Department of Psychology, Sapienza University of Rome, Italy; Department of Developmental and Social Psychology, Sapienza University of Rome, Italy.
Department of Human Sciences, University of Rome "G. Marconi"- Telematic, Italy.
Sleep Med Rev. 2021 Feb;55:101378. doi: 10.1016/j.smrv.2020.101378. Epub 2020 Sep 11.
Repetitive negative thinking (RNT), i.e., worry, rumination, and transdiagnostic repetitive thinking, is thought to exacerbate and perpetuate insomnia in cognitive models. Moreover, RNT is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Whilst accumulating evidence supports the efficacy of cognitive behavioural therapy for insomnia (CBT-I) in reducing depression and anxiety symptoms, the literature on the effects of CBT-I on RNT has never been systematically appraised. Importantly, preliminary evidence suggests that reduction of RNT following CBT-I may be associated with reduction of depression and anxiety. Therefore, we aimed to conduct a systematic review and meta-analysis on the effects of CBT-I on RNT. Seven databases were searched, and 15 randomised controlled trials were included. Results showed moderate-to-large effects of CBT-I on worry (Hedge's g range: -0.41 to g = -0.71) but small and non-reliable effects on rumination (g = -0.13). No clear evidence was found for an association between post-treatment reduction in RNT and post-treatment reduction in depression and anxiety. Although the literature is small and still developing, CBT-I seems to have a stronger impact on sleep-related versus general measures of RNT. We discuss a research agenda aimed at advancing the study of RNT in CBT-I trials.
重复性消极思维（RNT），即担忧、沉思和跨诊断性重复性思维，被认为会在认知模型中加剧和延续失眠。此外，RNT 是抑郁和焦虑的纵向前兆，而抑郁和焦虑往往与失眠同时存在。虽然越来越多的证据支持认知行为疗法治疗失眠（CBT-I）可以减轻抑郁和焦虑症状，但关于 CBT-I 对 RNT 影响的文献从未被系统评估过。重要的是，初步证据表明，CBT-I 后 RNT 的减少可能与抑郁和焦虑的减少有关。因此，我们旨在对 CBT-I 对 RNT 的影响进行系统评价和荟萃分析。我们检索了七个数据库，纳入了 15 项随机对照试验。结果表明，CBT-I 对担忧有中等至较大的影响（Hedge's g 范围为-0.41 至 g = -0.71），但对沉思的影响较小且不可靠（g = -0.13）。没有明确的证据表明 RNT 治疗后减少与治疗后抑郁和焦虑减少之间存在关联。尽管文献数量较少且仍在发展中，但 CBT-I 似乎对与睡眠相关的 RNT 测量与一般性的 RNT 测量相比具有更大的影响。我们讨论了一个旨在推进 CBT-I 试验中 RNT 研究的研究议程。
