Poor Sleep In Depression, Anxiety May Hinder Positive Reappraisal

In people with poor sleep who suffer from depression or anxiety, an area of the brain called the dorsal anterior cingulate cortex, may have to work harder to modify negative emotional responses, researchers have found.

The research team, led by Heide Klumpp, assistant professor of psychiatry at University of Illinois, used functional MRI to measure the activity in different regions of the brain as subjects were challenged with an emotion-regulation task. Participants were shown disturbing images of violence — from war or accidents — and were asked to simply look at the images and not to try to control their reaction or to “reappraise” what they saw in a more positive light.

An example of reappraisal would be to see an image of a woman with a badly bruised face and imagine her as an actress in makeup for a role, rather than as a survivor of violence, Klumpp said.

“Reappraisal is something that requires significant mental energy,” she said. “In people with depression or anxiety, reappraisal can be even more difficult, because these disorders are characterized by chronic negativity or negative rumination, which makes seeing the good in things difficult.”

Dorsal Anterior Cingulate Cortex

The participants comprised 78 patients, 18 to 65 years of age, who had been diagnosed with an anxiety disorder, a major depressive disorder, or both. They also completed a questionnaire to assess their sleep over the previous month.

A motion-sensing device called an actigraph measured their awake time in bed, or “sleep efficiency,” over a six-day period. The questionnaire results indicated that three out of four participants met criteria for significant sleep disturbance, and the actigraph results suggested the majority had insomnia.

Participants who reported poorer sleep on the questionnaire were seen to have less brain activity in the dorsal anterior cingulate cortex during the reappraisal task, while those with lower sleep efficiency based on the actigraph data had higher activity in the DACC.

“Because the questionnaire and actigraph measure different aspects of the sleep experience, it is not surprising that brain activity also differed between these measures,” said Klumpp. “The questionnaire asks about sleep over the previous month, and answers can be impacted by current mood.

Plus, respondents may not be able to accurately remember how they slept a month ago. The actigraph objectively measures current sleep, so the results from both measurements may not match. Higher DACC activity in participants with lower levels of sleep efficiency could mean the DACC is working harder to carry out the demanding work of reappraisal.”

The research suggests sleep may play an important role in the ability to regulate negative emotions in people who suffer from anxiety or depression.

Klumpp H, Roberts J, Kapella MC, Kennedy AE, Kumar A, Phan KL
Subjective and objective sleep quality modulate emotion regulatory brain function in anxiety and depression
Depress Anxiety. 2017;00:1–10. https://doi.org/10.1002/da.22622

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