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  • 1.
    Danielsson, Nanette
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Centre for Research on Child and Adolescent Mental Health.
    Norell-Clarke, Annika
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Hagquist, Curt
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Associations between adolescent sleep disturbance and different worry themes: findings from a repeated cross-sectional study from 1988 to 20112016In: Sleep Health, ISSN 2352-7218, E-ISSN 2352-7226, Vol. 2, no 3, p. 194-197Article in journal (Refereed)
    Abstract [en]

    Objective

    The objective was to investigate relationships between adolescent sleep disturbance and various worry themes.

    Methods

    Questionnaire data from 8 cross-sectional collections between 1988 and 2011 were used. The sample included more than 20,000 adolescents aged 15-16. Binary logistic regressions were used for the analyses.

    Results

    Sleep disturbance and female sex increased the odds of worrying about all themes. Sleep disturbance shared stronger associations with worry about financial security, accidents/illness, being bullied, and terrorist attacks (odds ratios, 2.65-3.35) compared with worry about environmental destruction or nuclear war (odds ratios, 1.73-2.11). No interactions between sleep and year of investigation were found.

    Conclusions

    Little is known about the association between adolescent worry and sleep, and about sleep disturbance and specific worry content. This study shows that the strength in the relationship between adolescent worry and sleep varies with worry themes. Knowledge of the worry content related to sleep may aid in targeting preventions and interventions.

  • 2.
    Jansson-Frojmark, Markus
    et al.
    Univ Orebro, Sch Law Psychol & Social Work, Ctr Hlth & Med Psychol CHAMP, S-31705 Orebro, Sweden.;Stockholm Univ, Dept Psychol, S-10691 Stockholm, Sweden..
    Norell-Clarke, Annika
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013). Univ Orebro, Sch Law Psychol & Social Work, Ctr Hlth & Med Psychol CHAMP, S-31705 Orebro, Sweden.; Stockholm, Sweden..
    Linton, Steven J.
    Univ Orebro, Sch Law Psychol & Social Work, Ctr Hlth & Med Psychol CHAMP, S-31705 Orebro, Sweden..
    The role of emotion dysregulation in insomnia: Longitudinal findings from a large community sample2016In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 21, no 1, p. 93-113Article in journal (Refereed)
    Abstract [en]

    The purpose of this longitudinal investigation was to examine the association between emotion regulation and future insomnia (incidence and persistence). DesignA longitudinal study in the general population. MethodsA survey was sent out to 5,000 individuals in the community. To those who returned the baseline questionnaire (n=2,333), two follow-up surveys, 6 and 18months later, were sent out and then completed by 1,887 and 1,795 individuals, respectively. The survey contained information about demographic factors, insomnia symptomatology, the Difficulties in Emotion Regulation Scale, anxiety, and depression. ResultsThe findings suggested that emotion regulation at baseline was not associated with the incidence or persistence of insomnia. Overall, the effect sizes were very small to medium. When examining changes in emotion regulation over time, a different pattern emerged. Partial support was established for the notion that decreases in emotion regulation were related to incident and persistent insomnia, as a decrease in emotion regulation was associated with a higher likelihood of future insomnia. Yet, the effect sizes were very small to small. ConclusionThis study does partly point towards a longitudinal association between emotion dysregulation and insomnia. This might have implications for the conceptualization and management of insomnia as well as for future research.

  • 3.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Harvey, Allison G.
    Department of Psychology, Berkeley University.
    Lundh, Lars-Gunnar
    Psykologiska insitutionen, Lunds universitet.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Psychometric properties of an insomnia-specific measure of worry: the anxiety and preoccupation about sleep questionnaire2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 1, p. 65-76Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the psychometric properties of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), with a focus on factorial validity and internal consistency as well as discriminative, convergent, and association with sleep parameters and daytime impairment. Among a randomly selected sample from the general population (N = 5,000), 2,333 participants completed a survey on nighttime symptoms, daytime symptoms, health outcomes, and psychological processes. The study sample consisted of 1800 participants who did not fulfill criteria for another sleep disorder than insomnia. A two-factor solution, accounting for 70.7% of the variance, was extracted from the 10 APSQ items. One six-item factor determined worries about the consequences of poor sleep (a = .91); the second factor, with four items, assessed worries about the uncontrollability of sleep (a = .86). The two factors were significantly intercorrelated (ρ = .65) and significantly associated with the total APSQ (ρs = .97 and .76, respectively). The APSQ and the two subscales showed discriminant validity between three sleep status groups (normal sleep, poor sleep, and insomnia disorder; R2 = .33-.41). The APSQ and the subscales demonstrated convergent validity with measures on cognitive arousal, sleep-related beliefs, anxiety, and depression. They also were significantly correlated with sleep parameters and daytime impairment. The findings suggest that the APSQ is a psychometrically sound instrument for assessing worry in insomnia.

  • 4.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Harvey, Allison G.
    Psychology Department, Berkeley University.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Associations between psychological factors and night-time/daytime symptomatology in insomnia2012Conference paper (Refereed)
    Abstract [en]

    Objectives: Cognitive models of insomnia underscore cognitive mechanisms as important in the maintenance of insomnia. The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms with night-time and daytime symptoms.

    Methods: In a cross-sectional examination, participants (n = 2327) from a randomly selected sample of the general population completed a survey on demographic parameters, night-time symptoms, daytime impairment, health outcomes, and psychological factors intended to index five cognitive processes (Harvey, 2002). Excluding those with a sleep disorder other than insomnia, the study sample consisted of 1890 participants.  

    Results: Relative to poor and normal sleepers, the insomnia group scored higher on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviours relative to the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviours (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance).

    Conclusion: The findings show that psychological factors discriminate those with insomnia from those with poor or normal sleep. The results also indicate that psychological factors are linked to insomnia-specific night-time and daytime symptomatology.

  • 5.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Harvey, Allison G.
    University of California.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Associations between psychological factors and nighttime/daytime symptomatology in insomnia2012In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 41, no 4, p. 273-287Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms and nighttime and daytime symptoms.

    Methods: A cross-sectional examination in the general population was used. The study sample consisted of 1890 participants from the general population. The participants completed a survey on nighttime and daytime symptoms, health outcomes, and psychological factors.

    Results: Relative to poor and normal sleepers, the insomnia group had higher scores on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviors than the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviors (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance).

    Conclusion: The findings indicate that psychological factors are linked to nighttime and daytime symptomatology in insomnia.

  • 6.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Granberg, Sarah
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Danermark, Berth
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Cognitive-behavioral therapy for insomnia co-morbid with hearing impairment: a randomized controlled trial2012In: Journal of clinical psychology in medical settings, ISSN 1068-9583, E-ISSN 1573-3572, Vol. 19, no 2, p. 224-234Article in journal (Refereed)
    Abstract [en]

    The purpose of the current study was to examine the effects of cognitive behavior therapy (CBT-I) for insomnia on patients with insomnia co-morbid with hearing impairment. A randomized controlled design was used with a 3-month follow-up. Thirty-two patients with insomnia co-morbid with hearing impairment were randomized to either CBT-I or a waitlist condition (WLC). The primary outcome was insomnia severity. Secondary outcomes were sleep diary parameters, dysfunction, anxiety, and depression. Compared to WLC, CBT-I resulted in lower insomnia severity at post-treatment and at follow-up (d = 1.18–1.56). Relative to WLC, CBT-I also led, at both assessment points, to reduced total wake time (d = 1.39) and increased sleep restoration (d = 1.03–1.07) and sleep quality (d = 0.91–1.16). Both groups increased their total sleep time, but no significant group difference emerged. Compared to WLC, CBT-I resulted in higher function (d = 0.81–0.96) and lower anxiety (d = 1.29–1.30) at both assessment points. Neither CBT-I nor WLC led to improvement on depression. Based on the Insomnia Severity Index, more CBT-I (53–77%) than WLC participants (0–7%) were treatment responders. Also, more CBT-I (24%) than WLC participants (0%) remitted. In patients with insomnia co-morbid with hearing impairment, CBT-I was effective in decreasing insomnia severity, subjective sleep parameters, dysfunction, and anxiety. These findings are in line with previous results on the effects of CBT-I in other medical conditions.

  • 7.
    Jansson-Fröjmark, Markus
    et al.
    Stockholms universitet.
    Norell-Clarke, Annika
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders2016In: Current sleep medicine reports, ISSN 2198-6401, Vol. 2, no 4Article in journal (Refereed)
    Abstract [en]

    Insomnia means difficulties in initiating or maintaining sleep and is commonly comorbid with psychiatric disorders. From being considered secondary to primary psychiatric disorders, comorbid insomnia is now considered an independent health issue that warrants treatment in its own right. Cognitive behavioural therapy for insomnia (CBT-I) is an evidence-based treatment for insomnia. The effects from CBT-I on comorbid psychiatric conditions have received increasing interest as insomnia comorbid with psychiatric disorders has been associated with more severe psychiatric symptomologies, and there are studies that indicate effects from CBT-I on both insomnia and psychiatric symptomology. During recent years, the literature on CBT-I for comorbid psychiatric groups has expanded and has advanced methodologically. This article reviews recent studies on the effects from CBT-I on sleep, daytime symptoms and function and psychiatric comorbidities for people with anxiety, depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder. Future strategies for research are suggested.

  • 8.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample2012In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, no 2, p. 103-110Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose was to examine the psychometric properties of the Pre-Sleep Arousal Scale.

    Methods: From a randomly selected sample of the general population (N = 5000), 2327 participants completed a survey on nighttime symptoms, daytime symptoms, health outcomes, and psychological processes. The study sample consisted of 1890 participants who did not fulfill criteria for a sleep disorder other than insomnia.

    Results: Findings indicated that the PSAS did not produce an adequate factorial solution. When three problematic items were removed, the solution, accounting for 48.5% of the variance, improved (PSAS-13). One subscale, cognitive arousal (alpha = .88), consisted of five items (37.1%), and one subscale, somatic arousal (alpha = .72), of eight items (11.4%). The two factors were significantly inter-correlated (rho = .51) and associated with the PSAS-13 (rho = .91, rho = .80). Among those with insomnia, a shortened PSAS (PSAS-14) was established, which consisted of a cognitive and a somatic subscale (48.6% of the variance). The PSAS-13 and the two subscales showed discriminant validity between three sleep groups (normal sleep, poor sleep, and insomnia disorder) (R-2 = .24-.34). The PSAS-13 and the subscales demonstrated convergent validity with measures on sleep-related worry, sleep-related beliefs, anxiety, and depression. The PSAS-13 and the two subscales were significantly correlated with sleep parameters and daytime impairment.

    Conclusion: Though acceptable psychometric properties were established for the PSAS, the cognitive sub-scale's focus upon general pre-sleep arousal and the relatively low variance accounted for calls for further work on and a possible re-conceptualization of the PSAS.

  • 9.
    Jansson-Fröjmark, Markus
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Norell-Clarke, Annika
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia: A systematic review2018In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 42, p. 19-36Article in journal (Refereed)
    Abstract [en]

    Since the beginning of the twenty-first century, there has been an increased focus on developing and testing cognitive components and therapies for insomnia disorder. The aim of the current review was thus to describe and review the efficacy of cognitive components and therapies for insomnia. A systematic review was conducted on 32 studies (N = 1455 subjects) identified through database searches. Criteria for inclusion required that each study constituted a report of outcome from a cognitive component or therapy, that the study had a group protocol, adult participants with diagnosed insomnia or undiagnosed insomnia symptoms or reported poor sleep, and that the study was published until and including 2016 in English. Each study was systematically reviewed with a standard coding sheet. Several cognitive components, a multi-component cognitive program, and cognitive therapy were identified. It is concluded that there is support for paradoxical intention and cognitive therapy. There are also other cognitive interventions that appears promising, such as cognitive refocusing and behavioral experiments. For most interventions, the study quality was rated as low to moderate. We conclude that several cognitive treatment components and therapies can be viewed as efficacious or promising interventions for patients with insomnia disorder. Methodologically stronger studies are, however, warranted.

  • 10.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    The role of emotion dysregulation in insomnia: Longitudinal findings from a large community sample2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no SI:1, p. 133-134, article id P452Article in journal (Refereed)
  • 11.
    Johansson, Magnus
    et al.
    Stockholms universitet.
    Jansson-Fröjmark, Markus
    Stockholms universitet.
    Norell-Clarke, Annika
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Linton, Steven
    Örebro universitet.
    The role of psychiatric and somatic conditions in incidence and persistence of insomnia: a longitudinal, community study2016In: Sleep Health, ISSN 2352-7218, E-ISSN 2352-7226, Vol. 2, no 3, p. 229-238Article in journal (Refereed)
    Abstract [en]

    ObjectiveThe objective was to investigate the role of psychiatric and somatic conditions in incident and persistent insomnia.DesignThis was a prospective study with 3 measurement points over 1.5 years.SettingThe participants were sent a survey to their home addresses.ParticipantsA survey was sent out to 5000 random individuals (18-70 years) in 2 Swedish counties. To those who returned the baseline questionnaire (n = 2333), 2 follow-up surveys (6 and 18 months later) were sent out and completed by 1887 and 1795 individuals, respectively.MeasurementsThe survey contained questions about sociodemographic factors and insomnia symptomatology, the Hospital Anxiety and Depression Scale, and items assessing 12 forms of somatic conditions (eg, heart disease and headache).ResultsBaseline depression, headache, and number of psychiatric and somatic conditions were found to be independent risk factors for incident insomnia. Also, deterioration in depression and heart disease status and increased number of conditions over time increased the risk for insomnia incidence. Anxiety; depression; pain in neck, back, or shoulders; and headache at baseline were found to significantly discriminate between those with persistent insomnia and those with persistent normal sleep. Those with persistent insomnia also reported a higher number of conditions relative to those with persistent normal sleep. None of the psychiatric or somatic conditions were found to be associated with persistence of insomnia relative to remission of insomnia.ConclusionThe current study suggests that both psychiatric and somatic conditions are involved in the incidence but not in the persistence of insomnia. Clinical and theoretical implications of the results are discussed.

  • 12.
    Norell-Clarke, Annika
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Cogito, ergo insomnis: I think, therefore I am sleepless2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems.

    The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

  • 13.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Hagquist, Curt
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Adolescent sleep duration in relation to psychosomatic complaints: development between 1985 and 2013 in Sweden2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no SI, p. 139-139Article in journal (Refereed)
  • 14.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Hagquist, Curt
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Changes in sleep habits between 1985 and 2013 among children and adolescents in Sweden2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 869-877Article in journal (Refereed)
    Abstract [en]

    Aims: The aim was to investigate changes in child and adolescent sleep habits in Sweden over time. This had not been done previously. Methods: Cross-sectional questionnaire data over three decades of investigations of the Health Behaviours of School Children study (1985/1986, 2005/2006 and 2013/2014) were used. The sample included 18,682 children and adolescents, aged 11, 13 and 15. Empirically based age-specific sleep duration recommendations were used to operationalise sleep duration. Results: The results showed that, over time, fewer go to bed early and more go to bed late. Regarding sleep duration, there have been decreases in the proportion of children and adolescents that sleep as much as is recommended for their age. Sleep onset difficulties have increased for all ages and increase the odds of sleeping less than recommended as well as having late bedtimes. Boys were more likely than girls to have later bedtimes and to sleep less than recommended. A vocational educational track, not planning to study further or being unsure of which track to choose increased the odds for 15 year olds to have late bedtimes and to sleep less than recommended compared with a college preparatory track. Conclusions: The results indicate that over time, fewer children and adolescents attain sufficient sleep duration. This may have implications for study results, mental health and cognitive abilities.

  • 15.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Hagquist, Curt
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Child and adolescent sleep duration recommendations in relation to psychological and somatic complaints based on data between 1985 and 2013 from 11 to 15 year-olds2018In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 68, p. 12-21Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the association between sleep duration, sleep initiation difficulties and psychological and somatic complaints. Methods: We used three cohorts of cross-sectional Swedish questionnaire data, from the Health Behaviours of School aged Children (1985/1986, 2005/2006, 2013/2014, n=>18 000, aged 11–15). Specific complaints (e.g. pain) and total complaint load were used as outcomes of sleep duration, sleep initiation difficulties and the combination of them both. Results: Sleeping less than recommended and sleep initiation difficulties were associated with increased odds of specific complaints and belonging to the group with the greatest complaint load. The combination of short sleep duration and sleep initiation difficulties were associated with higher odds than either sleep issue alone. No interaction effects between time and sleep variables were found regarding complaints. Conclusions: The findings support recent sleep duration recommendations. Further, sleep issues warrant a broad health assessment as they indicate a high likelihood of other complaints.

  • 16.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health. Örebro University, School of Law, Psychology and Social Work.
    Hagquist, Curt
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health.
    Psychosomatic problems in relation to alcohol use and physical exercise: A study between 1988 and 2011 among adolescents in Sweden2016In: Journal of Public Health, ISSN 2198-1833, E-ISSN 1613-2238, Vol. 24, no 4, p. 325-333Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to investigate the association between psychosomatic problems and lifestyle patterns of alcohol use and physical exercise in adolescence. Subject and Methods: Cross-sectional questionnaire data from 8 years of investigations (1988–2011) were used. The sample included over 20,000 adolescents (50 % girls), aged 15–16. Adolescents were divided into three groups depending on psychosomatic problem load: 10th, 11th–89th and 90th percentiles on the psychosomatic problems scale (PSP). A composite measure of alcohol use (frequent/rarely/never) and physical exercise (regular/little/never) was created, resulting in nine combinations of health-related behaviours, and used as dependent variable. Results: Multinomial regression analysis showed that those over the 90th percentile of the PSP had nearly 12 times higher odds of regular alcohol use combined with no exercise compared with those who had the least symptoms. The former subgroup also had higher odds of belonging to all suboptimal lifestyle categories. Those in the 11th–89th percentiles had increased, albeit smaller, odds of belonging to all lifestyle categories. Descriptive data analysis indicated gender differences and changes over time in the strength of the association between psychosomatic problems and health-related behaviours but the regression analysis did not show any statistically significant interactions. The proportion of adolescents engaging in the unhealthiest lifestyle had decreased over time while reports of psychosomatic problems had increased. Conclusion: Adolescents with the greatest psychosomatic symptom load were the most likely to engage in unhealthy lifestyles. This may mean multiplied risks of future psychopathology and warrants longitudinal investigations

  • 17.
    Norell-Clarke, Annika
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Stockholms universitet, Örebro Universitet.
    Tillfors, Maria
    Örebro Universitet.
    Harvey, Allison G.
    USA.
    Linton, Steven J.
    Örebro Universitet.
    Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 38-48Article in journal (Refereed)
    Abstract [en]

    Aim: Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population. Methods: In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper. Results: Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models. Conclusions: The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.

  • 18.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Jansson-Fröjmark, Markus
    Örebro universitet.
    Tillfors, Maria
    Göteborgs universitet.
    Holländare, Fredrik
    Örebro universitet.
    Engström, Ingemar
    Örebro universitet.
    Group cognitive behavioural therapy for insomnia: Effects on sleep and depressive symptomatology in a sample with comorbidity2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 74, p. 80-93Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symptomatology in a comorbid sample through a randomised controlled trial with a 6 month follow-up.

    METHODS: 64 participants were recruited through advertisements and randomised to receive CBT-I or an active control (relaxation training: RT) during four group sessions. Insomnia Severity Index and BDI-II were the primary outcome measures, assessed pre-treatment, post-treatment and at 6 month follow-up. Insomnia and depressive diagnoses, and functional impairment were assessed before and after treatment, whereas sleep diary data was gathered continuously from one week before treatment until after treatment.

    RESULTS: CBT-I was more efficient than RT in reducing insomnia severity and equally effective in reducing depressive symptoms, although CBT-I was associated with a higher proportion of remitted persons than RT, regarding both insomnia and depression diagnoses. Also, CBT-I was associated with less functional impairment, shorter sleep onset latency and wake after sleep onset but both treatments had equal improvements of sleep quality, early morning awakenings and total sleep time.

    CONCLUSION: Group CBT-I is an efficient form of insomnia-treatment for people with insomnia comorbid with depressive symptomatology. The mixed results regarding depression outcomes warrants replication and further studies into treatment mechanisms.

  • 19.
    Norell-Clarke, Annika
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Nyander, EvaLotta
    Jansson-Fröjmark, Markus
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Sleepless in Sweden: a single subject study of effects of cognitive therapy for insomnia on three adolescents2011In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 39, no 3, p. 367-374Article in journal (Refereed)
    Abstract [en]

    Background: Sleeping difficulties are an increasing problem for youths, but there is a lack of treatment research for this age group. Aim: The aim of this study was to investigate the effects of Cognitive Therapy for Insomnia (CT-I) on youths with primary insomnia; this treatment has never been tested on youths before. Method: The study was conducted according to an AB single-case experimental phase design, with pre-tests and post-tests. After 7–10 days of baseline assessment, three youths aged 16–18 (2 male) with primary insomnia participated in a 7-week long treatment. A sleep diary was used throughout the treatment. A followup assessment including one week with a sleep diary was conducted 3 months later. Visual inspection was used to analyze outcome. Results: Insomnia severity was greatly reduced for all participants after treatment. Daily measures showed that sleep onset latency was reduced for two participants but no change in total sleep time was confirmed. Daytime symptoms fluctuated for the participants. The insomnia-specific psychological processes were reduced to varying extents. These results were maintained at the follow-up measure. Conclusions: CT-I may be a promising treatment for youths with insomnia and the treatment should be tested further in randomized controlled studies.

  • 20.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Tillfors, Maria
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Jansson-Froejmark, Markus
    Karolinska institutet.
    Hollaendare, Fredrik
    Örebro University.
    Engstroem, Ingemar
    Örebro University.
    Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology2018In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 46, no 6, p. 726-737Article in journal (Refereed)
    Abstract [en]

    Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator. Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment. Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators. Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up. Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.

  • 21.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Tillfors, Maria
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Jansson-Fröjmark, Markus
    Karolinska institutet, Stockholm.
    Holländare, Fredrik
    Örebro universitet.
    Engstrom, Ingemar
    Örebro universitet.
    How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology2017In: International Journal of Cognitive Therapy, ISSN 1937-1209, E-ISSN 1937-1217, Vol. 10, no 4, p. 304-329Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to gain a greater understanding of the five cognitive processes from the cognitive model of insomnia, negative automatic thoughts, and time in bed as outcomes and potential mediators of cognitive behavioral therapy for insomnia (CBT-I), in a sample with insomnia and depressive symptomatology. Sixty-four participants were randomized to receive either CBT-I or an active control (relaxation training: RT) in groups during four biweekly sessions. Insomnia, depressive severity, and the potential processes of change were measured pre-, mid-, and post-treatment. CBT-I was associated with greater reductions of dysfunctional beliefs about sleep, sleep-related safety behaviors, and time in bed compared to RT. Mid-treatment dysfunctional beliefs about sleep was the only process that mediated between CBT-I and outcomes on insomnia and depressive severity, respectively. The relationships were reciprocal. Dysfunctional beliefs about sleep may be a transdiagnostic process of both insomnia and depression.

  • 22.
    Norell-Clarke, Annika
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Holländare, Fredrik
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    An investigation of dysfunctional beliefs as a mediator of cognitive behavioural therapy for insomnia in a sample with insomnia and depression2014Conference paper (Refereed)
  • 23.
    Norell-Clarke, Annika
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Centre for Research on Child and Adolescent Mental Health (from 2013).
    Tillfors, Maria
    Örebro University.
    Wilmenius, Lina
    Örebro University.
    Jansson Fröjmark, Markus
    Stockholms universitet, Klinisk psykologi.
    Holländare, Fredrik
    Örebro University.
    Engström, Ingemar
    Örebro University.
    Insomnia severity mediates between cognitive behavioural therapy for insomnia and depression in a sample with insomnia and depression: New possibilities for treatments of comorbid patients2016In: EABCT 2016 Abstract Book: Total Awareness, The European Association for Behavioural and Cognitive Therapies , 2016, p. 544-544Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    Clinical trials have shown that cognitive behavioural therapy for insomnia (CBT-I) may have an effect on both insomnia and depression in comorbid samples, but there is a gap in the knowledge on why CBT-I has an impact on depression. Neuropsychological theories suggest that disturbed sleep may work as a transdiagnostic process that maintains psychopathology. The aim was to test whether CBT-I impacts depressive symptoms through improved sleep, in a sample with insomnia comorbid with major depression and subthreshold depressive symptoms. 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four bi-weekly sessions. Insomnia (ISI) and depressive severity (BDI-II) were measured pre-, mid- and post-treatment. Mediational analyses were conducted. Insomnia and depressive severity lowered over the course of treatments. CBT-I was superior in reducing insomnia. The main treatment outcomes have been published elsewhere (Norell-Clarke et al, 2015). The relationship between CBT-I and post-treatment depressive severity was mediated by mid-treatment insomnia severity, which indicates that the effect of CBT-I on depression goes through improved sleep (b = -4.87, BCa CI = -9.21, -1.97). The results were maintained when pre-treatment insomnia and depressive severity were controlled for (b = -3.36, BCa CI = -8.86, -0.45). Testing for reciprocity, we found that mid-treatment depressive severity did not mediate between CBT-I and post-treatment insomnia severity. The results support the perpetuating role of insomnia in depression. This may have implications for other psychiatric patient groups with comorbid insomnia. Also, the results indicate that CBT for comorbid patient groups may need to target sleep specifically.

1 - 23 of 23
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