TOPIC: Pre-sleep arousal and fear of sleep in trauma-related sleep disturbances: A cluster-analytic approach
This HPCSA Accredited peer-reviewed article with multiple choice questionnaire is accredited for a total of 3 CEU's:
HPCSA Accreditation number:
PSB002/040/01/2021 (3 general ceu’s Level 1)
Werner, G.G., Danböck, S.K., Metodiev, S. and Kunze, A.E. (2020). Pre-sleep arousal and fear of sleep in trauma-related sleep disturbances: A cluster-analytic approach. Clinical Psychology in Europe, 2(2)
Gabriela G. Werner (a), Sarah K. Danböck (ab), Stanislav Metodiev (a), Anna E. Kunze (a)
(a) Department of Psychology, LMU Munich (study institution), Munich, Germany.
(b)Department of Psychology,University of Salzburg, Salzburg, Austria.
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Background: Trauma-related sleep disturbances constitute critical symptoms of posttraumatic stress disorder (PTSD), but sleep symptoms often reside even after successful trauma-focused psychotherapy. Therefore, currently unattended factors – like fear of sleep (FoS) – might play a crucial role in the development and maintenance of residual sleep disturbances. However, it is unclear whether trauma-exposed individuals exhibit different symptomatic profiles of sleep disturbances that could inform individualized therapeutic approaches and eventually enhance treatment efficacy.
Method: In a large online study, a two-step cluster analysis and a hierarchical cluster analysis using Ward’s method were performed to explore subgroups among trauma-exposed individuals (N = 471) in terms of FoS, different aspects of trauma-related sleep disturbances (e.g., insomnia symptoms, nightmares, arousal), and PTSD symptoms. These variables were compared between
resulting clusters using ANOVAs and Scheffé’s post-hoc tests.
Results: The hierarchical cluster analysis supported 3- and 4-cluster solutions. The 3-cluster solution consisted of one “healthy” (n = 199), one “subclinical” (n = 223), and one “clinical” (n = 49) cluster, with overall low, medium, and high symptomatology on all used variables. In the 4-cluster solution, the clinical cluster was further divided into two subgroups (n = 38, n = 11), where one cluster was specifically characterized by elevated somatic pre-sleep arousal and high levels of FoS.
Conclusions: A subgroup of trauma-exposed individuals with PTSD and sleep disturbances suffers from increased pre-sleep arousal and FoS, which has been suggested as one possible explanation for residual sleep disturbances. In these patients, FoS might be a relevant treatment target.
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