Emotion Regulation in Insomnia Disorder
Final Report Abstract
New models of psychopathology highlight the importance of basic psychophysiological processes in the occurrence and maintenance of mental disorders. Both sleep and emotions represent transdiagnostic aspects for mental health and are receiving major attention in clinical models. Nevertheless, the knowledge of their interactions is still limited by few studies and small sample sizes. In addition to this, insomnia disorder has been recognised as highly prevalent in the general population and as a risk factor for many common mental disorders. Its gold-standard treatment, Cognitive-Behavior Treatment for Insomnia (CBT-I), does not yet include standardised clinical strategies targeting directly emotional processes associated with the disorder. A deeper understanding of the role of emotional processes in insomnia disorder may drive new clinical perspectives. The ERID Project is so far the largest study evaluating bidirectional relationships between sleep and emotional processes. It combines ecological repeated measures data collected during several days with laboratory experimental data. The study compares patients with insomnia disorder with partially sleep deprived good sleeper controls, in order to understand the different dynamical interactions between sleep, insomnia, and emotional regulation skills. Three study parts were included, which compared patients with insomnia, partially sleep deprived good sleepers, and good sleepers sleeping as usual. The baseline study evaluated for 5 days reciprocal influences between sleep quality, intensity of positive and negative emotions, and use of emotion regulation strategies in daily life with both subjective and physiological measures. Laboratory experiment 1 compared the three groups with respect to physiological, behavioural and subjective responses to emotional film-clips related and non-related to insomnia. Spontaneous emotional reactivity responses were collected. Laboratory experiment 2 compared the three groups on the same outcomes in response to film-clips as Laboratory experiment 1, but responses were guided by previous training to instruct participants in using either the cognitive reappraisal emotion regulation strategy or the behavioural suppression emotion regulation strategy. Adopting a clinical perspective, results of Laboratory experiment 2 are particularly important. Indeed, the ability to train patients to use different emotion regulation strategies in response to negative stimuli was tested. Preliminary results from 96 patients with insomnia disorder and 96 good sleeper controls evidenced increased intensity of negative emotions and decreased intensity of positive emotions in patients compared to both control groups. Furthermore, in daily life, patients tend to use more often than good sleepers, emotion regulation strategies which are associated with increased levels of arousal and a longer time to return to baseline levels. First interpretation of data related to laboratory experiments indicate altered EEG reactivity to emotional stimuli in both patients with insomnia disorder and partially sleep deprived good sleepers controls. Further analyses are currently running and are described in Section II. Results are intended to be published in health-related scientific journals. Both basic research and clinical issues will be highlighted. All patients who took part in the ERID project were invited to take part in a clinical trial offering free intervention for insomnia by comparing standard CBT-I with CBT-I combined with clinical intervention directed to strength emotion regulation skills.
