The impact of negative mood state on sleep‐related attentional bias in insomnia

Abstract

Sleep-related attentional bias is thought to play a role in the maintenance of insomnia. However, this concept has been questioned by several studies that did not show the presence of sleep-related attentional bias in clinical insomnia or poor sleepers. Our goal in the present study was to test whether the mood state of individuals with insomnia affects the presence of sleep-related attentional bias. To this end, 31 individuals with insomnia and 34 good sleepers were randomly assigned to a negative mood-inducing condition or a control condition. They then completed a visual probe task with three types of pictorial stimuli (general threat, sleep-related negative pictures and sleep-related positive pictures). Vigilance, maintenance and the overall bias indexes were calculated based on the reaction time. We found individuals with insomnia only showed a greater overall bias compared with good sleepers following a negative mood induction, regardless of the pictures presented. In addition, we found that a negative mood state was significantly correlated with the overall attentional bias in good sleepers but not in individuals with insomnia. These findings suggest that sleep-related attentional bias in insomnia can be modulated by mood state. This effect may reflect the dysregulation of top-down attentional control in individuals with insomnia.

Sleep-Related Attentional Bias in Insomnia: Time to Examine Moderating Factors?

“…As such, current mood state should be taken into account in future studies rather than just trait-like characteristics. Indeed, inducing a negative mood state in people with insomnia influences the extent to which an attentional bias to threatening information is displayed (Zheng et al, 2018). Specifically, when assigned to a negative mood inducing (i.e., autobiographical recall of poor sleep) or control (i.e., reading recall) condition prior to completing a dot-probe task comprised of images differing in emotional valence and relatedness to sleep (i.e., general threat, sleep positive, sleep negative), an overall attentional bias to all images emerged only amongst individuals with insomnia who were subject to negative mood state induction Despite an absence of evidence for a sleep-related attentional bias in this study, it remains possible that the overall valance of an individual's emotional mood state, as well as its intensity, duration and frequency of occurrence, may act as moderating factors.…”

“…However, the number of studies conducted to date still remains limited. Whilst it is possible that a publication bias exists precluding studies demonstrating null effects, to the best of our knowledge, only a further seven studies have been conducted (Woods et al, 2013; Beattie et al, 2017; Akram et al, 2018a,b,c; Koranyi et al, 2018; Zheng et al, 2018; Zhou et al, 2018), of which four provide additional support (Beattie et al, 2017; Akram et al, 2018a,b,c; Koranyi et al, 2018). Therefore, we suggest that further research is required to clarify the presence of a sleep-related attentional bias in insomnia.…”

“…While a recent review (Harris et al, 2015) cautiously suggests biased attention for sleep-related threat information to be a likely feature of insomnia, the authors highlight the need to understand the specificity of this bias and its relationship with mechanisms believed to underpin the disorder (e.g., sleep preoccupation). Furthermore, whilst it is possible that the mixed evidence may stem from methodological differences relating to the task or population used, the possible moderating influence of these factors on the relationship between attentional bias for sleep-related threat information and insomnia have only recently been examined (e.g., Zheng et al, 2018). With this in mind, we propose candidate factors that may play a crucial role in addressing moderating questions such as “when,” “for whom” and “under which” conditions are sleep-related attentional biases evident in individuals characterized by insomnia.…”

Sleep‐related monitoring on awakening mediates the relationship between insomnia‐related interpretive bias and insomnia symptoms using the insomnia ambiguity paradigm

“…The examination of possible mediational factors underlying the relationship between disorder‐consistent processing of sleep‐related information and insomnia using experimental paradigms has only recently been carried out (Gerlach et al., 2020; Zheng et al, 2019). Gerlach and colleagues (2020) evidenced a positive relationship between pre‐sleep worry and poor sleep quality, with an increased tendency to choose sleep‐related interpretations of ambiguous sentences when using the IAT.…”

“…However, regression analyses determined suggestive evidence that these outcomes were mediated by trait anxiety but not any objectively determined parameters of sleep continuity (Gerlach et al., 2020). Zheng and colleagues (2019) determined that individuals with insomnia were more likely to exhibit an attentional bias following the induction of a negative (i.e., autobiographical recall of poor sleep), relative to control (i.e., reading recall), mood state (Zheng et al, 2019). Therefore, the valance and topical focus of an individual's emotional mood state may possibly mediate the relationship between sleep‐related cognitive biases and insomnia.…”