Exploration of Stress-Related Factors and Sleep Disturbance and Implementation of an Insomnia Intervention
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2020
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Melbourne Authors
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Melbourne Graduate School of Education
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PhD thesis
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Open Access
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© 2020 Wendy Anne Finck
Abstract
Insomnia, which is highly prevalent and on the rise, can adversely impact health and wellbeing, therefore identifying those at risk and developing optimal preventative and therapeutic programs is important. While many factors, including stress, can contribute to insomnia, knowledge concerning specific risk factors is limited. Further, despite the effectiveness of cognitive and behavioural therapies for insomnia (CBT-I), not everyone responds well to such treatments and therefore improvements are needed. With the broad objective of enhancing knowledge concerning insomnia risk factors and exploring the utility of including tailored strategies targeting these when delivering CBT-I, this research involved three studies, each comprising adult convenience samples recruited from the Australian general population. The first study (N = 242), which employed a cross-sectional survey design, explored the interrelationships between perceived stress, cognitive arousal (arising from general and sleep-related rumination), emotion dysregulation, adaptive change as operationalised through the Adaptive Change Model (ACM), vulnerability toward stress-related sleep disturbance (i.e., sleep reactivity), and insomnia. Together, high perceived stress, cognitive arousal, and emotion dysregulation, and low adaptive change contributed significantly to sleep reactivity. In turn, high sleep reactivity, perceived stress, cognitive arousal and emotion dysregulation were associated with insomnia symptomatology. Similarly, high sleep reactivity, perceived stress, cognitive arousal and emotion dysregulation were associated with lower capacity for adaptive change. While there was also evidence of an association between low adaptive change and insomnia, the strength of association was less strong. For the second study (N = 101), processes identified in Study 1 as contributing most significantly to sleep disturbance (i.e., high sleep reactivity, perceived stress, cognitive arousal, and emotion dysregulation) were used to define three vulnerability-risk groups (Low, Medium, and High) and then explore the trajectory of their respective sleep experience over a six-month interval. A direct relationship between sleep disturbance and vulnerability-risk was evident whereby higher vulnerability levels were associated with higher levels of insomnia symptomatology and vice a versa. While vulnerability level and respective sleep patterns were relatively enduring, reductions in vulnerability-risk corresponded to improvements in sleep. For the third study (N = 10), an individually-tailored small-group intervention was delivered to young-adult participants (n = 5) experiencing sleep problems. The intervention incorporated CBT-I with additional strategies for stress management and ruminative tendencies, alongside skills-training to promote adaptive change. Relative to no-treatment matched controls (n = 5), the intervention group demonstrated meaningful improvements in their sleep alongside evidence of greater use of the ACM’s Support factors and a more adaptive response to stress. Together, the research findings implicate sleep reactivity and various cognitive-emotional vulnerabilities as important predisposing risk factors for acute sleep disturbance and chronic insomnia, while higher capacity for adaptive change may offer some degree of protection. Cognitive and behavioural therapies incorporating stress management, psychoeducation around the processes of adaptive change, and addressing general as well as sleep-related rumination may help prevent insomnia and improve treatment outcomes.
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sleep, insomnia, sleep reactivity, stress, cognitive arousal, rumination, coping, emotion regulation, emotion dysregulation, adaptive functioning, adaptive change, stress management