Personality and insomnia: A systematic review and narrative synthesis.

The inherent nature of personality serves as a predisposing, and possible maintaining, factor of insomnia. However, methodological differences limit the ability to draw causal conclusions regarding the specific traits involved in the aetiology of the disorder. This systematic review of the relationship between insomnia and personality provides a narrative synthesis of the literature to date. Here, we identified N = 76 studies meeting the inclusion/exclusion criteria. The outcomes reliably evidenced the experience of insomnia to be associated with personality traits that are typically considered to be negative or maladaptive in nature. More specifically, insomnia was related to neuroticism, introversion, perfectionistic doubts and concerns, elevated personal standards, negative affect, social inhibition and avoidance, hysteria, hypochondriasis, psychasthenia, impulsive behaviour, anger, hostility, and psychopathic tendencies, schizotypal and borderline traits, reduced conscientiousness and self-directedness, and negatively perceived perception of the self. Several studies examined the role that personality plays in predicting the treatment efficacy and adherence of CBTi. Moving forward, longitudinal research, methodological consistency, the mediating role of treatment outcomes and adherence, and clinical and population representative samples should be prioritised. Methodological strengths and limitations of the literature are discussed alongside the next steps that should be taken to advance our understanding of the literature.

Adherence to sleep restriction therapy - An evaluation of existing measures.

Sleep restriction, a key element of cognitive behavioural therapy for insomnia, involves considerable behavioural changes in patients' lives, leading to side-effects like increased daytime sleepiness. Studies on sleep restriction rarely report adherence, and when assessed it is often limited to the average number of therapy sessions attended. This study aims to systematically evaluate different measures of adherence to cognitive behavioural therapy for insomnia and their relationship with treatment outcome. This is a secondary analysis of data from a randomized controlled trial investigating cognitive behavioural therapy for insomnia (Johann et al. (2020) Journal of Sleep Research, 29, e13102). The sample included 23 patients diagnosed with insomnia according to DSM-5 criteria who underwent 8 weeks of cognitive behavioural therapy for insomnia. The following adherence measures based on sleep diary data were used: number of sessions completed; deviations from agreed time in bed; average percentage of patients deviating from bedtime by 15, 30 or 60 min; variability of bedtime and wake-up time; change in time in bed from pre- to post-assessment. Treatment outcome was assessed using the Insomnia Severity Index. Multiple regression models were employed, and insomnia severity was controlled for. Results showed that none of the adherence measures predict insomnia severity. Baseline insomnia severity, dysfunctional thoughts and attitudes about sleep, depression or perfectionism did not predict adherence. The limited variance in the outcome parameter due to most patients benefiting from treatment and the small sample size may explain these findings. Additionally, using objective measures like actigraphy could provide a better understanding of adherence behaviour. Lastly, the presence of perfectionism in patients with insomnia may have mitigated adherence problems in this study.

The role of the COVID-19 pandemic in altered psychological well-being, mental health and sleep: an online cross-sectional study.

Coronavirus disease 2019 (COVID-19) is a global pandemic. Measures to reduce transmission of the virus have altered usual activities, routines, and livelihoods, and have had a significant impact on mental health. The current study aims to examine the potential alterations in psychological wellbeing, mental health, sleep and diurnal preference due to the COVID-19 pandemic. A cross sectional online questionnaire-based study with n = 200 participants (aged 18-62; 7.86.0% female, 93.0% white, 92.5% UK-based, 73.5% students). Data were collected between 15th April and 8 June 2020. Participants answered questions on lifestyle changes and their concerns and worries about COVID-19, and completed the SCI, PHQ9, GAD7, PWB18, UCLA3 and MEQ. Results showed self-isolation was linked to lower psychological well-being, and increased loneliness, anxiety and depression. Home-working was related to a shift in diurnal preference. Reduced work/income was related to decreased psychological well-being and sleep quality and increased anxiety, depression, loneliness and. Intensity of worried thoughts and concerns about COVID-19 were positively correlated with anxiety, depression and negatively with sleep quality. In conclusion, the social, occupational and economic disruption due to COVID19 has had a negative impact on psychological well-being. However, the transition to home-working may have been somewhat beneficial for some individuals in terms of sleep. These findings should be taken into account by policy makers during the transition to the 'new normal' post-pandemic.

Sleep-related monitoring on awakening mediates the relationship between insomnia-related interpretive bias and insomnia symptoms using the insomnia ambiguity paradigm.

A number of studies have examined and confirmed the presence of a sleep-related interpretive bias amongst poor sleepers and individuals with insomnia using an insomnia ambiguity task. This study explored possible mechanisms underlying the relationship between interpretive bias and insomnia using the insomnia ambiguity task. More importantly, the possible mediating role of sleep-associated monitoring, sleep preoccupation, sleep anticipatory anxiety and generalized anxiety was also examined. A total of N = 176 participants were stratified into normal sleepers and those displaying insomnia symptoms. Participants completed an online version of the insomnia ambiguity task and questionnaire measures pertaining to sleep and anxiety. Data concerning task response time and time of testing were also collected. Individuals in the insomnia symptom group presented significantly higher sleep-related interpretive bias scores compared to normal sleepers. When sleepiness, sleep-associated monitoring, sleep preoccupation, sleep anticipatory anxiety and generalized anxiety were controlled for, only monitoring on awakening predicted sleep-related interpretive bias. Multiple mediation modelling demonstrated that sleep-associated monitoring on awakening mediated the relationship between interpretive bias and insomnia symptoms. The current outcomes are consistent with previous research, supporting the notion that insomnia is characterized by a disorder-consistent interpretive bias. Furthermore, monitoring for insomnia-consistent cues on awakening appears to mediate group differences in interpretive bias.

Eye tracking and attentional bias for depressive internet memes in depression.

Previous research highlights the potential benefits of engaging with depressive internet memes for those experiencing symptoms of depression. This study aimed to determine whether: compared to non-depressed controls, individuals experiencing depressive symptoms were quicker to orient and maintain overall attention for internet memes depicting depressive content relative to neutral memes. N = 21 individuals were grouped based on the severity of reported depression symptoms using the PhQ-9. Specifically, a score of: ≤ 4 denoted the control group; and ≥ 15 the depressive symptoms group. Participants viewed a series of meme pairs depicting depressive and neutral memes for periods of 4000 ms. Data for the first fixation onset and duration, total fixation count and total fixation and gaze duration of eye-movements were recorded. A significant group x meme-type interaction indicated that participants with depressive symptoms displayed significantly more fixations on depressive rather than neutral memes. These outcomes provide suggestive evidence for the notion that depressive symptoms are associated with an attentional bias towards socio-emotionally salient stimuli.

Examining the Factor Structure, Reliability, and Validity of the Disturbing Dreams and Nightmare Severity Index (DDNSI) Consequences Sub-component.

Background: The Disturbing Dreams and Nightmares Severity Index (DDNSI) is commonly used when assessing the experience of nightmares. It comprises two parts examining i) chronicity and ii) nightmare consequences. The primary aim of the present study was to explore the dimensional structure of the optional and currently unvalidated nightmare consequences component using exploratory factor analysis. Internal reliability and construct validity were also examined. A secondary aim explored the relationships between nightmare chronicity and perceived consequences with measures of anxiety, depression, stress, self-efficacy, and insomnia.Methods: A cross-sectional survey was conducted with complete data from N = 757 students from six UK-based universities. Participants completed the chronicity and consequences components of the DDNSI, alongside the Sleep Condition Indicator, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Stress Scale, and General Self-Efficacy Scale.Results: Two nightmare consequences factors emerged; 'Sleep-Interference' (four items; α =.848), and 'Psychosocial Well-being' (six items; α =.946). Significantly moderate correlations were observed between the two emerging factors and the nightmare chronicity component, as well as with insomnia, anxiety, depression, perceived stress, and self-efficacy. Perceived 'Sleep-Interference' (ß =-.241) was the strongest predictor of insomnia, and 'Psychosocial wellbeing' was the strongest predictor of anxiety (ß =.688) depression (ß =.804) perceived stress and lower self-efficacy.Conclusions: The perceived nightmare consequences component of the DDSNI is a multidimensional construct comprising two internally consistent and distinct, but related dimensions. The potential importance of distinguishing between types of perceived nightmare consequences and the associations with mental health outcomes in a student population is highlighted.

Homogeneity of cognitive and behavioural processes underlying the relationship between insomnia and body image disturbance.

Specific cognitive behavioural mechanisms related to selective attention, situational avoidance and physical appearance are implicated in the development and maintenance of insomnia and negative reinforcement of body image disturbances. Therefore, we examined whether these processes potentially mediate the relationship between insomnia and body image perception. N = 728 participants completed self-reported measures of sleep-associated monitoring, insomnia symptoms, body image disturbance and coping with body image challenges. Symptoms of insomnia and sleep-associated monitoring behaviour were independently related to increased reports of body image disturbance, cognitive distortions of body image, appearance fixing (i.e. altering appearance by covering, camouflaging or correcting the perceived defect), avoidance (i.e. attempt to escape or avert stressful body image situations) and reduced levels of positive rationale acceptance (i.e. acceptance of the challenging event and positive self-care or rationale self-talk about one's appearance). More crucially, sleep-related monitoring on awakening, cognitive distortion of body image and negative coping strategies related to body image (i.e. appearance fixing, avoidance, rationale acceptance) mediated the relationship between reports of body image disturbance and insomnia symptoms. The current findings expand upon previous research demonstrating consistent relationships between poor sleep and increased dissatisfaction with cutaneous features, by providing novel evidence that body image disturbances are associated with symptoms of insomnia. More crucially, we highlight the role of particular cognitive and behavioural mechanisms pertaining to sleep (i.e. selective attention for physical signs of poor sleep) and body image (i.e. avoidance and rationale acceptance) which may be targeted as part of cognitive behavioural treatments.

Cognitive behavioural therapy for insomnia does not appear to have a substantial impact on early markers of cardiovascular disease: A preliminary randomized controlled trial.

According to the World Health Organization, cardiovascular diseases are the leading cause of death in the world. Therefore, early prevention of these diseases is a public health priority. Epidemiological data suggest that insomnia may be a modifiable risk factor for cardiovascular diseases. A randomized controlled trial in a sample of insomnia patients without cardiovascular disease was conducted to investigate the effects of insomnia treatment on early markers of cardiovascular diseases assessed by 24-hr ambulatory blood pressure, heart rate and heart rate variability monitoring, and morning fasting blood samples. Forty-six patients with insomnia disorder were randomized to cognitive behavioural therapy for insomnia (CBT-I; n = 23) or a waitlist control condition (n = 23). Contrary to the hypothesis, intention-to-treat analyses did not show any significant treatment effects on early markers of cardiovascular disease (d = 0.0-0.6) despite successful insomnia treatment (d = 1.3). Potential methodological and conceptual reasons for these negative findings are discussed. Future studies might include larger sample sizes that are at risk of cardiovascular diseases and focus on other cardiovascular markers.

Examination of sleep health dimensions and their associations with perceived stress and health in a UK sample.

BACKGROUND: Sleep health is a relatively new multidimensional concept, however, there is no consensus on its underlying dimensions. A previous study examined potential indicators of sleep health using an aggregated sleep health measure. However, the psychometric properties are yet to be determined. The primary aim was to assess the factor structure, reliability and validity of this measure. A secondary aim was to explore the relationships with perceived stress, and physical and mental health. METHODS: A cross-sectional online survey was conducted with 257 adults from the UK aged 18-65 (78.4% female, mean age = 29.39 [SD = 11.37]). Participants completed 13 Sleep health items, the Pittsburgh Sleep Quality Inventory, Insomnia Severity Scale, Epworth Sleepiness Scale, Perceived Stress Scale and SF-12 Health Survey. RESULTS: The measure exhibited good internal consistency (α = 0.785) and construct validity as determined by associations with existing measures. Principle components analysis produced four factors e; sleep quality (α = 0.818), sleep adaptability (α = 0.917), sleep wellness (α = 0.621) and daytime functioning (α = 0.582). Adaptability (ß = -241) was strongest predictor of perceived stress, and daytime functioning was strongest predictor of physical (ß = 0.322) and mental health (ß = 0.312). CONCLUSIONS: Sleep health is a multidimensional construct comprising four distinct but related dimensions. The importance of sleep health in terms of perceived stress and mental and physical health is highlighted.

Perceptual Differences in Emotionally Ambiguous Neutral Faces Among Individuals Displaying Clinically Significant Insomnia Symptoms.

Many psychiatric populations present deficits in the processing of neutral faces. While insomnia is associated with perceptual alterations of facially expressed fear, sadness, and happiness, the perception of neutral faces have not been explored in this population. This study compared normal sleepers and individuals experiencing insomnia symptoms in their expression intensity ratings of neutral faces. A total of 56 normal sleepers scoring <5 on the Insomnia Severity Index and 58 individuals experiencing clinically significant insomnia symptoms scoring ≥15 on the Insomnia Severity Index (19.24 ± 3.53) observed 12 neutral facial photographs from the Karolinska Directed Emotional Faces database. Participants rated the extent to which each face appeared as attractive, sad, happy, trustworthy, approachable, healthy, and sociable. The results revelated a main effect of group, F(1,117) = 4.04, p = .047, and expression, F(7, 819) = 39.08, p = .001, on intensity ratings. While no significant Group × Expression interaction was confirmed, F(7,819)=1.03, p = .41, simple effects analysis determined that those experiencing insomnia symptoms rated neutral faces as significantly more attractive (34.30 ± 14.82; t(117) = -2.73, p = .007; Cohen's d = 0.50) and happy (34.83 ± 13.87; t(117) = -2.23, p = .028; Cohen's d = 0.41) compared with normal sleepers (Attractive: 26.89 ± 14.76; Happy: 28.90 ± 12.48). The present outcomes tentatively suggest that individuals experiencing clinically significant insomnia symptoms differentially perceive neutral faces when compared with normal sleepers. These outcomes present potentially negative psychosocial implications for those with insomnia.

Dysfunctional sleep-related cognition and anxiety mediate the relationship between multidimensional perfectionism and insomnia symptoms.

Perfectionism is one of several personality traits associated with insomnia. Whilst research has examined the relationships between perfectionism and insomnia, the mediating role of dysfunctional sleep-related cognition (i.e. sleep-related worry and dysfunctional beliefs about the biological attribution of and consequences of poor sleep) has yet to be examined. This study aimed to determine whether aspects of multidimensional perfectionism were related to increased reporting of insomnia symptoms. In addition, the potential mediating role of dysfunctional sleep-related cognition and anxiety symptoms was examined. Members of the general population (N = 624) completed the Dysfunctional Beliefs and Attitudes About Sleep Scale, the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, and the Multidimensional Perfectionism Scale. The results showed that perfectionism dimensions, anxiety symptoms, and dysfunctional sleep-related cognition were significantly associated with insomnia symptoms. Regression-based mediation analyses further showed that both dysfunctional sleep-related cognition and anxiety significantly mediated the associations between insomnia symptoms and three perfectionism dimensions (i.e. doubts about action, parental expectations, and parental criticism). The experience of perfectionistic tendencies, anxiety, and dysfunctional sleep-related cognition may initiate behavioural strategies (e.g. daytime napping) when faced with an acute sleep problem. However, these strategies may serve to transition insomnia from an acute to a chronic condition.

Altered Perception of Facially Expressed Tiredness in Insomnia.

The present study compared normal sleepers and individuals displaying insomnia symptoms in their ratings for the expression intensity of tiredness and alertness whilst observing tired and neutral faces. Fifty-six normal sleepers and 58 individuals with insomnia symptoms observed 98 facial photographs (49 neutral, 49 tired). Using a visual analogue scale, participants were required to rate the extent to which each face appeared as tired and alert. Tired faces were created by manipulating neutral photographs to include previously identified facial tiredness cues. All participants rated sleep-related faces as more tired and less alert relative to neutral photographs. A significant Group × Face × Rating interaction demonstrated that, compared with normal sleepers, the insomnia symptoms group showed lower ratings for the expression of tiredness, but not alertness, whilst observing the tired faces. The findings suggest that the presence of insomnia symptoms is associated with reduced ratings of expression intensity for sleep-related facial photographs displaying tiredness. These outcomes add to the body of literature on how facial cues of tiredness are perceived by those with insomnia symptoms. Further work is required to elucidate the mechanisms underlying the relationship between insomnia symptoms and reduced perceptions of facially expressed tiredness.

Preferential attention towards the eye-region amongst individuals with insomnia.

People with insomnia often perceive their own facial appearance as more tired compared with the appearance of others. Evidence also highlights the eye-region in projecting tiredness cues to perceivers, and tiredness judgements often rely on preferential attention towards this region. Using a novel eye-tracking paradigm, this study examined: (i) whether individuals with insomnia display preferential attention towards the eye-region, relative to nose and mouth regions, whilst observing faces compared with normal-sleepers; and (ii) whether an attentional bias towards the eye-region amongst individuals with insomnia is self-specific or general in nature. Twenty individuals with DSM-5 Insomnia Disorder and 20 normal-sleepers viewed 48 neutral facial photographs (24 of themselves, 24 of other people) for periods of 4000 ms. Eye movements were recorded using eye-tracking, and first fixation onset, first fixation duration and total gaze duration were examined for three interest-regions (eyes, nose, mouth). Significant group × interest-region interactions indicated that, regardless of the face presented, participants with insomnia were quicker to attend to, and spent more time observing, the eye-region relative to the nose and mouth regions compared with normal-sleepers. However, no group × face × interest-region interactions were established. Thus, whilst individuals with insomnia displayed preferential attention towards the eye-region in general, this effect was not accentuated during self-perception. Insomnia appears to be characterized by a general, rather than self-specific, attentional bias towards the eye-region. These findings contribute to our understanding of face perception in insomnia, and provide tentative support for cognitive models of insomnia demonstrating that individuals with insomnia monitor faces in general, with a specific focus around the eye-region, for cues associated with tiredness.

Misperception of tiredness in young adults with insomnia.

People with insomnia often exhibit interpretive biases to cues associated with their condition. This study examined whether individuals with insomnia display an interpretive bias, such that they misperceive facial attributes of tiredness in a disorder-consistent manner. The efficacy of providing feedback related to the accuracy of participants' perception on later judgements of tiredness was further examined. Forty participants, 20 with DSM-5-defined insomnia disorder and 20 normal-sleepers, participated. The perception of one's own facial appearance of tiredness was assessed twice over two consecutive days using a visual task whereby participants indicated when a morphing image of their face represented their current level of tiredness. Visual and verbal feedback, related to participants' degree of misperception, was provided on completion of Day 1 testing. Overall, individuals with insomnia perceived their own face as significantly more tired than a baseline neutral photograph was, whereas normal-sleepers perceived themselves as appearing more alert. This pattern of results was only apparent on Day 1. Although no group × day interaction was established, mean scores suggest an improvement in perception on Day 2 amongst individuals with insomnia only. These findings suggest that individuals with insomnia exhibit a misperception of their facial attributes of tiredness, interpreting them in a disorder-consistent manner. This finding adds to the body of literature on cognitive models of insomnia, demonstrating more general cognitive biases in the disorder. Further, the results provide suggestive evidence that this misperception may be reformed.

Prevalence and Psychiatric Correlates of Illicit Substance Use in UK Undergraduate Students.

This study examined the prevalence of illegal drug use in UK students and motivators behind such behavior. Additionally, we explored possible relationships between substance use, psychosocial motivators, and psychiatric distress. A group (n = 543) of students completed online measures of substance use, anxiety, depression, perceived stress, and insomnia. A series of reasons behind their use were ranked based on importance. Reported cannabis, cocaine, nitrous oxide, ketamine, and MDMA use were most prevalent based on lifetime, past year, and month assessments. The experience of anxiety, depression, perceived stress, and insomnia were related to increased reports of substance use. Poor self-confidence and self-medication were key motivators of illicit drug use in those presenting greater psychiatric distress. These outcomes add to the sparse body of literature concerning illicit substance use in relation to psychiatric distress amongst UK students. Furthermore, we provided novel insight into the psychosocial motivators of such use.

Sleep-related attentional and interpretive-bias in insomnia: A systematic review and meta-analysis.

Cognitive models of insomnia highlight internal and external cognitive-biases for sleep-related "threat" in maintaining the disorder. This systematic review of the sleep-related attentional and interpretive-bias literature includes meta-analytic calculations of each construct. Searches identified N = 21 attentional-bias and N = 8 interpretive-bias studies meeting the inclusion/exclusion criteria. Seventeen attentional-bias studies compared normal-sleepers and poor-sleepers/insomnia patients. Using a random effects model, meta-analytic data based on standardized mean differences of attentional-bias studies determined the weighted pooled effect size to be moderate at 0.60 (95%CI:0.26-0.93). Likewise, seven of eight interpretive-bias studies involved group comparisons. Meta-analytic data determined the weighted pooled effect size as moderate at .44 (95%CI:0.19-0.69). Considering these outcomes, disorder congruent cognitive-biases appear to be a key feature of insomnia. Despite statistical support, absence of longitudinal data limits causal inference concerning the relative role cognitive-biases in the development and maintenance of insomnia. Methodological factors pertaining to task design, sample and stimuli are discussed in relation to outcome variation. Finally, we discuss the next steps in advancing the understanding of sleep-related biases in insomnia.

Does social media usage contribute to cross-border social commerce? An empirical evidence from SEM and fsQCA analysis.

Drawing from the S-O-R perspective, this paper proposes a theoretical model explicating the mechanism whereby social media usage functions on customers' engagement in cross-cultural social commerce by employing a mixed-method approach including SEM and fsQCA analysis technique. Analysis of the data collected from 135 countries' 2058 international students indicates that social media usage, either for information or socializing purpose, exerts positive effects on international customers' engagement in social commerce through the conduit of cultural identity change, and social support positively moderates the relationships between two dimensions of social media usage and cultural identity change. The analysis of fsQCA further augmented the robust results reached from SEM and identified four types of configurations that trigger customers' engagement in cross-border social commerce. Research implications and limitations are also discussed.

Unlocking luxury purchase intentions in China: A study of consumer attitude, perceived value, and the moderating effect of perceived enjoyment.

This research aims to provide a picture of the elements influencing customers' intentions to purchase luxury products online using social exchange theory (SET). Second, we determined whether perceived enjoyment moderates the relationship between perceived value, consumer attitude, and intention to purchase luxury products. Data were collected from 389 participants through an online survey. Structural equation modelling (SEM) was used to analyze the data. The results showed that eWOM, perceived value, and consumer attitudes significantly affected luxury purchase intention. Moreover, perceived enjoyment moderates the relationship between perceived value, consumer attitude, and purchase intention. This study is designed to help practitioners and researchers understand why young Chinese consumers are interested in purchasing luxury goods online. Luxury brand companies can improve their marketing strategies by developing strategies aligned with the mindset of digital native Generation Z.

Contributions of Multilevel Family Factors to Emotional and Behavioral Problems among Children with Oppositional Defiant Disorder in China.

Oppositional defiant disorder (ODD) is one of the most prevalent childhood mental health disorders and is extremely affected by family factors. However, limited studies have addressed the issue from the perspective of family systems. The current study examines the associations between multilevel family factors (i.e., family cohesion/ adaptability at system level, mother-child and father-child attachment at a dyadic level, and child self-esteem at an individual level) and emotional and behavioral problems among children with ODD in China. The participants were 256 Chinese children with ODD and their parents and class master teachers. A multiple-informant approach and structural equation model were used. The results revealed that system level factors (family cohesion/adaptability) were associated with child emotional and behavior problems indirectly through factors at the dyadic level (mother-child attachment) and the individual level (child self-esteem) in sequence. Mother-child, but not father-child, attachment, mediated the linkage between family cohesion/adaptability and the emotional problems of children with ODD. Moreover, child self-esteem mediated the association between mother-child attachment and child emotional and behavioral problems. The findings of the present study underscored that multilevel family factors are uniquely related to emotional and behavioral problems in children with ODD.