An exploration into the relationship between insomnia and repetitive negative thinking among cancer survivors

Abstract

Objective

Insomnia and repetitive negative thinking (RNT) are both prevalent among cancer survivors, yet little work has investigated their interrelationship. To explore the hypothesis that RNT and insomnia are related, we conducted secondary analyses on data from a pilot clinical trial of cognitive behavioral therapy for insomnia (CBT-I) for cancer survivors.

Methods

This study analyzed survey data from 40 cancer survivors with insomnia who participated in a pilot randomized trial of CBT-I. Correlations and linear regression models were used to determine associations between aspects of RNT and related constructs (fear of cancer recurrence [FCR], cancer-specific rumination, worry, and intolerance of uncertainty) and sleep (insomnia and sleep quality), while accounting for psychiatric symptoms such as anxiety and depression. Treatment-related change in RNT was examined using a series of linear mixed models.

Results

Evidence for an association between RNT and insomnia among cancer survivors emerged. Higher levels of FCR and cancer-related rumination were correlated with more severe insomnia symptoms and worse sleep quality. Notably, FCR levels predicted insomnia, even after controlling for anxiety and depression. Results identified potential benefits and limitations of CBT-I in addressing RNT that should be examined more thoroughly in future research.

Conclusions

RNT is a potential target to consider in insomnia treatment for cancer survivors.

Keywords:

• Anxiety
• cancer
• cognitive behavioral therapy
• depression
• insomnia
• negative thinking
• oncology
• survivorship

Acknowledgements

We wish to thank the cancer survivors who participated in this research. We also wish to dedicate this research to the memory of Michael H. Werner.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by an Institutional Research Grant from the American Cancer Society (DLH). DLH’s time was also supported by a career development award from the National Center for Complementary and Integrative Health (K23AT010157). SNP was supported by a fellowship from the National Cancer Institute (T32CA122061). Funders were not involved in the study design, collection, analysis, and interpretation of the data; in the writing of the report; or in the decision to submit the article for publication.