A moderated mediation model of the link between counterfactual processing at bedtime and insomnia diagnosis: The role of depressive symptoms and nocturnal maladaptive strategies of mental control
Résumé
This study investigated the relationship between bedtime counterfactual thoughts,
depressive symptoms, nocturnal counterproductive thought-control strategies and
insomnia disorder. Six hundred and fifty adults from the general population were
recruited and provided data on their counterfactual thoughts' frequency at bedtime,
depressive symptoms and use of nocturnal maladaptive strategies of thought control.
In addition, all participants followed a face-to-face clinical interview for the diagnosis
of insomnia disorder. A model positing moderated mediation was tested using conditional
process modelling. Overall, 19% of participants met diagnostic criteria for
a chronic insomnia diagnosis. Bootstrapped mediation analyses indicated that the
association of bedtime counterfactual processing and insomnia diagnosis is mediated
by depressive symptoms (B = 0.035, SE = 0.007, bootstrapped 95% CI = 0.023, 0.051).
Furthermore, the effects of such a mediation model were significantly larger among
individuals with high levels of aggressive suppression than those with low levels of
aggressive suppression (B = 0.002, SE = 0.001, bootstrapped 95% CI = 0.001, 0.004).
A second model in which a worry strategy moderates the relationship between bedtime
counterfactual processing and depressive symptoms was not statistically significant
(B = 0.0036, SE = 0.013, p = .78). The present study adds to the literature on the
importance of self-attacking thoughts and negative affects at bedtime. We recommend
the evaluation of the impact of adding self-attacks management strategies to
cognitive behavior therapy for individuals with an insomnia disorder