title: Metacognitions, worry and sleep in everyday life: Studying bidirectional pathways using Ecological Momentary Assessment in GAD patients.
abstract: BACKGROUND
  The metacognitive model of generalized anxiety disorder proposes that negative metacognitive beliefs are crucial in the maintenance of excessive worry. Furthermore, according to the cognitive model of insomnia, worry leads to problems falling or staying asleep and poor sleep quality. In order to test the assumed causal relationships, the present study examined the time-dependent course of negative metacognition and worry as well as worry and sleep quality, using Ecological Momentary Assessment (EMA).
  
  
  METHODS
  Negative metacognitions, worry and sleep were assessed by self-report questionnaires as well as EMA in 56 GAD patients who carried a portable device for 1 week and logged sleep quality, negative metacognition and worry processes four times a day.
  
  
  RESULTS
  Metacognitions, worry and sleep were significantly correlated. Structural equation modeling using multilevel analyses showed a unidirectional relationship of negative metacognitions leading to prolonged worry processes and a bidirectional relationship of worry and sleep quality.
  
  
  CONCLUSIONS
  These findings support the theoretically derived assumptions on the relationship between negative metacognitions, worry and sleep. Implications for further research as well as clinical implications are discussed.
authors.affiliation: Institute of Psychology, University of Münster, Germany. Electronic address: CarolinThielsch@uni-muenster.de.
authors.forename: Carolin
authors.initials: C
authors.lastname: Thielsch
authors.affiliation: Institute of Psychology, University of Münster, Germany; Department of Psychology, University of Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ehring
authors.affiliation: Institute of Psychology, University of Münster, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Nestler
authors.affiliation: Institute of Psychology, University of Münster, Germany.
authors.forename: Janina
authors.initials: J
authors.lastname: Wolters
authors.affiliation: Institute of Psychology, University of Münster, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Kopei
authors.affiliation: Institute of Psychology, University of Münster, Germany.
authors.forename: Fred
authors.initials: F
authors.lastname: Rist
authors.affiliation: Institute of Psychology, University of Cologne, Germany.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerlach
authors.affiliation: Institute of Psychology, University of Münster, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Andor
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition; D008875:Middle Aged; D012189:Retrospective Studies; D057566:Self Report; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Ecological Momentary Assessment; Generalized anxiety disorder; Insomnia; Metacognitions; Sleep; Worry