Insomnia: psychological mechanisms and early intervention : a cognitive-behavioral perspective

Abstract: This dissertation focused on the role of psychological mechanisms in the development of insomnia and the effectiveness of an early cognitive-behavioral intervention for insomnia. The first aim was to examine whether distress, worry, and dysfunctional beliefs and attitudes about sleep were related to the development of insomnia. The findings from study I indicated that distress (anxiety and, to some extent, depression) was related to the development of insomnia. In study II, the relationship between sleep-related worry and subjective sleep perception was demonstrated to intensify over time, indicating that sleep-related worry was also linked to the development of insomnia. This indicates that both distress and sleep-related worry may be mechanisms that can be regarded as two of several pathways to insomnia. While distress was related to developing an onset of insomnia, worry was linked to the early development of insomnia. In study IV, dysfunctional beliefs and attitudes about sleep were not related to clinical improvement following cognitive behavior therapy for early insomnia. However, reductions in dysfunctional beliefs and attitudes about sleep were consistently linked to improvements in daytime symptoms, but not to sleep improvements. Instead of implying that such beliefs and attitudes are less important than distress and worry in the development of insomnia, it may rather suggest that dysfunctional beliefs and attitudes about sleep play a slightly different role in insomnia than previously envisioned.The second aim of this dissertation was to compare the effects of cognitive-behavioral therapy for insomnia with self-help information in patients with a short history of insomnia. In study III, the results showed that an early cognitive-behavioral intervention was effective for individuals with insomnia. To the benefit of the patients with insomnia and to society, cognitive behavior therapy may have a deserving and vital role as an early intervention for patients with insomnia.Taken together, the results in this dissertation indicate that psychological mechanisms play an important role in the development of insomnia. The findings might thus add to the elaboration of cognitive-behavioral models of insomnia. While most previous research has examined insomnia only in its persistent form, the focus of this dissertation was to study insomnia in its early phase. An approach where insomnia is studied in its early phase of development has not only heuristic value to the development of cognitive-behavioral models of the condition, but might also have implications for how cognitive-behavioral therapy for insomnia can be elaborated in future research and integrated in clinical settings.