Night-time rumination in PTSD: Development and validation of a brief measure

European Journal of Psychotraumatology

Elizabeth Woodward, Juliane Sachschal, Esther T. Beier & Anke Ehlers

Background: Pre-sleep cognitive activity and arousal have long been implicated in the maintenance of insomnia. However, despite high comorbidity between insomnia and posttraumatic stress disorder (PTSD), pre-sleep thoughts in PTSD and their associations with disturbed sleep, have not yet been investigated.
Objective: This study presents the development and preliminary validation of a brief self-report measure of the content of trauma-related pre-sleep thoughts: the Trauma Thoughts before Sleep Inventory (TTSI).
Methods: Participants (N = 285) were recruited online into five groups: three groups with clinical symptoms, 1) PTSD; 2) depression without PTSD; 3) insomnia without depression or PTSD; and two healthy control groups 4) nontrauma-exposed controls; 5) trauma-exposed controls. The questionnaire was administered at baseline, and for a subsample (n= 157) again one week later to assess test-retest reliability. At baseline, participants also completed questionnaires of sleep
quality, PTSD and depression symptoms, and insomnia-related thoughts.
Results: The TTSI had good reliability and validity; it discriminated participants with PTSD from those with depression and insomnia, those with depression from insomnia, and correlated with existing measures of pre-sleep thoughts, self-reported pre-sleep arousal and poor sleep.
Conclusions: The results support the utility of the TTSI for measuring thoughts that keep people with PTSD awake, although replication in an independent clinical sample is required.

Keywords: sleep; posttraumatic stress disorder; insomnia; Pre-sleep cognitions; rumination

Received 18 Jan 2019, Accepted 25 Jul 2019, Published online: 27 Aug 2019

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