Abstract
BackgroundThe efficacy of attentional bias modification (ABM) as a treatment for anxiety and depression has been extensively studied with promising results. Despite some evidence of sleep-related attentional biases in insomnia, only a small number of studies, yielding mixed results, have examined the application of ABM in insomnia. This study specifically aims to determine whether ABM can reduce (i) the presence of an attentional bias for sleep-related threatening words; (ii) insomnia symptom severity; (iii) sleep onset latency; and (iv) pre-sleep cognitive arousal amongst individuals with insomnia compared to a non-treatment control group of individuals with insomnia.Methods/designWe propose a randomised controlled trial of 90 individuals from the general population who meet the criteria for Insomnia Disorder. Following an initial examination for the presence of a sleep-related attentional bias using the dot-probe paradigm, participants will be randomised to an online attentional bias modification training condition, or to a standard attentional bias task (non-treatment) control condition. Both conditions will be delivered online by a web platform. All participants allocated to the non-treatment control group will be offered ABM training once the study is complete. The primary outcome will be the attentional bias indices of vigilance and disengagement and self-reported insomnia symptoms, sleep onset latency and pre-sleep cognitive arousal. Attentional bias and insomnia symptoms will be assessed at baseline (day 1) and post-treatment (2 days after the final training session: day 9). Insomnia symptoms will be again assessed at follow-up (day 16). Secondary outcomes include examining whether sleep associated monitoring and worry are related to a sleep-related attentional bias in insomnia, and whether such reports reduce following ABM. All main analyses will be carried out on completion of follow-up assessments. The trial is supported by the Department of Psychology, Sociology and Politics at Sheffield Hallam University.DiscussionThis study will extend the research base examining the efficacy of attentional bias modification for insomnia.Trial registrationISRCTN (ISRCTN11643569, registered on 5 June 2018).
Highlights
The efficacy of attentional bias modification (ABM) as a treatment for anxiety and depression has been extensively studied with promising results
This study will extend the research base examining the efficacy of attentional bias modification for insomnia
Using a similar modified dot-probe task to Milkins et al [16], we aim to determine whether ABM can reduce (i) the presence of an attentional bias for sleep-related negative words characterised by either vigilance or disengagement; (ii) insomnia symptom severity; (iii) sleep onset latency; and (iv) pre-sleep cognitive arousal amongst individuals with insomnia compared to a non-treatment control group of individuals with insomnia
Summary
The efficacy of attentional bias modification (ABM) as a treatment for anxiety and depression has been extensively studied with promising results. It is theorized that selective attention for sleep-related information contributes to increased physiological and cognitive arousal, and excessive worry concerning the negative daytime consequences (i.e. impaired daytime functioning) which are perceived to precede night-time sleep difficulty These processes are said to generate and maintain sleep-specific anxiety, which produces a state that is incompatible with the initiation of sleep. In support of this notion, several studies have investigated attentional biases to sleep-related cues in insomnia using experimental reaction time (i.e. dot-probe, flicker, and emotional Stroop) and eye-tracking paradigms [3,4,5,6,7,8,9,10,11,12]. The majority of these studies suggest that poor sleepers and individuals with insomnia display attentional biases towards sleep-related words and images compared with normal-sleepers [3,4,5, 7,8,9,10,11,12,13]
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