Beyond sleep‐specific bias: Eye‐tracking observations of general negative attentional biases linked to insomnia

Although attentional bias toward sleep‐related stimuli is well documented in insomnia and is regarded as a cognitive outcome arising after the disorder's onset, it remains unclear whether insomnia also involves a general negative attentional bias toward nonsleep negative stimuli, a transdiagnostic vulnerability for psychiatric disorders. Clarifying this issue is critical for understanding cognitive mechanisms underlying insomnia onset and persistence. This study recruited 24 individuals with insomnia and 26 normal sleepers, excluding those with clinical anxiety or depression to isolate the insomnia‐specific effects. Combining an emotion‐competitive visual search paradigm with eye‐tracking, we investigated automatic early attentional bias. Individuals with insomnia exhibited a prominent negative bias: preferential attention to angry faces over happy faces when presented in competition with happy faces and longer initial fixations on negative stimuli, contrasting with the positive bias in controls. This negative bias correlated specifically with insomnia severity and persisted after controlling for subclinical anxiety and depression. Insomnia individuals also adopted a conservative response strategy prioritizing accuracy over speed. This eye‐tracking evidence suggests that general negative bias may serve as a potential cognitive feature of insomnia independent of mood factors. It updates cognitive models of insomnia by highlighting a pervasive emotional hypervigilance, providing implications for clinical intervention.