Distinguishing rumination from worry in clinical insomnia

Abstract

Research has found that repetitive thought processes, such as worry and rumination, play an important role in several disorders; however, these cognitive processes have not yet been examined in insomnia. This study explores rumination and worry in insomnia by examining: 1) whether those high and low on rumination and worry differ on subjective sleep measures, and 2) whether rumination and worry are distinct processes in insomnia. Participants (N = 242) were diagnosed with an insomnia disorder by sleep experts. Participants completed measures of worry and rumination and maintained a 2-week daily sleep log. Results of a multivariate analysis of variance found no main effect of worry; although high and low ruminators differed on several sleep log indices, including sleep efficiency, wakefulness after sleep onset and sleep quality. Factor analysis supported the idea that rumination and worry are separate constructs. Whereas previous research has focused on worry in insomnia, these findings suggest that rumination is important for understanding sleep disturbance. Further, although rumination and worry are both repetitive thought processes, these results indicate that they are distinct processes within insomnia and should be treated as such. The results are discussed with respect to treatment implications for Cognitive Behavioural Therapy for Insomnia.

When Thinking Impairs Sleep: Trait, Daytime and Nighttime Repetitive Thinking in Insomnia

“…However, as mentioned before, earlier studies were often done in student samples or used general sleep questionnaires. Similar research as ours also found no or small associations between worry or rumination and sleep disturbance (Carney et al, 2010;O'Kearney & Pech, 2014). Together, these recent studies (Carney et al, 2010; In study 2, trait repetitive thinking was also found to be unrelated to sleep problems (with the exception of sleep quality) when controlling for depression and anxiety.…”

“…Specifically, two types of repetitive thinking have been proposed to play an important role in insomnia: worry and rumination (Carney, Harris, Moss, & Edinger, 2010). Worry is a coping strategy that consists of engaging in abstract repetitive verbal thinking focused on uncertain events with a potential future negative outcome (Borkovec, Ray, & Stöber, 1998;Borkovec, Robinson, Pruzinsky, & Depree, 1983).…”

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

“…Concerning this, we replicated previous findings of an association between cognitive arousal and subjectively reported sleep latency. [10][11][12][13][14][15][16][17] However, there has been a lack of information about the association between cognitive arousal and sleep maintenance parameters. The current study filled this gap by investigating sleep efficiency and wake after sleep onset and their relationship to sleep-related and general cognitive arousal.…”

“…Accordingly, previous studies have shown that cognitive arousal is positively correlated with prolonged sleep onset latency in insomnia patients. [10][11][12][13][14][15] Furthermore, some studies included an experimental increase of pre-sleep cognitive arousal levels that resulted in diffi culties falling asleep as well as in distorted sleep perception. 16,17 Focusing on the content of these intrusive thoughts revealed that thinking about sleep and the anticipated consequences of poor sleep is very common in poor sleepers.…”

“…Finally, only one study has evaluated the relationship between cognitive variables and sleep parameters in a clinically referred sample of primary insomnia patients. 10 However, this investigation focused primarily on the distinction between worry and rumination as independent constructs and not on the distinction between sleep-related cognitive arousal and general cognitive arousal. Additionally, objectively determined sleep parameters were not used in this study.…”