Repetitive negative thinking (RNT) involves recurring, intrusive, and negative thoughts, such as worrying about future events (e.g., “What if I fail this exam?”) or ruminating on past experiences (e.g., “I shouldn’t have said that.”).
RNT is a common feature of GAD and can contribute to other symptoms, such as sleep disturbances and fatigue.
Struggling to sleep due to repetitive negative thoughts may be a common occurrence in women who have Generalized Anxiety Disorder according to new research.
Key Points:
Rationale
Fatigue is a prominent symptom of Generalized Anxiety Disorder (GAD), but the mechanisms contributing to this elevated fatigue are not well understood (McCallum et al., 2019).
Sleep disturbance, which frequently co-occurs with anxiety (Cox & Olatunji, 2020), has been shown to only partially account for elevated fatigue in GAD (McCallum et al., 2019).
Repetitive negative thinking (RNT), a cognitive feature of both GAD and sleep disturbance, has been associated with fatigue in various conditions such as insomnia, major depressive disorder, and multiple sclerosis (Carney et al., 2014; Hare et al., 2019; Harris et al., 2021).
Additionally, rumination and worry have been found to predict higher fatigue in the general population and workforce, with sleep disturbance mediating these effects (Andrea et al., 2004; Querstret & Cropley, 2012; Thorsteinsson et al., 2019).
However, the potential role of RNT in contributing to heightened fatigue in anxiety disorders, particularly GAD, has not been assessed.
Understanding the role of RNT and how it can affect fatigue and sleep quality can provide a better understanding of methods in which to help people withGAD manage when anxiety strikes at bedtime.
Therefore, this study aimed to examine whether RNT and self-reported sleep quality together account for elevated physical and mental fatigue in women with GAD compared to women without GAD.
Method
Procedure
Between-group,correlational design
Women completed self-reportquestionnairesassessing:
Sample
Measures
Statistical measures
Results
The study found that women with GAD reported lower sleep quality, higher RNT, and higher levels of both physical and mental fatigue compared to women without GAD.
Sleep quality partially accounted for the group differences in both types of fatigue (β’s > −0.4), while RNT fully accounted for these differences (β’s > 0.29).
Insight
The key findings of this study suggest that women with GAD experience elevated levels of physical and mental fatigue, which can be attributed to their heightened levels of repetitive negative thinking (RNT) and its detrimental effects on sleep quality.
The study highlights the importance of addressing RNT in the treatment of GAD, as it may not only alleviate the core symptoms of the disorder but also improve sleep quality and, consequently, reduce fatigue.
Future research could focus on developing and testing targeted interventions that specifically address RNT in GAD, such ascognitive-behavioral techniquesor mindfulness-based approaches.
Additionally, longitudinal studies could help establish the temporal relationships between RNT, sleep disturbance, and fatigue in GAD, providing further insights into the causal pathways involved.
Investigating the role of RNT and sleep disturbance in fatigue across different psychiatric conditions could lead to the development of transdiagnostic interventions targeting these common mechanisms.
Strengths
The study had several methodological strengths, including:
Limitations
The study had some limitations that should be considered when interpreting the results:
Implications
The results of this study have significant implications for the understanding and treatment of fatigue in Generalized Anxiety Disorder (GAD).
By identifying repetitive negative thinking (RNT) as a key factor contributing to elevated physical and mental fatigue in women with GAD, the findings suggest that targeting RNT in clinical interventions may be an effective strategy for alleviating fatigue symptoms.
In clinical psychology practice, incorporating techniques that address RNT, such as cognitive restructuring, mindfulness-based interventions, or metacognitive therapy, could be beneficial for individuals with GAD who experience significant fatigue.
Furthermore, the findings highlight the importance of assessing and monitoring RNT, sleep quality, and fatigue in individuals with GAD. Clinicians should be aware of the potential interplay between these variables and consider them when developing treatment plans and evaluating treatment outcomes.
The study also underscores the need for further research to investigate the effectiveness of interventions targeting RNT for the reduction of fatigue in GAD.
Additionally, exploring the role of RNT and sleep disturbance in fatigue across other mental health conditions could lead to the development of transdiagnostic approaches that address these common mechanisms.
References
Primary reference
Leung, P., Li, S. H., & Graham, B. M. (2022). The relationship between repetitive negative thinking, sleep disturbance, and subjective fatigue in women with Generalized Anxiety Disorder.British Journal of Clinical Psychology,61(3), 666-679.https://doi.org/10.1111/bjc.12356
Other references
Andrea, H., Beurskens, A. J. H. M., Kant, I. J., Davey, G. C. L., Field, A. P., & van Schayck, C. P. (2004). The relation between pathological worrying and fatigue in a working population.Journal of Psychosomatic Research, 57, 399–407.https://doi.org/10.1016/j.jpsychores.2003.09.013
Carney, C. E., Harris, A. L., Moss, T. G., & Edinger, J. D. (2010). Distinguishing rumination from worry in clinical insomnia.Behaviour Research and Therapy, 48(6), 540-546.https://doi.org/10.1016/j.brat.2010.03.004
Carney, C. E., Moss, T. G., Lachowski, A. M., & Atwood, M. E. (2014). Understanding mental and physical fatigue complaints in those with depression and insomnia.Behavioral Sleep Medicine, 12, 272–289.https://doi.org/10.1080/15402002.2013.801345
Cox, R. C., & Olatunji, B. O. (2020). Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research.Sleep Medicine Reviews, 51, 101282.https://doi.org/10.1016/j.smrv.2020.101282
Hare, C. J., Crangle, C. J., Carney, C. E., & Hart, T. (2019). Insomnia symptoms, subjective appraisals, and fatigue: A multiple mediation model.Behavioral Sleep Medicine, 17, 269–280.https://doi.org/10.1080/15402002.2017.1342167
Harris, A. L., Carmona, N. E., Moss, T. G., & Carney, C. E. (2021). Testing the contiguity of the sleep and fatigue relationship: A daily diary study.Sleep, 44(5).https://doi.org/10.1093/sleep/zsaa252
McCallum, S. M., Batterham, P. J., Calear, A. L., Sunderland, M., Carragher, N., & Kazan, D. (2019). Associations of fatigue and sleep disturbance with nine common mental disorders.Journal of Psychosomatic Research, 123, 109727.https://doi.org/10.1016/j.jpsychores.2019.05.005
Querstret, D., & Cropley, M. (2012). Exploring the relationship between work-related rumination, sleep quality, and work-related fatigue.Journal of Occupational Health Psychology, 17, 341–353.https://doi.org/10.1037/a0028552
Thorsteinsson, E. B., Brown, R. F., & Owens, M. T. (2019). Modeling the effects of stress, anxiety, and depression on rumination, sleep, and fatigue in a nonclinical sample.Journal of Nervous and Mental Disease, 207, 355–359.https://doi.org/10.1097/NMD.0000000000000973
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
