Latest / Sleep Science Friday Series / Transdiagnostic Dimensions of Hyperarousal

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Transdiagnostic Dimensions of Hyperarousal · Sleep Science Friday Series

• 0:09
  SPEAKER_01: Hello everyone and welcome to the Sleep Science Guided Podcast.
• 0:14
  SPEAKER_01: Today we are talking about hyperousal.
• 0:16
  SPEAKER_01: We often use the term hyperousal when we talk about different disorders like insomnia, anxiety, depression, and others.
• 0:23
  SPEAKER_01: And by hyperarousal, we usually mean a state of increased tension.
• 0:27
  SPEAKER_01: However, what exactly is hyperarousal?
• 0:30
  SPEAKER_01: Is it one single process or are we talking about multiple distinct dimensions?
• 0:36
  SPEAKER_01: Today we are discussing a new study titled Hyperarousal Transdiagnostically Detective, which takes on this question in a comprehensive way.
• 0:45
  SPEAKER_01: I'm joined today by Dr.
• 0:46
  SPEAKER_01: Tom Brett, one of the authors of the study.
• 0:50
  SPEAKER_01: Tom is a postdoctoral researcher at the Department of Sleep and Cognition at the Netherlands Institute for Neuroscience.
• 0:57
  SPEAKER_01: Dear Tom, welcome to the podcast.
• 0:59
  SPEAKER_01: It's great to have you here.
• 1:02
  SPEAKER_00: Thank you.
• 1:03
  SPEAKER_00: I'm uh glad to be here.
• 1:05
  SPEAKER_01: Thank you.
• 1:06
  SPEAKER_01: So before we move to discuss your paper, could you please tell a few words about yourself and what brought you to study hyperosals?
• 1:14
  SPEAKER_00: Yeah, sure.
• 1:16
  SPEAKER_00: Well, my name is Tom Bresser, and uh, as you nicely uh introduced uh uh me, I'm a postdoctoral researcher at the Anells Institute for Neuroscience.
• 1:25
  SPEAKER_00: Um, and our lab is uh has a strong focus on insomnia disorder.
• 1:30
  SPEAKER_00: And my uh background, my PhD research was also an insomnia disorder, and hyperouse is a big key component to insomnia disorder.
• 1:39
  SPEAKER_00: But in the lab, we also realized that it is uh actually a key symptom in multiple mental health uh disorders.
• 1:47
  SPEAKER_00: Have you realized that it was actually understudied in that uh context?
• 1:51
  SPEAKER_00: So that is how we uh moved towards uh the current uh research that we did.
• 1:58
  SPEAKER_01: Okay, yeah.
• 1:59
  SPEAKER_01: Then let's start very simply because we have already mentioned several several times the term hyper arousal, but to make it um more understandable for our audience, could you explain in simple words what do you usually mean by hyper arousal?
• 2:15
  SPEAKER_00: Yeah, that's always the biggest the biggest question.
• 2:17
  SPEAKER_00: Uh, I think hyper arousal is a term that everyone has sort of an instinctive feeling about what it represents.
• 2:24
  SPEAKER_00: Um, I think that we now uh mainly describe if describe it as a state that is characterized by cognitive, emotional, and somatic experiences of tension and distress.
• 2:35
  SPEAKER_00: Um, and for our study specifically, we focused on the subjectively experienced hyperarousal people.
• 2:42
  SPEAKER_00: So uh we survey how people experience hyperarousal um in their day-to-day life.
• 2:50
  SPEAKER_01: So you mean that the hyperarousal is not a single definition, as I understand?
• 2:56
  SPEAKER_01: Or at least some researchers do not agree that it's only single definition.
• 3:01
  SPEAKER_00: Yeah, yeah.
• 3:02
  SPEAKER_00: Um I when we went through literature, we realized that the definition is usually quite fake, uh, and it slightly differs between fields.
• 3:12
  SPEAKER_00: Different mental disorders have different views on uh on hyper arousal, so that's why we try to umbrella it uh a bit.
• 3:20
  SPEAKER_00: And that was also uh one of the reasons why we did this research to sort of collect everything questionnaire-wise on hyper arousal that we could find, um, to see is there a unified construct or are there different dimensions in this sort of big hyperarousal term.
• 3:41
  SPEAKER_01: Why your approach was uh different from how it has been studied before?
• 3:47
  SPEAKER_01: What has been missing in before uh in previous studies?
• 3:52
  SPEAKER_00: I think previous studies uh mainly focused on the hyperarousal component, important and within their specific field, so let it be insomnia, uh post-traumatic stress disorder, uh, anxiety, uh depression, uh even.
• 4:09
  SPEAKER_00: But uh they all had their own surveys, questionnaire to measure aspects of hyperarousal.
• 4:15
  SPEAKER_00: But to us, it was unclear if the hyperarousal that we looked at in insomnia is actually the same as hyperarousal as they view it in PTSD, for example, and how they relate.
• 4:27
  SPEAKER_00: So we thought we should take a more transdiagnostic approach and look at hyperarousal across multiple mental disorders and also in uh healthy people.
• 4:40
  SPEAKER_01: Yeah, that's really um that's what I noticed in your paper that you have a very comprehensive approach, like you um involved uh participants with different disorders and also participants uh without mental disorders, but you also used um a huge number of questionnaires, like uh more than two hundreds or three hundreds questionnaire items from multiple scales.
• 5:02
  SPEAKER_01: And can you please walk us through how the study was designed, why you used so many different tools, and um how did you manage with all of that things?
• 5:15
  SPEAKER_00: Yeah, yeah, it it got a bit out of hand with collecting all the different uh uh questionnaire items uh for the for the study.
• 5:23
  SPEAKER_00: We wanted to be as inclusive and uh complete um as possible.
• 5:29
  SPEAKER_00: So we asked a large international panel of experts in different fields uh of mental health disorders to give their input on questionnaires that they thought were hyper-arousal related, and we basically just gathered all of them uh together with like complementary uh internet searches of ourselves to find all the hyperarousal questionnaires that are out there and and collect them.
• 5:56
  SPEAKER_00: And we ended up with over 200 questions uh to ask our people, and then on top of that were the basic demographics, uh symptom severity questionnaires.
• 6:06
  SPEAKER_00: So, in total, I think our participants answered more than 200 questions to uh to to gather the data.
• 6:14
  SPEAKER_00: So it was very extensive uh in that uh sense, and it was also one of the big reasons why um we developed the uh the new transdiagnostic uh hyperousal dimensions questionnaire because it allowed to collect this the same information basically in a way briefer format.
• 6:35
  SPEAKER_00: So we first had the first big data collection with uh over 200 questionnaires, and then from the uh our results in that initial sample, we were able to make the new questionnaire and we collected data again, but now people only needed to answer 27 questions.
• 6:55
  SPEAKER_01: Yeah, I I hope that we will talk about your tool a bit later in more detail.
• 7:01
  SPEAKER_01: Uh, but now could you tell me because I'm interested in myself as a clinician and as a researcher, uh that when people have to answer so many questionnaires, so many tools, they can become really annoyed.
• 7:14
  SPEAKER_01: How have you persuaded them?
• 7:16
  SPEAKER_01: How have you made them to answer all this huge number of questions and uh not having much missing data?
• 7:25
  SPEAKER_00: Yeah, it's uh a big challenge.
• 7:27
  SPEAKER_00: Uh, luckily, we have some experience in the lab with uh setting up survey uh studies on our uh our platform, the National Sleep Registry that we have, and um how we try to handle it and make it as uh doable as possible is that we gathered all the questions and then we chopped them up into four blocks so that participants can do a block of uh questions that took like uh I think 10 or 15 minutes, or we aimed to do to do that, and then they could do a small break.
• 7:57
  SPEAKER_00: Uh, sometimes people even just did the next one the next day to make it a bit more bearable to complete all the different questionnaires.
• 8:07
  SPEAKER_00: Uh, but still, I think we are very lucky that we have some very dedicated participants in this study.
• 8:13
  SPEAKER_00: Um, and not everyone uh made it, so to say.
• 8:16
  SPEAKER_00: So I think over 800 people started uh filling out the questionnaires, but the the 467 people that completed all questionnaires, uh they are the real uh diehards that made the research possible.
• 8:30
  SPEAKER_01: Yeah.
• 8:31
  SPEAKER_01: Yeah, so you still had not full respondents, not full respondents as well.
• 8:36
  SPEAKER_00: No, definitely not, definitely not.
• 8:39
  SPEAKER_01: But still you could recruit many people who fulfilled all your who completed all your questionnaires.
• 8:45
  SPEAKER_01: And then I have a question about how you recruited people because as I could understand, you recruited them via website and newsletter advertisement, and you recruited people with um wide uh range of symptoms and this diagnosis, and also health people.
• 9:01
  SPEAKER_01: As I could understand uh from the paper, I was really surprised to know that over two-thirds of your participants met the criteria of at least one mental disorder.
• 9:14
  SPEAKER_01: So less than one-third were considered mentally healthy.
• 9:17
  SPEAKER_01: How could it be?
• 9:19
  SPEAKER_01: I believe that the um uh the prevalence of mental disorders in population is less than two-thirds.
• 9:27
  SPEAKER_01: So, how do you explain this um imbalance, let's say?
• 9:31
  SPEAKER_01: Yeah.
• 9:32
  SPEAKER_00: Yeah, so it's a very good uh very good question.
• 9:35
  SPEAKER_00: So I think it's it it has multiple uh facets.
• 9:38
  SPEAKER_00: Uh, one of the things is that we we recruited for partially through the Nether Dutch sleep registry, uh, which is also a big um database to do um uh sleep research.
• 9:52
  SPEAKER_00: Uh so there are a lot of people in there that also have sleep problems.
• 9:56
  SPEAKER_00: So we um uh a part of our sample also shows uh a lot of uh uh sleep problems, but I think the the the big number that that you were impressed by is also a bit driven by the fact that those numbers are based on the uh the cutoffs using questionnaires.
• 10:13
  SPEAKER_00: So the uh the 60% of uh at least one mental health uh disorder was based on cutoff scores on the ISI and the Adam Day 20 uh uh survey, which are all sort of uh quick questionnaires to determine severity of certain disorders.
• 10:31
  SPEAKER_00: Uh, and I think the 60% is very driven by the ISI using a cutoff of 10.
• 10:37
  SPEAKER_00: Uh so many people experience uh sleep problems, and that actually does fit what we see in the general population uh as well here in the Netherlands, that a lot of people report sleep problems and then they tend to score high on the ISI already.
• 10:53
  SPEAKER_00: Okay, so the or at least the the the the the we also included the question uh of confirmed diagnoses by a professional, and there we saw that the percentages were way lower and they fit the the range that we are used to in the in the published literature.
• 11:10
  SPEAKER_01: Okay, okay, so the um uh doctor-based diagnosis rate was lower than questionnaire-based.
• 11:18
  SPEAKER_01: Okay, that explains the the numbers.
• 11:22
  SPEAKER_01: Thank you for uh clarifying this.
• 11:25
  SPEAKER_00: No, yeah, because it's a big number, it was a big number.
• 11:27
  SPEAKER_00: We were sharp ourselves as well.
• 11:30
  SPEAKER_01: Okay, then let's come to the central finding.
• 11:33
  SPEAKER_01: Uh, what were you expecting to find?
• 11:35
  SPEAKER_01: Was it something simple or already something more complex?
• 11:39
  SPEAKER_01: Because uh it seemed that you ran the analysis and then instead of one dimension, you got seven.
• 11:45
  SPEAKER_01: Can you tell a bit more about your findings and how you interpreted this?
• 11:52
  SPEAKER_00: Yeah, so I think from the get-go, I wasn't expecting one big hyper-arousal uh dimension or a factor, uh so to say, because uh, despite that we all talk about hyperarousal when we were reading through the literature, we already noticed that different disorders have different focuses within hyper-arousal and different sort of uh manifestations of hyper-arousal.
• 12:21
  SPEAKER_00: Uh so we did expect to find something more complex than one, uh, but I have to say that I not necessarily expected seven as well.
• 12:29
  SPEAKER_00: So it turned out more complex or intriguing than uh expected.
• 12:35
  SPEAKER_01: Okay, then could you name those seven dimensions of hyperarousal and describe what they are?
• 12:43
  SPEAKER_00: Yeah, of course.
• 12:44
  SPEAKER_00: So uh we found uh uh seven dimensions of uh hyperarousal.
• 12:49
  SPEAKER_00: So the the first and uh the one with the strongest effects was anxious hyperarousal, which is a sort of a general sense of worry and expecting the worst um outcomes, uh basically.
• 13:02
  SPEAKER_00: Uh we also had somatic hyperarousal, which is really focused on the uh experience of physical uh physiological arousal, so racing heart is a very dense feeling in like muscles, for example.
• 13:17
  SPEAKER_00: Um we termed sensitive hyperarousal, uh, which I think reflects uh uh how people can be really sensitive to stimuli and respond more strongly compared to, for example, other people uh people.
• 13:34
  SPEAKER_00: The the sleep-related hyper arousal is something I think we are very familiar with with from Insomnia, which is a lot of arousal surrounding falling asleep and rumination prior to bedtime.
• 13:47
  SPEAKER_00: Uh irritable hyper arousal, I think, is very explanatory by itself.
• 13:53
  SPEAKER_00: Uh so this is very like an agitated, irritable kind of uh sensation that is uh driving it, and uh vigilant hyper arousal, which is very focused around uh scanning the environment and that is uh the source of their elevated uh arousal.
• 14:11
  SPEAKER_00: Uh and the last one was uh pseudomotor uh hyperarousal, uh which is uh really about having like the hot, cold sweats, this warm sensation, the clammy hands uh kind of uh things.
• 14:26
  SPEAKER_00: Uh so those were the the seven dimensions.
• 14:30
  SPEAKER_01: Yeah, this is a clear distinction between them, but when I read a paper, I got a bit confused because for me the vigilant and anxious um anxious uh hyperallus seem a bit similar.
• 14:45
  SPEAKER_01: How would you differ them like make it more understandable the differentiation?
• 14:52
  SPEAKER_00: Yeah, uh of course.
• 14:54
  SPEAKER_00: Uh so how I view it is that the anxious might be a bit more internally focused, so it's sort of uh anxious worry about things you might see in the future or about the current situation, but it's really sort of the the the the uh uh within, and I think the the vigilance is very related to the uh PTSD kind of descriptions of hypervigilance, so you're very uh aware of the environment, scanning for uh the situation and feeling uncomfortable if you don't have control about it.
• 15:30
  SPEAKER_00: Uh so I think that's sort of the distinction between the two.
• 15:33
  SPEAKER_01: Okay, thank you.
• 15:34
  SPEAKER_01: Now I think I got it.
• 15:36
  SPEAKER_01: Thank you very much.
• 15:37
  SPEAKER_01: What also looked interesting to me is that sleep-related dimension was not related to the severity of symptoms of panic disorder and post-traumatic disorder, while pseudomotor type was related only to post-traumatic disorder.
• 15:50
  SPEAKER_01: How would you explain this?
• 15:53
  SPEAKER_00: Yeah, sometimes uh the results were uh surprising, but I think it also has to do with uh the significance level.
• 16:01
  SPEAKER_00: So, for example, with the the pseudomotor as an example, uh that that effect size was also compared to the other dimensions, relatively small to the symptom severity of the different ones.
• 16:13
  SPEAKER_00: And when we looked at the complete table, so including all effect sizes, independent of if they were significant, we saw that uh pseudomotor also has an effect on different disorders, uh, but it's just an even smaller magnitude than the pseudomotor one, for example, so it didn't reach significance in that sense.
• 16:34
  SPEAKER_00: Um, so I think it's also a bit with like the the level of contribution and our power to detect these kind of uh kind of things.
• 16:45
  SPEAKER_01: But could you give a few examples of uh this kind of associations with different disorders for maybe other types of hyperasoles which you think is uh more significant and relevant for clinical practice, maybe or research?
• 17:02
  SPEAKER_00: Yeah, uh of course.
• 17:04
  SPEAKER_00: Yeah, so uh I think uh the most important things about the the differences in how the different dimensions contribute to different uh symptom severities is uh how they hopefully can help us to better understand also the the overlap between mental health uh problems.
• 17:25
  SPEAKER_00: So if someone has a very high level of anxious uh um hyperarousal, uh it also makes them uh and there, for example, uh they come into uh a clinical uh they call they visit a clinician for their uh anxiety, general anxiety symptoms.
• 17:45
  SPEAKER_00: Um it also makes them maybe vulnerable to shift towards other mental uh uh problems if we only focus too much on the general anxiety kind of uh factor.
• 17:59
  SPEAKER_00: So, what we hope to um reach with these uh dimensions is that it also provides a clearer view for can for clinicians and researchers on how these dimensions might uh provide how these dimensions might contribute, how people can have comorbid comorbid mental health disorders, or how they might switch from one disorder to another after treatment, for example.
• 18:27
  SPEAKER_00: If that answers your question, that's an interesting point.
• 18:32
  SPEAKER_01: Uh so do you think that these hyper arousals are this like reflect the disorder-specific profile, or is it something else?
• 18:43
  SPEAKER_01: Is it understandable?
• 18:46
  SPEAKER_00: Uh yeah, so I uh I do not think that based on someone's hyper arousal profile, you could say, like, oh, this person has insomnia, or and this person has um uh depression, for example, but I would say that it's the other way around.
• 19:04
  SPEAKER_00: So if someone is diagnosed with, for example, insomnia, and if we would look at the different dimensions and we would see uh a high level of the anxious hyperarousal, for example, we would see we could also take that as an uh um uh take that into account in the the treatment options, and because we realize like oh, the high the anxious hyperarousal is also a strong predictor for other mental health problems, and if we leave it untreated, people might uh uh get a different uh mental health problem in the future.
• 19:42
  SPEAKER_01: Okay, yeah, that makes clear.
• 19:45
  SPEAKER_01: Thank you for this explanation.
• 19:47
  SPEAKER_01: But do you also think that these dimensions could reflect different biological systems, like in different people with different types of hyper arousals, different um, let's say, mediating systems are involved, or something, neuromediators, or something like this?
• 20:04
  SPEAKER_00: Uh that's a good question.
• 20:06
  SPEAKER_00: Uh, I think that's uh still an open question and something that we are uh really eager to look into further.
• 20:14
  SPEAKER_00: Uh, one of the follow-up projects after this uh research is also to look at the different brain mechanisms of the different hyperarousal uh dimensions to see if maybe different uh brain networks are involved for different hyper-arousal systems.
• 20:31
  SPEAKER_00: Because we could hypothesize that there might be some differences um in the underlying mechanisms of one dimension versus another dimension.
• 20:43
  SPEAKER_01: Yeah, but for this you would need some more objective measures, as I understand.
• 20:47
  SPEAKER_01: Yeah, because here you use only subjective questionnaires.
• 20:51
  SPEAKER_00: Yeah, yeah, yeah.
• 20:52
  SPEAKER_01: One more question about these dimensions do we see them as stable traits or something that changes depending on the situation or changing with the time, with the course of the disease, or something else?
• 21:06
  SPEAKER_00: Yeah, so uh, based on what we saw in our study, I would say that it's uh more of a stable trait than uh uh than a response to a situation.
• 21:16
  SPEAKER_00: So uh in our first sample where we did the exploratory factor analysis and we sort of discovered the dimensions, um, we also collected a second sample almost a year later with the newly um questionnaire.
• 21:32
  SPEAKER_00: So we uh and there was an overlap between the two samples.
• 21:36
  SPEAKER_00: So we were actually able to compare the scores at the first time point with the new scores of the second time point in a subsample of both uh uh data collections, and there we saw that the hyper arousal scores actually correlated pretty strongly despite being a year apart.
• 21:55
  SPEAKER_00: Um, so that's why we think that these hyper ausal Traits are quite stable over time.
• 22:03
  SPEAKER_01: That's interesting.
• 22:04
  SPEAKER_01: So in one person, it seems like one person seems to have a very specific dimension type of hyperarousal, which is his or her specific feature.
• 22:20
  SPEAKER_01: Okay, you mentioned again your new tool.
• 22:22
  SPEAKER_01: Let's come to look at it in more detail.
• 22:25
  SPEAKER_01: So the key outcome of your study is the development of this new tool, the transdiagnostic hyperarousal dimensions questionnaire.
• 22:33
  SPEAKER_01: Or whether you call it THDQ.
• 22:37
  SPEAKER_01: So what gave that this feel compared to pre-existing or existing questionnaires?
• 22:43
  SPEAKER_01: What does it add for researchers, for clinicians?
• 22:47
  SPEAKER_00: Yeah.
• 22:48
  SPEAKER_00: Well, the aim was to basically develop a uniform standardized measure for these seven hyperousal dimensions that we uh described in the paper.
• 22:59
  SPEAKER_00: And we wanted to make it concise so that people just fill out 27 questions instead of the 200 and something that were in the initial uh in the initial study to make it really feasible to use in both research and maybe in the future also in clinical practice.
• 23:18
  SPEAKER_00: Um that was really the the drive to develop this uh questionnaire.
• 23:23
  SPEAKER_01: So, as I understand, now you recommend it uh mainly for research, yeah.
• 23:28
  SPEAKER_01: Uh, but when would you recommend to use it in any type of research or some specific research, or is it only now for your lab uh to develop it further?
• 23:38
  SPEAKER_01: Or what would be your recommendation?
• 23:41
  SPEAKER_00: No, we we highly encourage people to uh have a look at the questionnaire and uh try it out if you're interested.
• 23:50
  SPEAKER_00: Uh they're uh freely available in the in the supplement of the paper, and we also put up a website where people can download the questionnaire in three different languages uh so that it is uh freely available.
• 24:03
  SPEAKER_00: Um and yeah, we we encourage people to use their research to better understand this transdiagnostic hyper arousal and what kind of mechanisms might be driving it uh to better understand a whole range of mental health disorders because uh originally our lab is very focused on insomnia, but I think this work is very uh relevant for multiple mental health uh disorders, and uh it's always nice to work on these things in a big community instead of uh as a solo lab.
• 24:35
  SPEAKER_01: Do you think that in the future it will replace existing questionnaires or will it be an additional tool to look um in more detail at hyper arousal types?
• 24:47
  SPEAKER_00: That's always a good question.
• 24:49
  SPEAKER_00: I think it will be an addition.
• 24:52
  SPEAKER_00: Um most questionnaires that we came across were also not always dedicated hyperarousal questionnaires.
• 25:01
  SPEAKER_00: So some of the anxiety questionnaires, for example, have a hyperarousal component to it, but not the entire questionnaire is focused on hyperarousal.
• 25:12
  SPEAKER_00: So if you're interested in anxiety severity and also in hyperarousal that might interact with each other, it makes sense to have a look at both and not replace one with the with the other.
• 25:26
  SPEAKER_01: Okay, so we will get one more tool in our practice.
• 25:31
  SPEAKER_01: Yeah, it's available online, so everyone can can look at it and uh and you and take it for the practice.
• 25:38
  SPEAKER_01: And also I mean you mentioned that it is already translated into German and in Dutch, so it's available on three languages, as I understand.
• 25:45
  SPEAKER_01: Yes, yeah.
• 25:46
  SPEAKER_01: So good good to know for our listeners.
• 25:50
  SPEAKER_01: So let's talk more about implications of your study and your results.
• 25:56
  SPEAKER_01: What do you think?
• 25:57
  SPEAKER_01: How could distinguishing these different dimensions of the hyperousals improve our understanding of mental disorders?
• 26:07
  SPEAKER_01: Yeah, so we hope that oh like you already mentioned a little bit of this, but this is more like a summary to yeah, to give a clear uh uh explanation for the audience.
• 26:19
  SPEAKER_00: Yeah, so the I think the implications of the our findings, the hyperalysis dimensions, I hope that it can contribute to improve our understanding and also help to understand the underlying mechanisms.
• 26:34
  SPEAKER_00: I think that in uh the fields that we're working in, we're uh uh suffering or struggling a lot with comorbidity, with heterogeneity, uh sometimes difficulty pinpointing specific mechanisms.
• 26:51
  SPEAKER_00: And uh this might be due to shared mechanisms, uh different mechanisms with the same output, the same symptoms.
• 27:01
  SPEAKER_00: Uh so we hope that by moving sort of a layer down to sort of the transdiagnostic factors that might interact to uh uh express these mental health symptoms, that it makes it more uh easy to detect these kind of mechanisms and then uh ultimately improving treatment of multiple mental health disorders.
• 27:26
  SPEAKER_01: So it can help with a more personal personalized treatment.
• 27:30
  SPEAKER_01: If we know better mechanisms, we can go more for individualized treatment.
• 27:34
  SPEAKER_01: Is that uh idea?
• 27:37
  SPEAKER_00: Yeah, we hope so.
• 27:38
  SPEAKER_01: Yeah, great.
• 27:41
  SPEAKER_01: We hope to get more uh results from your lab about this part of your future study, and this is the next mic, next question.
• 27:50
  SPEAKER_01: What are the next steps uh for this study?
• 27:53
  SPEAKER_01: What still needs to be validated or explored?
• 27:58
  SPEAKER_00: Yeah, so uh uh I think validation always continues with these kinds of uh questionnaires.
• 28:04
  SPEAKER_00: So we uh uh are happy and would also like to invite others to use the questionnaire and further validate it in clinical samples, uh younger samples, uh all different kinds of samples that we can imagine, because the more data we collect, the more we can uh start to use it in that sense.
• 28:24
  SPEAKER_00: Uh, and for within our lab, we're incorporated in different uh ongoing insomnia studies, for example, that we're conducting.
• 28:33
  SPEAKER_00: And for myself, I'm currently looking at the uh brain correlates of the different dimensions in a large uh neuroimaging data set.
• 28:41
  SPEAKER_00: So we're trying to see if we can find the brain networks that are uh underlying these hyperusal dimensions.
• 28:49
  SPEAKER_01: Okay, so find correlation with objective data.
• 28:53
  SPEAKER_01: That's interesting.
• 28:55
  SPEAKER_01: Next step for your study.
• 28:57
  SPEAKER_01: Was there a moment in this project when you thought that okay, this is actually more interesting or more complicated, or something unexpected than you have been planning to find?
• 29:12
  SPEAKER_00: I I think it's in the process of the uh determining the seven dimensions, the the process of the exploratory factor analysis.
• 29:22
  SPEAKER_00: It's a lot of back and forth trying out do solutions make sense, are they stable?
• 29:29
  SPEAKER_00: Uh, and that at some points was tiring, but also very intriguing because uh you find seven dimensions, then you're like, but what if we try to force it to be six dimensions, and then weird things happen, and you're like, okay, that's definitely not a good solution.
• 29:46
  SPEAKER_00: So there's a lot of uh trial and error in that uh in that sense.
• 29:51
  SPEAKER_00: So that made it a very interesting challenge, uh challenging uh part of the project.
• 29:57
  SPEAKER_01: Yeah, thank you very much.
• 29:59
  SPEAKER_01: Thank you for sharing your results and your insights in this um uh topic because your study really reframes a concept that many clinicians uh take as it is before.
• 30:13
  SPEAKER_01: And instead of treating hyperosals as a single idea, it shows that it's a multidimensional phenomenon with different roles across these orders, and we hope to read more of your results about objective measures and correlations with them.
• 30:26
  SPEAKER_01: Uh so thank you very much.
• 30:28
  SPEAKER_01: And now I have a few couple of questions not related to your paper, because you know that this year sleep congress will be held in the Netherlands in Maastricht, and the Dutch National Sleep Society is hosting this Congress.
• 30:42
  SPEAKER_01: Are you planning to participate in this big event?
• 30:45
  SPEAKER_00: Yes, definitely.
• 30:47
  SPEAKER_00: Uh, I'm actually part of uh a symposium on uh hyper razzle, so uh I will give uh uh a nice talk on uh these findings, and I will uh I'm also planning to present some of the the new work that we're currently uh doing uh during that uh during that talk.
• 31:04
  SPEAKER_00: So I will definitely attend uh it must be.
• 31:07
  SPEAKER_01: Great.
• 31:08
  SPEAKER_01: And what do your colleagues think about hosting such a central European sleep conference in your country?
• 31:14
  SPEAKER_01: This must be very exciting.
• 31:15
  SPEAKER_01: Have you talked to them about this?
• 31:18
  SPEAKER_00: Yeah, it's no, it's uh very exciting.
• 31:20
  SPEAKER_00: It's uh I think a really cool and nice opportunity to uh show them uh the of the joint hosting countries because we're organizing it uh together uh with our neighbors uh and the venue will be in uh Maastricht.
• 31:37
  SPEAKER_00: Uh and we're yeah very excited to uh host everyone from Europe and uh beyond uh for the for this cool uh event.
• 31:47
  SPEAKER_01: Okay, could you share any tip or any uh recommendation to those who plan to visit Maastricht for the Congress?
• 31:54
  SPEAKER_01: Where to go, or which symposium to visit to attend?
• 32:00
  SPEAKER_00: Definitely attend uh uh the hyperrousal uh symposium.
• 32:04
  SPEAKER_00: I could tip that one.
• 32:06
  SPEAKER_00: No, yeah, uh if you have the opportunity, definitely also uh uh uh reserve some time around the conference to uh to visit the the beautiful uh city center of uh Mastiff because I think there's a lot of uh to see, to do, and to taste uh of the Dutch culture uh there.
• 32:24
  SPEAKER_00: So uh that uh could also be a nice part uh complementary to the uh ESRS uh conference uh being held.
• 32:34
  SPEAKER_01: Tom, thank you very much.
• 32:36
  SPEAKER_01: Thank you for joining us and sharing your work and your advice.
• 32:39
  SPEAKER_01: This was a really fascinating conversation, unraveling different roles of hyper housers across disorders.
• 32:45
  SPEAKER_01: Uh, and thank you all to our listeners for tuning in.
• 32:50
  SPEAKER_01: Uh till next time, have an enjoyable day.
• 32:53
  SPEAKER_01: Bye.
• 32:54
  SPEAKER_00: Thank you, you're welcome.