Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Cogito, ergo insomnis: I think, therefore I am sleepless
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0003-2008-0784
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems.

The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2014. , 96 p.
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 30
Keyword [en]
insomnia, CBT, cognitive therapy, worry, dysfunctional beliefs, arousal, selective attention, safety behaviours
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-35794ISBN: 978-91-7529-035-5 (print)OAI: oai:DiVA.org:oru-35794DiVA: diva2:735203
Public defence
2014-10-03, Långhuset, Hörsal 2, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-07-24 Created: 2014-07-24 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Sleepless in Sweden: a single subject study of effects of cognitive therapy for insomnia on three adolescents
Open this publication in new window or tab >>Sleepless in Sweden: a single subject study of effects of cognitive therapy for insomnia on three adolescents
2011 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 39, 367-374 p.Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

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

Place, publisher, year, edition, pages
Cambridge University Press, 2011
Keyword
insomnia, cognitive therapy, single-case, adolescence
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-32221 (URN)10.1017/S1352465810000664 (DOI)000289726000010 ()21205358 (PubMedID)2-s2.0-79956156486 (Scopus ID)
Available from: 2013-11-01 Created: 2013-11-01 Last updated: 2017-12-06Bibliographically approved
2. Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population
Open this publication in new window or tab >>Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population
Show others...
2014 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, 38-48 p.Article in journal (Refereed) Published
Abstract [en]

Aim: Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.

Methods: In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.

Results: Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.

Conclusions: The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
Insomnia, Worry, Safety behaviours, Selective attention, Dysfunctional beliefs, Physiological arousal
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-34997 (URN)10.1016/j.brat.2014.01.002 (DOI)000334009000006 ()24513668 (PubMedID)2-s2.0-84893596229 (Scopus ID)
Available from: 2014-05-09 Created: 2014-05-09 Last updated: 2017-12-05Bibliographically approved
3. An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depression
Open this publication in new window or tab >>An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depression
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

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

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

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

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

Keyword
Insomnia, depression, cognitive behavioural therapy, dysfunctional beliefs, mediation
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-36103 (URN)
Available from: 2014-08-25 Created: 2014-08-25 Last updated: 2017-10-17Bibliographically approved

Open Access in DiVA

Introductory chapter(15936 kB)274 downloads
File information
File name FULLTEXT02.pdfFile size 15936 kBChecksum SHA-512
3d946bb82f114d1b0b75005c87fcb2983132eb505fa887b9557cde2db89782e87474f5539e3140cdc37d492eb80095b9606467dfdb03766d100b31a373844183
Type fulltextMimetype application/pdf
Cover(475 kB)72 downloads
File information
File name COVER01.pdfFile size 475 kBChecksum SHA-512
a42b51540155a10d27e62a6a1a76193868172ae73f009a7c683a9c3676b2abd50d01f87ccc8a6e64860c328086a439ad36c8f77cd4842df267eb2781967bfb2a
Type coverMimetype application/pdf
Spikblad(153 kB)32 downloads
File information
File name SPIKBLAD01.pdfFile size 153 kBChecksum SHA-512
ea1e81298445c264eed7ad9c9531ebabad44c8672721f8b738aab4e0cc58399fdab57b3a8872882812c7a187a6f2c9ab6a5b6540747de788f17c851911141a54
Type spikbladMimetype application/pdf

Authority records BETA

Norell-Clarke, Annika

Search in DiVA

By author/editor
Norell-Clarke, Annika
By organisation
School of Law, Psychology and Social Work
Psychology

Search outside of DiVA

GoogleGoogle Scholar
Total: 274 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 945 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf