Christina Neitzert Semler

Monitoring for Sleep-related Threat: A Pilot Study of the Sleep Associated Monitoring Index (sami)

Objective The aims of this pilot study were: 1) to establish the reliability and validity of a new self-report instrument designed to index monitoring for sleep-related threat; 2) to determine the presence of ten monitoring types proposed in a recent cognitive model of insomnia and to examine the relationship between monitoring for sleep-related threat and severity of sleep disturbance; and 3) to explore the association between monitoring and the established constructs of amplification and self-focus. Methods Participants (N = 400) completed the Sleep Associated Monitoring Index (SAMI) and the Pittsburgh Sleep Quality Index (PSQI) (1). Based on the PSQI score, the sample was split into two groups to compare normal sleepers (NS) and individuals with a clinically significant sleep disturbance (CSSD). A subset of the sample completed the SAMI and a battery of questionnaires to examine convergent validity between monitoring, amplification, and self-focus. Results Individuals in the CSSD group had higher SAMI scores than the NS group and the SAMI correlated positively with severity of sleep disturbance as indexed by the PSQI. A principal components analysis extracted 8 components accounting for 69% of the variance. The 30-item SAMI demonstrated high validity, consistency, and reliability. Scores on the SAMI were moderately positively correlated with scores on measures of amplification and self-focus. Conclusions Preliminary evidence suggests that the SAMI offers a valid and reliable instrument to index monitoring before and after treatment for sleep disturbance. The implications for the presence of monitoring for sleep-related threat in chronic insomnia are discussed.

Daytime Functioning in Primary Insomnia: Does Attentional Focus Contribute to Real or Perceived Impairment?

A study was conducted to test the proposal that self-focused attention or monitoring exacerbates the perception of poor daytime functioning in the absence of objective deficits among individuals with insomnia. Fifty-one participants meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for primary insomnia were randomly assigned to a self-focus group (viewing themselves on a TV monitor), a monitoring group (instructed to focus on their thoughts, body sensations, mood, and performance), or a no instruction group while completing a battery of neuropsychological tests. The results indicated that all participants performed within published normative ranges on all tests. The groups did not differ on their objective test performance, but the self-focus group perceived their performance on the tests as significantly worse than the no instruction group. These findings suggest that self-focused attention may contribute to perceived impairment in daytime functioning in primary insomnia.

An experimental investigation of daytime monitoring for sleep-related threat in primary insomnia

An experimental manipulation was conducted to test the hypothesis that monitoring for sleep-related threat during the day triggers a cycle of cognitive processes that includes increased negative thinking, increased use of safety behaviours, increased perceived impairment in functioning, and increased self-reported sleepiness. Forty-seven individuals with primary insomnia were randomly assigned to a monitoring group (instructed to monitor their body sensations), a no-monitoring group (instructed to distract from their body sensations), or a no-instruction group. The manipulations to monitor or not monitor were administered immediately on waking and participants were asked to continue the manipulation throughout the experimental day. The monitoring group reported more negative thoughts, the use of more safety behaviours, and more sleepiness during the day relative to the no-instruction group. These findings offer support to a recent cognitive model, which identifies daytime monitoring for sleep-related threat as a key factor in the maintenance of the daytime distress and difficulty functioning in chronic insomnia.

Mood and Temperament David Watson New York: Guilford, 2000. pp. 340. £29.95 (hardback). ISBN: 1-57230-526-6.

This informative and comprehensive textbook provides a review of research and clinical studies of mood and temperament. Integrating these two areas of study, the author summarizes recent literature in an understandable and organized format. While covering a great deal of information, the book is straightforward and thorough, offering details of a number of empirical investigations in support of several theories of personality and individual differences. The book begins with a review of the author’s model of mood and temperament. Subsequent chapters cover environmental and situational factors, circadian rhythms and seasonal cycles and their influence on mood state, and dispositional aspects of personality. The final two chapters discuss applications to psychopathology and relevant topics in health psychology. The introduction provides basic information about mood, emotions, and temperament, providing thorough and concise definitions with clear examples. The author emphasizes a distinction between negative and positive affective states, and reviews his model of biobehavioural regulation systems for negative and positive mood. He argues that these systems coexist, and that they operate in feedback loops, thereby influencing cognitions, biological components, and behaviour. In his model he outlines four main factors of mood and temperament: trait variables, situational variables, socio-cultural and cyclical factors, and individual differences. The next section deals with assessment of short-term positive and negative affective states, and the author strongly encourages separate assessment of these factors, suggesting that positive and negative mood function independently. He outlines his own assessment measure (the PANAS-X) in detail in Chapter 2. The book continues with a focus on research regarding situational and environmental factors influencing mood state. Chapter 3 concludes that, broadly speaking, positive affect is altered more by external factors such as social experiences, while negative affect is altered more by internal factors such as rumination. The next chapter describes some of the cyclical, socio-cultural patterns impacting affective states, using examples such as weather, climate and seasonal variables. The second part of the book is concerned with long-term factors associated with affect. The author outlines literature on personality such as neuroticism and extraversion, describing in particular the five-factor model. Chapter 7 provides a synopsis of demographic, genetic and neurobiological factors believed to be related to temperament, briefly reviewing supportive empirical evidence. While a complete summary of the research on individual differences is beyond the scope of the book, Watson tends to focus heavily on his own research and this chapter in particular lacks information about alternative theories. The last two chapters of the text have a more applied focus, and provide information about relationships between affect and both psychopathology and health. I found these two chapters particularly interesting, as they provide substantial data regarding the associations between illness, emotional state and dispositional trait variables.

Sleep Disorders: Diagnosis and Treatment J. Steven Poceta and Merrill M. Mitler (Eds.). Totowa, New Jersey: Humana Press Inc, 1998. pp. 232. £49.51 (hardback). ISBN: 0-89603-527-1.

This book provides a general overview of the prominent features of several common sleep disorders and offers some limited information regarding treatment. Concise definitions and detailed characteristics of four specific sleep disturbances are carefully evaluated but the section reviewing therapeutic interventions for these disorders is restricted by its fundamentally pharmacological approach. Chapter One contains a brief introduction to sleep and its disorders, reviewing prevalence and outlining general facts about sleep. I feel that this chapter would strongly benefit from a more in-depth discussion about sleep stages and circadian rhythms as these underlying factors are essential to understanding sleep patterns. Subsequent chapters discuss assessment and diagnosis of specific disorders including insomnia, restless legs syndrome, narcolepsy and obstructive sleep apnea. These chapters are comprehensive and detailed, and contain useful information about various symptoms, signs and features common to each disorder. Several case studies are included, which help to give the reader a clear picture of the clinical impact of these problems. An interesting chapter focusing on sleep disorders among children is also included. The remainder of the book is essentially a review of relevant pharmacological interventions, although a short chapter about light therapy has also been incorporated. The strengths of this book lie in its organized format and its provision of clear definitions and criteria for the assessment and diagnosis of a handful of particular sleep problems. In addition, the chapter on pharmacological treatments presents a long list of effective medications along with information about their respective contraindications and side-effects. This information is likely to be useful to any clinician treating patients with sleep disorders. The book, however, is limited by its restricted approach to treatment. It is disheartening that despite the abundance of research concerning behavioural and cognitive treatments for sleep disorders, this text still maintains such a strong pharmacological perspective. While the chapter on insomnia contains a brief review of two behavioural treatments (stimulus control and sleep hygiene), the effectiveness of some of these treatments has been criticized in the literature (Harvey, 2000). Furthermore, descriptions of cognitive therapies, recently found to provide an effective means of treating insomnia (Espie, 1991; Morin, 1993) are conspicuously missing. Finally, a less significant yet frustrating oversight was the omission of several references to research studies discussed in the text. Although providing a detailed clinical description of a few common sleep disorders, this book is limited by its pharmacological approach to treatment. Little information about established cognitive and behavioural treatments for these disorders is provided. Use of this text among clinicians in the mental health community is likely to be