The link between improvement in sleep and depressed mood: Exploring the role of repetitive negative thinking and behavioural activation

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There is extensive evidence supporting a link between poor sleep and worse depression outcomes. Moreover, improvement in sleep contributes to enhanced depression outcomes. However, processes underlying this sleep—depression link are unclear. The current study examined whether changes in potential underlying processes, namely repetitive negative thinking (RNT) and behavioural activation (BA) can explain the relationship between improvement in reported sleep disturbance (reduction in the number of days participants experience sleep difficulties) and depressed mood. Data were analysed from 127 participants (mean [SD] age 39.16 [14.81], 60.6 % women) who attended a group CBT mood management program at a government mental health service. Our study found a significant association between improvement in sleep difficulties and improvement in depressed mood, however, this relationship was no longer significant (no direct association) when controlling for improvements in RNT, ab = 0.56, CI [0.21, 1.01], and BA, ab = 1.08, CI [0.41, 1.84]. The preliminary findings suggest that reduced RNT and enhanced BA may play an important role in explaining how improvement in sleep is related to improvement in depressed mood. Future research should investigate whether early improvements in sleep contributes to subsequent improvements in depressed mood via improvements in RNT and BA. To establish temporal ordering and assess causality, future studies should collect data across multiple time points; and incorporate a more comprehensive measure of sleep. • Greater improvements in sleep difficulties were associated with greater improvements in depressed mood. • Greater improvements in sleep difficulties were associated with greater reduction in repetitive negative thinking (RNT). • Greater improvements in sleep difficulties were associated with greater engagement in daily and meaningful activities. • The direct link between improvement in sleep and mood was not significant after controlling for changes in RNT and BA. • Changes in RNT and BA may explain how improvement in sleep can improve depressed mood, and vice versa.

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