Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, School of Medicine, Pisa, Italy.
Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Pisa, School of Medicine, Pisa, Italy.
Sleep Med. 2017 Feb;30:97-104. doi: 10.1016/j.sleep.2016.11.004. Epub 2016 Nov 19.
Insomnia-specific rumination has presented in subjects with insomnia. Research has identified hyperarousal as a key factor, with both trait and state components. It has been shown that emotion dysregulation also plays a role in insomnia. Hence, the aim was to investigate how insomnia rumination is associated with both trait- and state-dependent arousal and emotion dysregulation in insomnia.
Sixty-eight subjects with insomnia disorder (DSM-5) and 36 good sleepers were evaluated using: Insomnia Severity Index (ISI), Daytime Insomnia Symptom Response Scale (DISRS), Arousal Predisposition Scale (APS), Pre-sleep Arousal Scale (PSAS), and Difficulties in Emotion Regulation Scale (DERS). Univariate and multivariate regression analyses and mediation analyses were performed.
Subjects with insomnia (F 41, mean age 50.2 ± 10) presented higher scores than good sleepers (F 22, mean age 49.7 ± 14) in all the scales (ISI, DISRS, APS, PSAS, DERS; p < 0.0001). Insomnia rumination was directly correlated with trait (APS, B = 0.22, p < 0.0001) pre-sleep state arousal (PSAS cognitive B = 0.22, p < 0.0001, PSAS somatic B = 0.24, p < 0.0001) and emotion dysregulation (B = 0.5, p = 0.03). It mediated the association between trait and pre-sleep state hyperarousal (Z = 3.3, p = 0.0008), the bidirectional association between cognitive and somatic arousal (p = 0.02), and the association between trait hyperarousal and emotion dysregulation (Z = 2.3, p = 0.04).
In insomnia, specific rumination is related to both trait predisposition to arousal and to state-dependent arousal. It is also related to emotion dyregulation. Insomnia-specific ruminative response style may modulate the complex association between trait- and state-dependent arousal factors and arousal and emotion regulation in insomnia. In this framework, a broad range of cognitive processes may be considered when dealing with subjects with insomnia: the use of rumination-oriented psychological strategies could be important.
特定于失眠的反刍思维在失眠患者中出现。研究已经确定了过度觉醒是一个关键因素，包括特质和状态成分。情绪调节障碍也在失眠中起作用。因此，本研究旨在调查失眠反刍思维如何与失眠的特质和状态相关的觉醒和情绪调节障碍相关联。
使用失眠严重度指数（ISI）、日间失眠症状反应量表（DISRS）、觉醒倾向量表（APS）、睡前觉醒量表（PSAS）和情绪调节困难量表（DERS）评估 68 例失眠障碍患者（DSM-5）和 36 例睡眠良好者。进行了单变量和多变量回归分析和中介分析。
与睡眠良好者（F22，平均年龄 49.7±14）相比，失眠患者（F41，平均年龄 50.2±10）在所有量表（ISI、DISRS、APS、PSAS、DERS；p<0.0001）中的得分均较高。失眠反刍与特质（APS，B=0.22，p<0.0001）、睡前状态觉醒（PSAS 认知 B=0.22，p<0.0001，PSAS 躯体 B=0.24，p<0.0001）和情绪调节障碍直接相关（B=0.5，p=0.03）。它介导了特质和睡前状态过度觉醒之间的关联（Z=3.3，p=0.0008）、认知和躯体觉醒之间的双向关联（p=0.02）以及特质过度觉醒和情绪调节障碍之间的关联（Z=2.3，p=0.04）。
在失眠中，特定的反刍与特质性觉醒倾向和状态依赖性觉醒有关。它还与情绪调节障碍有关。失眠特异性反刍反应模式可能调节特质和状态相关的觉醒因素与觉醒和情绪调节在失眠中的复杂关联。在这个框架内，当处理失眠患者时，可以考虑广泛的认知过程：使用以反刍为导向的心理策略可能很重要。
