The attention–intention–effort pathway in the development of psychophysiologic insomnia: A theoretical review

Espie, Colin A.; Broomfield, Niall M.; Macmahon, Kenneth; MacPhee, L.M.; Taylor, Lynne

doi:10.1016/j.smrv.2006.03.002

Cited by 420 publications

(394 citation statements)

References 97 publications

Supporting

Mentioning

345

Contrasting

Unclassified

Order By: Relevance

“…It may be hypothesized that individuals prone to perfectionism actively attempt to force sleep initiation, a strategy called sleep effort that does not pay off and leads to sleep disturbances. 3,8 In line with these theoretical considerations, previous evidence suggests that individuals who fulfill the diagnostic criteria for insomnia present with higher levels of perfectionism than good sleepers. 9,10 Additionally, several studies showed that patients with insomnia strive for perfection on a behavioral level.…”

Section: Introductionmentioning

confidence: 75%

“…2 In addition, perfectionism may be a predisposing factor for poor sleep. [3][4][5] This may be due to the fact that the maladaptive form of perfectionism includes excessive concerns about making mistakes and is associated with worry and rumination. 6 Worry and rumination at bedtime are, in turn, assumed to lead to sleep onset and sleep maintenance difficulties.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perfectionism and Polysomnography-Determined Markers of Poor Sleep

Johann

Hertenstein

Kyle

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Perfectionism has been suggested to represent a predisposing factor for poor sleep. However, previous studies have relied on selfreported measures. The association between perfectionism and poor sleep measured by polysomnography (PSG) warrants further investigation. Methods: The current retrospective exploratory study used the Frost Multidimensional Perfectionism Scale and PSG in an unselected sample of 334 consecutive sleep laboratory patients (140 males, 194 females, 44.6 ± 15.9 years). Data were analyzed using linear regression analyses. Results: High levels of perfectionism were associated with PSG-determined markers of poor sleep in the first sleep laboratory night. The total Frost Multidimensional Perfectionism Scale score was significantly associated with the number of nocturnal awakenings in the first sleep laboratory night. The subscales "concern over mistakes" and "personal standards" of perfectionism were significantly associated with markers of poor sleep. In contrast, there were only a few associations between perfectionism and PSG variables of the second sleep laboratory night. Conclusions: This pattern of results suggests that high levels of perfectionism may predispose individuals to sleep disturbances in the context of acute stressors. Thus, the influence of perfectionism on poor sleep should be further investigated to improve treatment. I NTRO DUCTI O NPerfectionism is a personality trait that has been defined as a dispositional tendency to set excessively high standards and to evaluate one's own performance in an overly critical manner. 1 Perfectionism has been linked to several mental disorders including eating, anxiety, and depressive disorders.2 In addition, perfectionism may be a predisposing factor for poor sleep. [3][4][5] This may be due to the fact that the maladaptive form of perfectionism includes excessive concerns about making mistakes and is associated with worry and rumination. 6 Worry and rumination at bedtime are, in turn, assumed to lead to sleep onset and sleep maintenance difficulties.7 In particular, it has been suggested that individuals with high levels of perfectionism are more concerned about the effects of acute sleep disturbances on their daytime performance. 4 This may lead to increased worry and arousal at bedtime; therefore, perfectionism may contribute to the transition from acute to chronic sleep disturbances. It may be hypothesized that individuals prone to perfectionism actively attempt to force sleep initiation, a strategy called sleep effort that does not pay off and leads to sleep disturbances. 3,8 In line with these theoretical considerations, previous evidence suggests that individuals who fulfill the diagnostic criteria for insomnia present with higher levels of perfectionism than good sleepers. 9,10 Additionally, several studies showed that patients with insomnia strive for perfection on a behavioral level. [11][12][13] Longitudinal studies suggest that perfectionism Perfectionism is often assessed using the Hewitt and Flett Multidimen...

show abstract

Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Perfectionism and Polysomnography-Determined Markers of Poor Sleep

Johann

Hertenstein

Kyle

et al. 2017

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…As reviewed earlier, a central tenet of these models is that excessive mental activity at bedtime may be considered as the main impediment to sleep [5,6]. Researchers have also proposed that cognitive arousal at bedtime can take the form of worry or rumination and that the two may be distinguished temporally: Worry refers to distress regarding future events, whereas rumination concerns thoughts of past events and current symptoms (e.g., [32]).…”

Section: Discussionmentioning

confidence: 99%

“…According to these approaches, excessive cognitive activity at bedtime may be considered as a central impediment to the process of falling asleep [5,6]. More recently, the importance of investigating affective processes in insomnia has been recognized [7] and a corresponding research agenda has been formulated [8].…”

Section: Introductionmentioning

confidence: 99%

The Nocturnal Return of Neglected Regrets: Deficits in Regret Anticipation Predict Insomnia Symptoms

Schmidt¹,

Linden²

2011

TOOSLPJ

View full text Add to dashboard Cite

Abstract:Cognitive accounts of insomnia generally assume that excessive mental activity at bedtime constitutes a central impediment to the process of falling asleep, yet the affective aspects of this mental hyperactivity still remain largely unexplored. The present study explored whether failures in regret anticipation might lead to a rise of regret-related counterfactual thoughts and emotions at bedtime, thereby hindering or interrupting sleep. A sample of 105 undergraduate students completed the newly developed Regret Anticipation Failures Scale (RAFS), the Bedtime Counterfactual Processing Questionnaire (BCPQ), and the Insomnia Severity Index (ISI). Analyses revealed that both regret anticipation failures and bedtime counterfactual processing were related to insomnia severity and that the effect of regret anticipation failures on insomnia was mediated by the frequency of regret-related thoughts and emotions at bedtime. These findings reveal for the first time that failures in antecedent-focused emotion regulation may contribute to sleeping difficulties.

show abstract

“…Th e model specifi cally focuses on the attentionintention-eff ort pathway as one sleep inhibitory process, in which three processes occur: (1) increased selective attention to sleep and symptoms of insomnia; (2) an increase in the subjective value of sleep, which may contribute to explicit "intention to sleep"; and (3) gradual development of increased eff ort to sleep, described as "sleep eff ort syndrome. " 114 Th us, treatment of insomnia should focus on cognitive strategies that aim to reverse sleep-related attentional bias 113 and behavioral strategies 115 aimed at reducing sleep eff ort.…”

Section: Cognitive Modelmentioning

confidence: 99%

The Pathophysiology of Insomnia

Levenson

Kay

Buysse

2015

Chest

276

147

View full text Add to dashboard Cite

Insomnia disorder is characterized by chronic dissatisfaction with sleep quantity or quality that is associated with diffi culty falling asleep, frequent nighttime awakenings with diffi culty returning to sleep, and/or awakening earlier in the morning than desired. Although progress has been made in our understanding of the nature, etiology, and pathophysiology of insomnia, there is still no universally accepted model. Greater understanding of the pathophysiology of insomnia may provide important information regarding how, and under what conditions, the disorder develops and is maintained as well as potential targets for prevention and treatment.The aims of this report are (1) to summarize current knowledge on the pathophysiology of insomnia and (2) to present a model of the pathophysiology of insomnia that considers evidence from various domains of research. Working within several models of insomnia, evidence for the pathophysiology of the disorder is presented across levels of analysis, from genetic to molecular and cellular mechanisms, neural circuitry, physiologic mechanisms, sleep behavior, and self-report. We discuss the role of hyperarousal as an overarching theme that guides our conceptualization of insomnia. Finally, we propose a model of the pathophysiology of insomnia that integrates the various types of evidence presented.

show abstract

The attention–intention–effort pathway in the development of psychophysiologic insomnia: A theoretical review

Cited by 420 publications

References 97 publications

Perfectionism and Polysomnography-Determined Markers of Poor Sleep

Perfectionism and Polysomnography-Determined Markers of Poor Sleep

The Nocturnal Return of Neglected Regrets: Deficits in Regret Anticipation Predict Insomnia Symptoms

The Pathophysiology of Insomnia

Contact Info

Product

Resources

About