Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

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Highlights

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    Examined sleep disturbance and emotion dysregulation as transdiagnostic processes.

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    Both processes uniquely predicted anxiety, depression, PTSD and AD symptom severity.

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    Sleep disturbance and emotion dysregulation may be important treatment targets.

Abstract

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.

Section snippets

Emotion dysregulation & psychopathology

Emotion dysregulation refers to difficulties modulating emotional experiences in a way that is responsive to both the immediate context of the situation and the long-term objectives of the individual (Fairholme et al., 2010, Kring and Werner, 2004). Studies have found support for emotion dysregulation as a maintaining factor for a range of psychiatric disorders, including panic disorder (Levitt, Brown, Orsillo, & Barlow, 2004), social phobia (Turk, Heimberg, Luterek, Mennin, & Fresco, 2005),

Sleep disturbance & psychopathology

Sleep disturbance is specified as a diagnostic criterion for many mood and anxiety disorders (APA, 2000). Evidence from epidemiological studies shows that insomnia-type sleep disturbance is ubiquitous, occurring across the range of psychopathology (e.g., Ford & Kamerow, 1989), including panic disorder (Sheehan, Ballenger, & Jacobsen, 1980), social phobia (Stein, Kroft, & Walker, 1993), generalized anxiety disorder (Fuller, Waters, Binks, & Anderson, 1997), obsessive–compulsive disorder (Insel

Present study

Despite separate literatures linking emotion dysregulation and insomnia to symptom severity in each of these four domains, no study has examined the simultaneous relationship of these two processes to psychopathology. Regarding the relationship between emotion dysregulation and sleep disturbance, research increasingly supports that these two factors are reciprocally related. A number of studies have found support for a deleterious relationship between insomnia and emotion regulation, such that

Participants & procedure

All incoming clients at a residential substance use treatment facility were informed about the opportunity to participate in an ongoing study (investigating efficacy of psychotherapy for trauma) by their program therapist. Exclusion criteria were current psychosis or acute mania/hypomania. Interested clients who reported experiencing a potentially traumatic event (PTE) completed the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and the Alcohol Use Disorders Identification

Data analysis

Raw data were analyzed using Mplus 5.2 (Muthen & Muthen, 1998–2008). Missing data were minimal (listwise N = 208, pairwise Ns ranged from 214 to 219) and were accommodated in all models using direct maximum likelihood under the assumption of missingness at random. The data analytic scheme allowed for the simultaneous estimation and evaluation of model parameters and primary study hypotheses within a single data analytic model as opposed to separate multiple regressions for each of the four

Results

Descriptive statistics for the primary study variables are presented in Table 3. Bivariate relationships among the study variables were examined in order to establish that the two potential transdiagnotic processes were related to psychopathology symptom severity. As predicted, insomnia severity was related to symptom severity in each of the four domains: anxiety (r = .41), depression (r = .41), PTSD (r = .40), and AD (r = .26; all p values < .001). Emotion dysregulation was also associated

Discussion

The primary purpose of this study was to evaluate whether insomnia and emotion dysregulation might serve as transdiagnostic processes in a highly comorbid, diagnostically heterogeneous sample. Consistent with predictions and prior research (Berking et al., 2011, Liverant et al., 2008, Mennin et al., 2005, Tull et al., 2007), emotion dysregulation was uniquely associated with anxiety, depression, PTSD, and AD symptom severity. This extends previous investigations to examine emotion dysregulation

Acknowledgments

This research was supported, in part, by National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant R01AA016816 (PI: Coffey). The NIAAA had no role in the drafting or review of the manuscript, nor in the collection or analysis of the data. Correspondence concerning this article should be addressed to Scott F. Coffey, Department of Psychiatry and Human Behavior, The University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216. E-mail: [email protected].

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