Eternal Fallacies of the Sleepless Mind: Investigating the Relationship Between Sleep Loss and Emotion Regulation in the Development of Psychotic Experiences

Johnson, Madeleine R. (2025) Eternal Fallacies of the Sleepless Mind: Investigating the Relationship Between Sleep Loss and Emotion Regulation in the Development of Psychotic Experiences. Doctoral thesis, University of East Anglia.

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Abstract

Background: Sleep disturbances and emotion regulation difficulties are both linked to psychotic experiences through previous research. Given sleep’s impact on emotional functioning, regulatory processes may mediate the relationship between sleep loss and psychosis, however this remains largely unexplored.

Methods: A systematic review was conducted to evaluate whether emotion regulation bridges the impact of sleep loss on psychotic experiences. This was done through a synthesis of studies assessing emotion regulation changes that i) experimentally manipulated sleep and ii) targeted emotion regulation for improving psychosis symptoms. Following this, a within-subjects crossover experimental study (N = 58) investigated whether one night of partial sleep restriction (≤ 4 hours) increased psychotic experiences relative to standard sleep in a non-clinical sample, with mediation by negative affect, affect intolerance, and dissociative experiences.

Results: The systematic review of 15 studies found little support for the influence of sleep loss on emotion regulation. While evidence linked emotion regulation difficulties to the severity of psychotic experiences, the absence of direct tests of association by studies and heterogeneity of measures used limited the ability to draw robust conclusions about a causal mechanism. The empirical study found that sleep loss significantly impacted emotion regulation reflected by elevated affect intolerance, and significantly increased next day negative affect, dissociative experiences, paranoia, hallucinations, cognitive disorganisation, anhedonia and distress. Mediation analyses showed that combined mediators (negative affect, affect intolerance and dissociation) accounted for 89.1% of the association of sleep loss with paranoia. Additionally, dissociative experiences significantly mediated the effect of sleep loss on paranoia (46.2%) and partially mediated the effect on hallucinations (38.5%).

Conclusions: Findings support a causal role of sleep loss in the aetiology of psychosis, with mediation by dissociation and affective processes. Theoretical and clinical implications are considered, as well as recommendations for future research to further develop our understanding of this mechanism.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	28 Oct 2025 11:11
Last Modified:	28 Oct 2025 11:11
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100812
DOI:

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