, Annika, 1979-
(författare)
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Cogito, ergo insomnis : I think, therefore I am sleepless
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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| 29. |
- Norell-Clarke, A., 1979-, et al.
(författare)
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Cognitive behavioural therapy for comorbid insomnia and depression : A randomised, controlled study
- 2013
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Ingår i: Sleep Medicine. - Amsterdam : Elsevier. - 1389-9457 .- 1878-5506. ; 14:Suppl. 1, s. e99-e99
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Insomnia and depression is a common comorbidity and several pilot studies have demonstrated promising results on both conditions by targeting insomnia only. The aim was to investigate the effects of CBT for insomnia (CBT-I) on both sleep and depressive symptoms in a sample with insomnia comorbid with major depression, minor depression or depressive symptoms, using a randomized controlled study.Materials and 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 and depressive severity was measured before, during and after treatment, using Insomnia Severity Index (ISI) and Beck Depression Inventory (BDI- II).Results: We used independent t-tests to investigate if groups were different on symptom severity prior to treatment. There was no difference between CBT-I and RT regarding insomnia severity (t (55) = 1.30, p = 0.20) or depression severity (t (53) = −0.77, p = 0.44). Looking at development over time, mixed between-within subjects ANOVAs demonstrated a significant interaction between treatment type and time for both insomnia and depression (ISI: F (2, 54) = 4.96, p = 0.01; BDI: F (2, 58) = 2.80, p = 0.07) meaning that CBT-I meant a larger decrease of both insomnia and depressive severity compared to control treatment. There was also a significant main effect for time with decreasing scores for both groups over time on ISI (F (2, 52) = 28.86, p = 0.0005) and BDI-II (F (2, 58) = 7.11, p = 0.002) and a main effect for group on ISI (F (1, 53) = 9.25, p = 0.01) but not on BDI-II (F (1, 59) = 0.27, p = 0.60). A six months follow-up assessment is currently conducted and those results will also be presented during the conference.Conclusion: CBT-I was associated with a greater reduction in insomnia and depression severity compared to control treatment. These results show that it is possible to have an effect on both insomnia and depression during a relatively short and cost effective group treatment, targeting insomnia only.
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| 30. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Cognitive processes and their association with persistence and remission of insomnia : Findings from a longitudinal study in the general population
- 2014
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 54, s. 38-48
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 31. |
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| 32. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Movement between insomnia, poor sleep and normal sleep in the general population
- 2011
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Konferensbidrag (refereegranskat)abstract
- Introduction: The purpose was to explore the development and remission of insomnia in the general population. Models of chronic insomnia suggest that cognitive and behavioural factors may maintain and worsen sleep problems. This had not been investigated prospectively before.Method: A survey with sleep related questionnaires was sent out to 5000 in the general public three times over 1, 5 years. Respondents were classified as normal sleepers, poor sleepers, and insomniacs.Results: Statistical software EXACON was used to examine expected and unexpected movement between sleep classifications over time. It was typical to remain in the same sleep category (p<.0001), and typical to move from insomnia to poor sleep (p<.0001). It was atypical to move from normal sleep to poor sleep or insomnia (p<.0001), and atypical to move from poor sleep or insomnia to normal sleep (p<.0001). Poor sleepers showed most classification movements. A multinomial logistic regression explored if worry (APSQ), somatic arousal (PSAS), monitoring (SAMI), dysfunctional beliefs (DBAS) and safety behaviours (SRBQ) could predict development to insomnia and normal sleep respectively for people with poor sleep at baseline. The model was significant (p<.01) with increased safety behaviours as a unique predictor of movement to insomnia (p<.01) Decreased safety behaviours showed a tendency towards significance for development to normal sleep (p>.01).Conclusion: Complete remission was unusual once sleep problems had developed, although the severity varied over time. Safety behaviours seem to influence the development of insomnia for people with poor sleep. The role of psychological processes for insomnia needs to be explored further.
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| 33. |
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| 34. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Remission from insomnia associated with psychological factors
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Psychological factors and their association with persistent insomniaObjectives: Models of chronic insomnia suggest that cognitive and behavioural factors may maintain sleep problems. This study focused on five psychological factors outlined by Harvey (2002): unhelpful beliefs about sleep, monitoring for sleep-related threats, sleep-related safety behaviours, pre-sleep somatic arousal, and sleep-related worry. The aim was to investigate if the degree of psychological factors at baseline would differ between three groups of stable sleep classifications over 18 months, defined as having either “insomnia disorder”, or “poor sleep” or “normal sleep” at both times. Another aim was to investigate if people with persistent insomnia would differ from those with improved sleep (e.g. insomnia to normal sleep) regarding the same psychological factors.Methods: A longitudinal design with two measurement points, 18 months apart, was used. Participants (n=1561) from a randomly selected sample of the general population completed a survey that included the five factors outlined by Harvey (2002).Results: The persistent insomnia group had higher scores on all factors, compared with the persistent poor sleep group (worry: d = .92; beliefs: d = .85; somatic arousal: d = .58; monitoring: d = .88; safety behaviours: d = .91) who in turn had higher scores than the persistent normal sleep group (worry: d = .72; beliefs: d = .46; somatic arousal: d = .79; monitoring: d = .67; safety behaviours: d = .84). Investigating insomniacs only, the persistent insomnia group displayed more worry (d=.47), safety behaviours (d=.45), and more monitoring (d=.40) at baseline, compared with the group of people whose insomnia remitted fully over time. Those with remitted insomnia had a larger change (lowering) of worry (d=.43), dysfunctional beliefs (d=.52), monitoring (d=.52) and safety behaviours (d=.67) between the two measure points compared with the persistent insomnia group.Conclusion: Persistent insomnia was linked to a higher degree of psychological factors compared with those with persistent poor sleep or persistent normal sleep. Worry, dysfunctional beliefs, monitoring and safety behaviours may have maintaining effects, as lower scores at baseline and/or a lowering of them over time were associated with remittance from insomnia.
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| 35. |
- Norell Clarke, Annika, 1979-, et al.
(författare)
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Sleepless in Sweden : a single subject study of effects of cognitive therapy for insomnia on three adolescents
- 2011
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Ingår i: Behavioural and Cognitive Psychotherapy. - : Cambridge University Press. - 1352-4658 .- 1469-1833. ; 39, s. 367-374
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 36. |
- Sunnhed, Rikard, et al.
(författare)
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Are Changes in Worry Associated with Treatment Response in Cognitive Behavioral Therapy for Insomnia?
- 2014
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Ingår i: Cognitive Behaviour Therapy. - : Taylor & Francis Group. - 1650-6073 .- 1651-2316. ; 43:1, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Little is known about why some patients respond to cognitive behavioral therapy for insomnia, whereas other patients do not. To understand differences in treatment response, there is a dire need to examine processes of change. The purpose was to investigate the long-term association between insomnia-related worry and outcomes following cognitive behavior therapy for insomnia. Methods: Sixty patients with early insomnia (3-12 months duration) received group cognitive behavioral therapy for insomnia. At pretreatment and at a 1-year follow-up, the patients completed questionnaires indexing two domains of insomnia-related worry (sleeplessness and health), insomnia severity, anxiety, and depression as well as sleep diaries. Results: Decreases in the two worry domains were associated with improvements in all of the outcomes, except for sleep onset latency (SOL), at a medium to large level. Reductions in insomnia-related worry were associated with improvements in insomnia severity, wake after sleep onset (WASO), total sleep time (TST), and depression, but not in SOL or anxiety. While reductions in worry for sleeplessness were related to improvements in insomnia severity and TST, decreases in worry for health were associated with enhancements in WASO and depression. Conclusion: The findings suggest that reductions in insomnia-related worry might be one process route in which cognitive behavioral therapy operates to improve insomnia symptomatology. The results are discussed in relation to theory, clinical implications, and future research.
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