University of Sussex
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The role of sleep problems and sleepiness in cognitive and behavioural processes of childhood anxiety

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posted on 2023-06-08, 20:24 authored by Donna Ewing
Sleep in children is important for the functioning of a range of cognitive processes, including memory, attention, arousal, executive functioning, and the processing of emotional experiences. This, in addition to the high comorbidity between sleep problems and anxiety, may suggest that sleep plays a role in the cognitive and behavioural processes associated with childhood anxiety. Although a body of research exists which considers the associations between sleep problems and anxiety, there is currently little research evidence available for the effect of children’s sleepiness on anxiety, or for the effect of childhood sleep problems or sleepiness on anxiety related processes. To address this, this thesis begins with a meta-analysis exploring the efficacy of transdiagnostic cognitive-behavioural therapy (CBT) for the treatment of childhood anxiety (Paper 1). CBT is generally the treatment of choice for childhood anxiety, and targets the processes that the subsequent papers in this thesis consider in relation to children’s sleepiness and sleep problems. Papers two to five consider the effect of sleepiness on a range of cognitive and behavioural processes, including vicariously learning and unlearning fear (Paper 2), ambiguity resolution (Paper 3), emotion recognition (Paper 4), and habituation and avoidance (Paper 5). The final paper considers sleep problems in relation to a CBT intervention for childhood anxiety (Paper 6). Overall, while sleep problems and usual sleepiness were found to be associated with childhood anxiety, current sleepiness was not. On the other hand, sleepiness (usual and current), and reduced sleep, affected children’s behavioural processes when exposed to anxiety provoking stimuli, but were not found to affect children’s anxietyrelated cognitive processes. Sleep problems interacted with vicarious learning processes, but not with ambiguity resolution or emotion recognition processes, or with change in anxiety symptoms following a CBT intervention for childhood anxiety. Implications for treatment and future research directions are discussed.


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University of Sussex

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