Individuals with clinically significant insomnia symptoms are characterised by a negative sleep-related expectancy bias: Results from a cognitive-experimental assessment

Abstract

Cognitive models of insomnia consistently suggest that negative expectations regarding the consequences of poor sleep contribute to the maintenance of insomnia. To date, however, no research has sought to determine whether insomnia is indeed characterised by such a negative sleep-related expectancy bias, using objective cognitive assessment tasks which are more immune to response biases than questionnaire assessments. Therefore, the current study employed a reaction-time task assessing biased expectations among a group with clinically significant insomnia symptoms (n = 30) and a low insomnia symptoms group (n = 40). The task involved the presentation of scenarios describing the consequences of poor sleep, and non-sleep related activities, which could be resolved in a benign or a negative manner. The results demonstrated that the high insomnia symptoms group were disproportionately fast to resolve sleep-related scenarios in line with negative outcomes, as compared to benign outcomes, relative to the low insomnia symptoms group. The two groups did not differ in their pattern of resolving non-sleep related scenarios. This pattern of findings is entirely consistent with a sleep-specific expectancy bias operating in individuals with clinically significant insomnia symptoms, and highlights the potential of cognitive-experimental assessment tasks to objectively index patterns of biased cognition in insomnia.

Cognitive performance in adolescents with Delayed Sleep‐Wake Phase Disorder: Treatment effects and a comparison with good sleepers

“…However, this difference did not reach statistical significance. Adolescents with Delayed Sleep‐Wake Phase Disorder rated their performance on 3 of the 4 cognitive tasks significantly worse than the good sleepers (see Table 1), which may indicate a negative expectations bias towards the consequences of poor sleep (Courtauld, Notebaert, Milkins, Kyle, & Clarke, 2017).…”

“…With such few studies within the field, replication is needed to confirm this hypothesis. Despite a lack of objective evidence, adolescents with Delayed Sleep-Wake Phase Disorder subjectively rated their performance on the cognitive performance tasks significantly worse than the good sleepers, which may indicate a negative expectancy bias (Courtauld et al, 2017). In general, people tend to rate their performance as better-than-average (Alicke & Govorun, 2005).…”

Sleep-related Attentional and Interpretive Bias In Insomnia: A Systematic Review and Meta-analysis.

“…The IAT was initially validated by Ree and colleagues (2006), where items were rated and verified by six independent judges to ensure that interpretations accompanying each sentence were equally probable, and that one interpretation of each ambiguous sentence was insomnia-consistent whilst the other was not. The remaining studies comprised of: individually programmed face-morph tasks for each participant in the study to examine how individuals with insomnia and controls interpret the extent of their own facially expressed tiredness (Akram et al, 2016); resolving a series of scenarios describing the consequences of poor sleep, and non-sleep-related activities in either a benign or negative manner (Courtauld et al, 2017); and choosing between answering sleep-related or eating-related questions .…”

Perceptual Differences in Emotionally Ambiguous Neutral Faces Among Individuals Displaying Clinically Significant Insomnia Symptoms

“…This resulted in complete data from N ¼ 222 people. Following the approach by Courtauld et al (2017), participants were stratified into low insomnia symptoms (n ¼ 56; 19.69 AE 4.07 years, 73% females) determined as scoring below 5 on the Insomnia Severity Index (ISI: Bastien et al, 2001; 3.73 AE 2.12), and those experiencing clinically significant insomnia symptoms (n ¼ 63; 20.32 AE 4.08 years, 85% females) determined as scoring 15 or more on the ISI (13.14 AE 3.94). A score of 15 or more on the ISI is suggestive of clinically moderate-to-severe insomnia.…”