A cognitive model of insomnia.

Full Abstract

Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.

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Author information

Author/s: Harvey, A G (AG);

Affiliation: Department of Experimental Psychology, University of Oxford, UK. allison.harvey(-atsign-)psy.ox.ac.uk

Journal and publication information

Publication Type: Journal Article; Review

Journal: Behaviour research and therapy (Behav Res Ther), published in England. (Language: eng)

Reference: 2002-Aug; vol 40 (issue 8) : pp 869-93

Dates: Created 2002/08/20; Completed 2002/09/11; Revised 2005/11/16;

PMID: 12186352, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Circadian Rhythm - physiology
Cognition Disorders - etiology
Humans

Neuropsychological Tests
Psychological Theory
Sleep Initiation and Maintenance Disorders - complications

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