Presleep Cognitive Activity and Thought Control Strategies in Insomnia

The aim of this study was to examine presleep cognitive activity and thought control strategies used by individuals with insomnia, with and without comorbid generalized anxiety disorder (GAD), and by good sleepers. Fifty participants were divided into the following comparison groups: (a) individuals with insomnia alone (n = 14), (b) individuals with insomnia and comorbid GAD (n = 16), and (c) good sleepers (n = 20). Participants completed a standardized evaluation including interviews and questionnaires on insomnia, anxiety, presleep cognitive activity, and thought control strategies. Results showed that individuals with insomnia and comorbid GAD reported greater presleep cognitive arousal than individuals with insomnia alone, who in turn reported greater cognitive arousal than good sleepers. Results also showed that individuals with insomnia and comorbid GAD used avoidance as a mean of controlling disturbing presleep cognitions more frequently than the other two groups. Both groups of individuals with insomnia evaluated their presleep thought control strategies as being less effective than good sleepers did. These results support the assertion that higher presleep cognitive arousal plays a role in insomnia and, by distinguishing individuals with insomnia alone (i.e., without comorbid anxiety disorders) from individuals with comorbid GAD, this study further suggests that higher cognitive arousal in individuals with insomnia is not necessarily accounted for by high rates of comorbidity between insomnia and GAD. The main clinical implication of these findings is that the evaluation and treatment of insomnia should consider these cognitive features in order to optimize outcome.