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Abstract
Insomnia is one of the most prevalent psychological disorders, causing sufferers severe
distress as well as social, interpersonal, and occupational impairment. Drawing on
well-validated cognitive models of the anxiety disorders as well as on theoretical
and empirical work highlighting the contribution of cognitive processes to insomnia,
this paper presents a new cognitive model of the maintenance of insomnia. It is suggested
that individuals who suffer from insomnia tend to be overly worried about their sleep
and about the daytime consequences of not getting enough sleep. This excessive negatively
toned cognitive activity triggers both autonomic arousal and emotional distress. It
is proposed that this anxious state triggers selective attention towards and monitoring
of internal and external sleep-related threat cues. Together, the anxious state and
the attentional processes triggered by it tricks the individual into overestimating
the extent of the perceived deficit in sleep and daytime performance. It is suggested
that the excessive negatively toned cognitive activity will be fuelled if a sleep-related
threat is detected or a deficit perceived. Counterproductive safety behaviours (including
thought control, imagery control, emotional inhibition, and difficulty problem solving)
and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating
factors. The unfortunate consequence of this sequence of events is that the excessive
and escalating anxiety may culminate in a real deficit in sleep and daytime functioning.
The literature providing preliminary support for the model is reviewed and the clinical
implications and limitations discussed.