title: Cognitive processes and their association with persistence and remission of insomnia: findings from a longitudinal study in the general population.
abstract: OBJECTIVE
  Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.
  
  
  METHODS
  In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.
  
  
  RESULTS
  Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.
  
  
  CONCLUSIONS
  The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.
authors: School of Law, Psychology, and Social Work, Örebro University, SE-701 82 Örebro, Sweden. Electronic address: annika.norell@oru.se.
authors: Annika
authors: A
authors: Norell-Clarke
authors: School of Law, Psychology, and Social Work, Örebro University, SE-701 82 Örebro, Sweden; Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden.
authors: Markus
authors: M
authors: Jansson-Fröjmark
authors: School of Law, Psychology, and Social Work, Örebro University, SE-701 82 Örebro, Sweden.
authors: Maria
authors: M
authors: Tillfors
authors: Department of Psychology, University of California, 3210 Tolman Hall, Berkeley, CA 94720-1650, USA.
authors: Allison G
authors: AG
authors: Harvey
authors: School of Law, Psychology, and Social Work, Örebro University, SE-701 82 Örebro, Sweden.
authors: Steven J
authors: SJ
authors: Linton
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology; D001143:Arousal / Q000502:physiology; D001294:Attitude to Health; D003071:Cognition / Q000502:physiology*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology* / Q000628:therapy; D055815:Young Adult
keywords: Dysfunctional beliefs; Insomnia; Physiological arousal; Safety behaviours; Selective attention; Worry