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Sleep quality is associated with better mental health, but it does not impact a person’s stress-coping strategies, a study found. Image credit: Studio Firma/Stocksy.
  • Chronic stress can increase the risk of certain mental illnesses, including anxiety and depression.
  • Results from a recent study found that adaptive emotion regulation strategies and sleep both play a key role in reducing the risk for anxiety and depression among people who are experiencing chronic stress.
  • T​his study utilized an event where people experienced a lot of chronic stress: the COVID-19 pandemic. However, management of chronic stress is vital, regardless of the source.

T​he COVID-19 pandemic produced a unique situation where many people experienced a time of chronic stress. Researchers are seeking to understand how such periods of chronic stress affect mental illness and what factors can help improve mental health.

A​ study published in the journal Cortex examined how adaptive emotion regulation strategies—or positive coping strategies—and sleep quality relate to rates of anxiety and depression.

The authors found that both components are helpful in reducing rates of anxiety and depression. However, in contrast to their hypothesis, they found that the effectiveness of emotion regulation strategies was not majorly dependent on sleep quality.

This study was a secondary analysis of data on sleep and mental health collected during the COVID-19 pandemic from the spring through the autumn of 2020.

The first priority of the research was to see if adaptive emotion regulation strategies are associated with better mental health.

Adaptive cognitive emotion regulation strategies are thought processes that help improve mental health in the long term. An example would be seeking to find positive meaning in an event or situation, known as “positive reappraisal.”

Second, researchers wanted to understand if adaptive emotion regulation strategies’ effectiveness depended on sleep quality. They looked at these factors within “the context of a naturally-occurring and chronic stressor, the COVID-19 pandemic.

Study co-author Emma Sullivan explained the key goals of the research to Medical News Today:

“We were interested in firstly whether using positive coping strategies more frequently would be associated with reduced depression and anxiety symptoms during the COVID-19 pandemic. Secondly, we were interested in whether the benefits of using positive coping strategies for reducing depression and anxiety symptoms depended on being able to obtain good sleep quality. This is because sleep quality has been associated with both positive coping strategy use and depression and anxiety symptoms.”

The study included 1,600 adult participants. The participants provided information via online forms and provided vital information on demographics. They also completed questionnaires collecting data on emotion regulation strategies, sleep quality, depression, and generalized anxiety.

Based on data analysis, the researchers found that more use of adaptive cognitive emotion regulation strategies was associated with lower scores for anxiety and depression.

They also found that reports of higher sleep quality were associated with lower scores for anxiety and depression.

Regarding the relationship between adaptive cognitive emotion regulation strategies and sleep quality, they found that people who reported higher quality sleep had higher use of adaptive cognitive emotion regulation strategies.

Their final model that accounted for sleep quality found that using adaptive cognitive emotion regulation strategies did not significantly predict anxiety outcomes.

In other words, the effectiveness of using positive coping strategies in reducing depression and anxiety did not seem to depend on how well a person slept. The positive regulation strategies still showed benefits for mental health, regardless of sleep quality.

Sullivan explained the subtleties of these findings to MNT:

“We indeed found that more frequent use of positive coping strategies was associated with reduced depression and anxiety symptoms. In addition, better sleep quality was also associated with reduced depression and anxiety symptoms. However, using positive coping strategies to reduce depression and anxiety symptoms did not depend on obtaining good sleep quality as we had predicted.”

Licensed clinical psychologist Dr. Lindsay Oberleitner, education director at SimplePractice, who was not involved in this research, commented on the study findings to MNT.

“Interestingly, sleep quality and cognitive emotion regulation strategies didn’t work together in their relationship to depression and anxiety as was expected,” she told us.

Nevertheless, she noted, this may not be as surprising as it may seem at first.

“If we step back from the present study, this might not surprise us too much. We know there are complex factors that influence depression and anxiety symptoms across individuals. Sleep is just one aspect of physical health that impacts mental health, and adaptive cognitive strategies are only a portion of emotion regulation approaches.”
— Dr. Lindsay Oberleitner

I​t is still essential to note the limitations of this study. Researchers relied on self-reporting from participants, which is not always accurate.

They note that people often report lower sleep quality than what is objectively measured. They could only measure adaptive cognitive emotion regulation strategy and sleep quality once, which means they could not measure changes that may have occurred throughout the study.

The authors also had more data points on depression than on anxiety. The study did not have the power to measure smaller interaction effects that may have been present.

Because of the measurements they used, they could not look into whether a specific cognitive emotion regulation strategy or a combination was most effective and how these strategies interacted with sleep quality.

The study mainly included white female individuals in the United States with higher levels of education. Researchers could not account for specific covariates, and data was collected online. All of these factors limit how much the study’s results can be generalized and indicate the need for greater diversity in future research.

Finally, the study authors acknowledge that the COVID-19 pandemic provided a unique source of stress, so it is difficult to compare this study to other sources of prolonged stress and the resulting mental health outcomes.

Sullivan noted that future research could look into other stressor sources.

“​Obviously, the COVID-19 pandemic was a unique stressful situation, so it would be good to replicate these findings in the face of other long-term stressful events,” she explained to MNT.

“Moreover, as we looked at a range of positive coping strategies together, it may be important in the future to see how specific strategies, such as positive reappraisal (rethinking the situation in a positive light) and putting into perspective (i.e. thinking about the bigger picture) are associated with both sleep quality and depression and anxiety symptoms,” she added.

Regardless of the factors contributing to it, taking steps to manage stress is critical for mental health. This may involve taking steps to lead a healthy lifestyle, seeking support from friends, and recognizing when to seek help from a mental health specialist.

The World Health Organization(WHO) further notes that limiting time on social media and following a daily routine can further help with stress management.

Betsy Serrano, a board-certified psychiatric mental health nurse practitioner at Cora Health Solutions in Phoenix, Arizona, who was also not involved in the recent study, offered a few tips for managing stress effectively:

“Reducing moderate stress and anxiety is achieved through some simple activities. Physical activities help to relax the mind by releasing good endorphins that make you feel better. Eating healthy, not drinking too much caffeine, meditation, and yoga, even some of the apps on the phone, like Calm, have great benefits when feeling stressed. But if you feel overly stressed that it just interferes with everyday life, then you should consider some counseling and, if needed, maybe some medication.”
— Betsy Serrano, mental health nurse practitioner