Abstract
Metacognition is defined as the ability to reflect on one’s mental state and to govern thoughts and beliefs. Metacognitive dysfunctions are typical of several psychopathologic conditions, and also a feature of insomnia disorder, possibly playing a crucial role in its genesis and maintenance. In the context of insomnia, metacognition describes how individuals react to their own sleep-related thoughts and beliefs, boosting the hyperarousal state experienced by these patients. Up to now, no studies evaluated the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning. Therefore, the aim of our study was to evaluate the effect of CBT-I administered in group format in patients with insomnia disorder. As expected, all patients showed significant improvements in both insomnia and sleep diary parameters after treatment. Furthermore, an improvement was observed also in dysfunctional metacognitive levels, assessed by means of the Metacognitions Questionnaire-Insomnia (MCQ-I). However, 63% of patients still showed a MCQ-I score above the clinical cutoff after treatment. Dividing the sample on the basis of MCQ-I questionnaire scores after CBT-I, we found that patients, who still presented metacognitive impairment, received significant beneficial effects from CBT-I both on insomnia symptoms and on dysfunctional beliefs, but not on dysfunctional metacognitive functioning. These findings suggest that metacognition should be carefully evaluated in insomnia patients and further studies are needed to evaluate long-term implications of this remaining dysfunction.
Highlights
Insomnia disorder is a highly prevalent disorder, as it is the most common sleep disorder encountered in clinical practice and the second most prevalent mental disorder in the European countries (Wittchen et al, 2011; Sateia, 2014)
The aim of this study was to confirm the presence of impairment in sleep-related metacognition and to evaluate the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning in patients with insomnia disorder
Regarding CBT-I, we found that metacognitive dysfunctions received beneficial effect from the treatment as measured by Metacognitions Questionnaire-Insomnia (MCQ-I)
Summary
Insomnia disorder is a highly prevalent disorder, as it is the most common sleep disorder encountered in clinical practice and the second most prevalent mental disorder in the European countries (Wittchen et al, 2011; Sateia, 2014). It is characterized by difficulties in initiating and maintaining sleep and early morning awakenings associated with a complaint of sleep. One of the most accredited hypothesis for the genesis and the maintenance of the disorder is the hyperarousal model This model described insomnia patients as characterized by increased neurophysiological and cognitive activities that impede relaxation and physiological drive to sleep resulting in prolonged sleep latencies and increased nocturnal awakenings (Riemann et al, 2010)
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