Dysfunctional Beliefs And Attitudes About Sleep Research Articles

Knowledge, attitude, and practice toward sleep disorders and sleep hygiene among perimenopausal women

This cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) toward sleep disorders and sleep hygiene among perimenopausal women, who were enrolled in Dezhou region of Shandong Province between July and September 2023. A total of 720 valid questionnaires were collected (mean age: 51.28 ± 4.32 years old), and 344 (47.78%) reported experiencing insomnia. The mean scores for knowledge, attitude, practice, and Dysfunctional Beliefs and Attitudes about Sleep (DBAS) were 15.73 ± 7.60 (possible range: 0–36), 29.35 ± 3.15 (possible range: 10–50), 28.54 ± 4.03 (possible range: 10–50), and 6.79 ± 1.90 (possible range: 0–10), respectively. Path analysis showed that knowledge had direct effects on attitude (β = 0.04, 95% CI 0.01–0.07, P = 0.001), and DBAS (β = 0.04, 95% CI 0.02–0.05, P < 0.001). Knowledge had direct effects (β = 0.11, 95% CI 0.08–0.15, P < 0.001) and indirect (β = 0.02, 95% CI 0.00–0.03, P = 0.002) effect on practice. Moreover, attitude also had a direct impact on practice (β = 0.34, 95% CI 0.25–0.43, P < 0.001). In conclusion, perimenopausal women exhibited insufficient knowledge, negative attitude, inactive practice toward sleep disorders and sleep hygiene, and unfavorable DBAS, emphasizing the need for targeted healthcare interventions.

Dysfunctional beliefs and attitudes about sleep (DBAS) mediate outcomes in dCBT-I on psychological distress, fatigue, and insomnia severity

Objective/backgroundDigital cognitive behavioral therapy for insomnia (dCBT-I) improves several sleep and health outcomes in individuals with insomnia. This study investigates whether changes in Dysfunctional Beliefs and Attitudes about Sleep (DBAS) during dCBT-I mediate changes in psychological distress, fatigue, and insomnia severity. Patients/methodsThe study presents a secondary planned analysis of data from 1073 participants in a randomized control trial (Total sample = 1721) of dCBT-I compared with patient education (PE). Self-ratings with the Dysfunctional Beliefs and Attitudes about Sleep (DBAS), the Hospital Anxiety Depression Scale (HADS), the Chalder Fatigue Scale (CFQ), and the Insomnia Severity Index (ISI) were obtained at baseline and 9-week follow-up. Hayes PROCESS mediation analyses were conducted to test for mediation. Results and conclusionsDBAS scores were significantly reduced at 9-week follow-up for those randomized to dCBT-I (n = 566) compared with PE (n = 507). The estimated mean difference was −1.49 (95% CI -1.66 to −1.31, p < .001, Cohen's d. = 0.93). DBAS mediated all the effect of dCBT-I on the HADS and the CFQ, and 64% of the change on the ISI (Estimated indirect effect −3.14, 95% CI -3.60 to −2.68) at 9-week follow-up compared with PE.Changes in the DBAS fully mediated the effects of dCBT-I on psychological distress and fatigue, and the DBAS partially mediated the effects on insomnia severity. These findings may have implications for understanding how dCBT-I works and highlights the role of changing cognitions in dCBT-I.

Validation of the Parental Understanding and Misperceptions about BAby's Sleep Questionnaire using auto-videosomnography.

Previous studies have suggested that parental cognitions about child's sleep may be an important factor underlying pediatric sleep problems. The current study aimed to (a) develop an assessment tool measuring parental understanding and misperceptions about baby's sleep (PUMBA-Q); (b) validate the questionnaire using self-report and objective sleep measures. There were 1,420 English-speaking caregivers (68.0% mothers, 46.8% of children being females, mean age 12.3 months), who has completed online self-reported questionnaires. The PUMBA-Q, which was developed for this study, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) were included to evaluate participant's thoughts on their own or child's sleep. Insomnia Severity Index (ISI) was collected to access participant's subjective insomnia severity. Brief Infant Sleep Questionnaire-Revised (BISQ-R) was used to assess parental-reported child sleep. Auto-videosomnography was used to record child's sleep. Exploratory factor analysis indicated the best fit with a 4-factor model using 23 items (RMSEA = .039). The four subscales were labeled: (a) Misperceptions about parental intervention; (b) Misperceptions about feeding; (c) Misperceptions about child's sleep; and (d) General anxiety of parents. Internal consistency was adequate (Cronbach's alpha = .86). PUMBA-Q scores were significantly associated with MCISQ (r = .64, p < .01), DBAS (r = .36, p < .01), ISI (r = .29, p < .01), BISQ-R (r = .-49, p < .01), objective child's total sleep time (r = -.24, p < .01) and objective number of parental nighttime visits (r = .26, p < .01). The results demonstrated that PUMBA-Q 23 is a valid assessment tool for parental cognitions of child sleep. The link between parental cognitions and child sleep highlights the importance of managing parental cognitions about child sleep when treating pediatric sleep problems.

Guided Internet-Based Cognitive Behavioral Therapy for Insomnia: Prognostic and Treatment-Predictive Factors

Understanding which factors predict the outcome of internet-based cognitive behavioral therapy for insomnia (iCBT-I) may help to tailor this intervention to the patient's needs. We have conducted a secondary analysis of a randomized, controlled trial comparing a multicomponent iCBT-I (MCT) and an online sleep restriction therapy (SRT) for 83 chronic insomnia patients. The difference in the Insomnia Severity Index from pre- to post-treatment and from pre-treatment to follow-up at 6 months after treatment was the dependent variable. Prognostic and treatment-predictive factors assessed at baseline were analyzed with multiple linear regression. The shorter duration of insomnia, female gender, high health-related quality of life, and the higher total number of clicks had prognostic value for a better outcome. Other factors were found to be prognostic for outcome at the follow-up assessment: treatment with benzodiazepines, sleep quality, and personal significance of sleep problems. A high level of dysfunctional beliefs and attitudes about sleep (DBAS) was a moderator for better effects in the MCT at post-treatment assessment. Various prognostic factors (e.g., duration of insomnia, gender, or quality of life) may influence the success of treatment. The DBAS scale may be recommended to select patients for MCT rather than SRT.

Effectiveness of one-week internet-delivered cognitive behavioral therapy for insomnia to prevent progression from acute to chronic insomnia: A two-arm, multi-center, randomized controlled trial

Acute insomnia is common and a substantial proportion of people with acute insomnia (i.e. 3 days to 3 months) transit into chronic insomnia (i.e. 3 months or longer). Therefore, early intervention for acute insomnia is vital to prevent chronicity. Previous trials with small sample sizes have shown that brief versions of both individual and group-based face-to-face cognitive behavioral therapy for insomnia (CBT-I) can improve insomnia symptoms among those with acute insomnia. However, it is unknown whether one-week internet-delivered cognitive behavioral therapy for insomnia (CBT-I) is effective in treating acute insomnia. This was a randomized controlled trial and 192 participants were randomly assigned to the CBT-I group (n = 95) or control group (n = 97). The primary outcome was the incidence of chronic insomnia, determined via a structured diagnostic questionnaire for insomnia disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Secondary outcomes were Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Epworth Sleepiness Scale (ESS), Pre-sleep Arousal Scale (PSAS), Ford Insomnia Response to Stress Test (FIRST), Sleep Hygiene and Practices Scale (SHPS), Hospital Anxiety and Depression Scale (HADS), and Short-Form 12-Item Health Survey version 2 (SF-12v2). At week 12, the incidence of chronic insomnia was significantly lower in the CBT-I group compared with control group (33.3% [27/81] vs. 65.8% [52/79]). Participants in the CBT-I group achieved significantly more improvements in ISI, ESS, PSAS, FIRST, SHPS, HADS-Depression, and the mental component summary and physical component summary of SF-12v2 than control group, but not DBAS and HADS-Anxiety. This one-week internet-delivered CBT-I program is an effective tool to prevent the chronicity of acute insomnia.

P135 Intervention adherence and usefulness as predictors of the efficacy of Cognitive Behavioural Therapy for Insomnia during perinatal periods

Abstract Introduction One third of birthing parents experience insomnia symptoms during perinatal periods. Cognitive Behavioural Therapy for Insomnia (CBT-I) is effective for perinatal insomnia. However, it is unclear how adherence to and perceived usefulness of individual CBT-I components predict treatment efficacy. Methods 76 nulliparous birthing parents (age M±SD=33.07±3.10) with prenatal insomnia received CBT-I from two randomised controlled trials. Insomnia symptoms, sleep-related impairment, dysfunctional beliefs and attitudes about sleep (DBAS), and adherence and usefulness were self-reported at 30 and 35-weeks gestation, and 2 and 6-months postpartum. Linear regressions assessed whether adherence and usefulness predicted sleep-related outcomes, controlling for age, mental health history and social support. Results Adherence and perceived usefulness decreased over time across all components. “Cognitive restructuring” and “sleep hygiene” had the highest usefulness and adherence ratings, while “relaxation and mindfulness” was the least useful and adhered to. Controlling for covariates, higher adherence to “sleep hygiene” predicted lower DBAS at 35-weeks gestation (p=.024). At 6-months postpartum, higher usefulness of “relaxation and mindfulness” predicted lower DBAS (p=.032), and higher usefulness/adherence to “managing sleep deprivation, sleepiness, and fatigue” predicted lower insomnia symptoms (usefulness p=.003; adherence p=.029) and lower sleep-related impairment (usefulness p=.007). No significant relationships were found between sleep-related outcomes and usefulness/adherence to other CBT-I components (i.e., psychoeducation, cognitive restructuring, and stimulus control). Conclusion Individual CBT-I components play different roles in treatment efficacy as birthing parents navigate diverse sleep challenges in perinatal periods. Strategies to enhance adherence to and perceived usefulness of relevant treatment components for specific perinatal milestones may enhance efficacy.

Relationship Between Attitudes and Beliefs About Sleep, Sleep Disturbance, and Pain Interference in Patients With Spinal Pain.

Sleep impairments are a strong predictor of pain, making sleep a potential interest when treating patients with spine pain. Typical beliefs about the importance of sleep in patients seeking care for spinal pain are unknown. The purpose of this study was to describe the beliefs and attitudes about sleep in patients seeking care for spinal pain and to examine the relationships between dysfunctional beliefs and attitudes about sleep (DBAS), disordered sleep, and pain interference. This cross-sectional study included patients presenting to physical therapy with spine pain. Participants completed questionnaires including demographics, medical history, pain interference (pain, enjoyment, and general activity), DBAS-16, and sleep-related impairment (Patient-Reported Outcome Measurement Information System). Correlations were calculated between DBAS-16 scores and measures of sleep quality/quantity, and a generalized linear model was used to investigate the predictive ability of DBAS-16 scores on pain interference. The mean DBAS-16 score was 4.22 (SD=2.03), with 52.5% of participants having DBAS. There was a strong relationship between DBAS-16 and Patient-Reported Outcome Measurement Information System ( rs =0.7; P <0.001). For every point higher score on the DBAS-16, pain interference scores increased by approximately half a point (B=0.46; 95% CI 0.33, 0.59, 1.80; P <0.001). These results highlight a strong relationship between beliefs and attitudes about sleep and measures of sleep quality/quantity and a linear association with pain interference scores. These findings provide a rationale for targeting beliefs and attitudes about sleep when managing pain-related symptoms in patients seeking care for spine pain.

Cognitive Appraisal of Sleep and Brain Activation in Response to Sleep-Related Sounds in Healthy Adults.

PurposeSounds play important roles in promoting and disrupting sleep. How our brain processes sleep-related sounds and individual differences in processing sleep-related sounds must be determined to understand the role of sound in sleep. We investigated neural responses to sleep-related sounds and their associations with cognitive appraisals of sleep.Participants and MethodsForty-four healthy adults heard sleep-related and neutral sounds during functional magnetic resonance imaging using a 3T scanner. They also completed the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire, which was used to assess cognitive appraisals of sleep. We conducted a voxel-wise whole-brain analysis to compare brain activation in response to sleep-related and neutral sounds. We also examined the association between the DBAS score and brain activity in response to sleep-related sounds (vs neutral sounds) using region of interest (ROI) and whole-brain correlation analyses. The ROIs included the anterior cingulate cortex (ACC), anterior insula (AI), and amygdala.ResultsThe whole-brain analysis revealed increased activation in the temporal regions and decreased activation in the ACC in response to sleep-related sounds compared to neutral sounds. The ROI and whole-brain correlation analyses showed that higher DBAS scores, indicating a negative appraisal of sleep, were significantly correlated with increased activation of the ACC, right medial prefrontal cortex, and brainstem in response to sleep-related sounds.ConclusionThese results indicate that the temporal cortex and ACC, which are implicated in affective sound processing, may play important roles in the processing of sleep-related sounds. The positive association between the neural responses to sleep-related sounds and DBAS scores suggest that negative and dysfunctional appraisals of sleep may be an important factor in individual differences in the processing of sleep-related sounds.

0468 Predictors of Response to Digital CBTI in a Randomized Controlled Trial of Middle Aged and Older Adults with Insomnia

Abstract Introduction Digital CBTI (dCBTI) may serve as a good initial intervention in a stepped-care approach to treat insomnia. Understanding who is likely to respond to dCBTI can guide triaging of care, thus shortening wait times for those who most need to meet with an insomnia therapist. The purpose of this study was to examine baseline predictors of response to a dCBTI program after two months of access. Methods Participants were 173 middle aged and older adults with insomnia (M age=63.56 [SD=8.43], 76% female) who received the dCBTI SleepioTM for two months in the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. Baseline predictors included the Epworth Sleepiness Scale (ESS), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), preference for treatment (digital vs. therapist-delivered), and comfort with technology. At baseline and two-month follow-up, participants completed outcome measures, including the Insomnia Severity Index (ISI) and the PROMIS-Sleep Related Impairment (PROMIS-SRI). Multilevel modeling was used. Results In the full sample, no predictors were associated with change on the ISI. Among our predictors, only higher DBAS scores were associated with a smaller reduction in PROMIS-SRI scores from baseline to two-month follow-up (Beta=-0.88, SE=0.35, p=0.01 , 95% CI=-1.57, -0.19). Among those who preferred digital CBTI (n=52), none of the predictors were associated with the ISI or PROMIS-SRI. Among those who preferred therapist-led CBTI (n=66), greater comfort with technology was associated with greater reduction on the ISI (Beta=-1.77, S =0.78, p=0.02 , 95% CI=-3.30, -0.24) and higher DBAS scores were associated with a smaller reduction on the PROMIS-SRI (Beta=-1.63, S =0.56, p&amp;lt;0.01 , 95% CI=-2.73, -0.53). Conclusion The results highlight the importance of targeting dysfunctional beliefs and attitudes, which is consistent with research examining the DBAS in CBTI. Results also indicate that patient preference is an important factor to consider when triaging patients to insomnia care. While additional predictors should be examined, these preliminary findings indicate that dCBTI may be a good initial treatment option for those with high level of comfort using technology and lacking a preference for therapist-led CBTI. Support (If Any) R01AG057500 and T32MH019938

Dysfunctional Beliefs and Attitudes about Sleep and Its Relation with Insomnia in Three Groups of Psychiatric Patients

Background and Objective: Reports have shown a link between dysfunctional beliefs about sleep and sleep disorders. We investigated the frequency of dysfunctional beliefs about sleep in three groups of patients suffering from psychiatric disorders (patients with major depression, bipolar disorder, and anxiety).&#x0D; Materials and Methods: In this cross-sectional study, 150 patients with psychiatric disorders referred to psychiatry clinic affiliated to Qazvin University of Medical Sciences, Qazvin, Iran. Fifty patients were selected in each group (anxiety, depression, and bipolar disorder). Two questionnaires of Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Insomnia Severity Index (ISI) were completed for all patients. Data were analyzed with Student’s t, chi-square, analysis of variance (ANOVA), and Pearson correlation tests.&#x0D; Results: A significant difference was observed between the three groups in the latency to fall asleep at night (P = 0.002) and Pittsburgh Sleep Quality Index (PSQI) ≤ 5 (P = 0.002). Patients with anxiety and bipolar disorder more than other groups believed that insomnia caused loss of life joy (P = 0.010) and the only solution for sleeplessness was medication (P = 0.003), respectively. There was a significant relationship between sleep quality and anxiety (P = 0.030), total sleep time (P = 0.040), sleep latency (P = 0.020), and ISI (P &lt; 0.010) with depression, awakening time during night, and bipolar disorder (P = 0.030).&#x0D; Conclusion: Patients with psychiatric disorders have high frequency of dysfunctional beliefs about sleep. Regarding the relationship between dysfunctional beliefs about sleep and insomnia, future work is needed for better treatment.

O010 The role of dysfunctional beliefs and attitudes about sleep in the association between daily sleep and affect in adolescents and emerging adults

Abstract Introduction Sleep and affect are closely related. Late adolescence and emerging adulthood are associated with unique sleep patterns and risk for mood disturbances. This daily study examined whether dysfunctional beliefs and attitudes about sleep (DBAS), a modifiable cognitive vulnerability factor, moderated daily sleep-affect associations. Methods 421 community adolescents (n=205, 54.1% females, M±SDage=16.9±0.87) and emerging adults (n=216, 73.1% females, M±SDage=21.31±1.73) self-reported sleep and affect (adapted 12-item PANAS) and wore an actigraphy device for 7–28 days, providing &amp;gt;5000 daily observations. Linear mixed models tested whether DBAS moderated daily associations between self-reported and actigraphic sleep duration (total sleep time), sleep efficiency, and next-day affect on between and within-person levels. Both valence (positive/negative) and arousal (high/low) dimensions of affect were examined. Covariates included age, gender, ethnicity, day of week, and previous-day affect. Results DBAS significantly moderated associations between average sleep and next-day positive, but not negative, affect. Individuals with higher DBAS had significantly lower high arousal positive affect as average sleep duration (actigraphic: p=.002; self-reported: p=.014) and efficiency (actigraphic: p=.014) decreased. Similar moderation was found for average self-reported sleep duration and low arousal positive affect (p=.032). No significant results emerged on the within-person level. Previous-day affect significantly predicted next-day affect across models and outcomes (all p&amp;lt;.001). Discussion Adolescents and emerging adults with more negative views about sleep may experience dampened positive affect in shorter, or poorer, sleep periods. DBAS may constitute a modifiable factor increasing affective vulnerability on a global but not day-to-day level, and a therapeutic target for sleep-related affect disturbances in youths.

How Elderly People’s Quality of Life Relates to Their Sleep Quality and Sleep-Related Beliefs

ABSTRACT Objective/Background Quality of life (QoL) is a broad multidimensional construct, which can be influenced by several factors across the lifespan, including sleep quality. The aim of this study was to examine the association between QoL (and its specific domains), objective and self-reported sleep quality, and subjective sleep-related factors (i.e., dysfunctional beliefs and attitudes about sleep, and metacognitive beliefs about sleeping difficulties) in healthy elderly people. Participants Fifty healthy older adults (mean age = 70.40 years, SD = 7.43) participated in the study. Methods QoL was assessed using the World Health Organization’s Quality of Life Assessment, BREF version (WHOQOL-BREF). Self-reported sleep quality and efficiency were measured with the Pittsburgh Sleep Quality Index (PSQI) and sleep diary. Dysfunctional beliefs and attitudes about sleep (DBAS), and metacognitive beliefs about sleeping difficulties (MCQ-I) (subjective sleep-related factors) were assessed with self-report questionnaires. Objective sleep quality and efficiency were measured using actigraphy over 7 days. Results Regression analyses showed that self-reported sleep efficiency and dysfunctional beliefs and attitudes about sleep explained 24% of the variance in global QoL. Dysfunctional beliefs and attitudes about sleep were the only significant predictor of QoL in the environmental domain. Conclusions Taken together, these findings underscore the influence of sleep-related factors, and particularly dysfunctional beliefs and attitudes about sleep, along with sleep efficiency, on the perception of QoL in healthy older adults. These factors need to be considered in efforts to sustain QoL, in late adulthood at least.

Clinical success of greater occipital nerve blockade in improving sleep quality of chronic migraineurs: a prospective observational study.

The success of various therapy methods in the treatment of insomnia and poor quality sleep, both of which play an active role in the chronicization process of migraine, has been the subject of investigation. The aim of this research was to evaluate the success, acceptability, and efficacy of greater occipital nerve block (GON-B) therapy in chronic migraine (CM) patients in improving their sleep quality and developing their beliefs about sleep . The study included 40 patients with CM from the general population who agreed to receive blockade therapy. Before the injection treatment, 1-week sleep diaries as well as depression and anxiety symptoms were examined. The Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Epworth Sleepiness Scale (ESS), and Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scales were measured and evaluated both before and after the completion of 3 months of treatment. Thirty-seven patients with CM successfully completed our 12-week treatment period. The anxiety and depression scales of the patients decreased after 3 months (p < 0.001). PSQI and itssubgroups ratings significantly improved after treatment (p < 0.001). Similarly, ISI, ESS, PSAS, and DBAS test scores also improved after treatment (p < 0.001). This study provides evidence as to the applicability and acceptability of GON-B in CM treatment in terms of increased sleep quality; improved sleep beliefs, attitudes, and behaviors; and arousals and decreased insomnia findings.

REDUCING DYSFUNCTIONAL BELIEFS ABOUT SLEEP PROVIDES LONG-TERM BENEFIT IN OLDER ADULTS WITH INSOMNIA

Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment in older adults. Changing dysfunctional beliefs and attitudes about sleep is an important component of CBTI, but the long-term impact of these changes are unknown, particularly in older adults. Methods involved secondary analyses of data from a large randomized controlled trial comparing CBTI (provided in 5 weekly sessions) to sleep education control, among older veterans with insomnia (N=159, mean age 72.2 years, 97% male, 79% non-Hispanic white). The purpose was to examine whether changes in a validated scale of Dysfunctional Beliefs and Attitudes about Sleep (DBAS) with CBTI treatment (baseline to post-treatment) was associated with later changes in self-reported sleep (post-treatment to 6 months follow-up). Sleep measures included Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and 7-day sleep diary measures. Analyses compared the slope of change in DBAS (baseline to post-treatment) between CBTI and control with respect to the slope of change in sleep outcomes (post-treatment to 6-months). Compared to controls, the CBTI group had stronger associations between DBAS improvement (baseline to post-treatment) and subsequent PSQI improvement (post-treatment to 6-months) (difference in slopes=1.3, 95% CI=[.52,2.1], p=0.001). This pattern of significant results was also found for ISI (difference in slopes=1.8, 95% CI=[.58,3.0], p=0.004) and ESS (difference in slopes=1.0, 95% CI=[.25,1.7], p=0.009). Slopes were not different for sleep diary measures. These findings suggest that changing dysfunctional beliefs and attitudes may continue to confer sleep benefits well after completion of CBT-I in older adults.

Decreased regional brain activity in response to sleep‐related sounds after cognitive behavioral therapy for psychophysiological insomnia

Patients with psychophysiological insomnia (PI) experience hyperarousal, especially as a reaction to sound stimuli. In the current study, we explored brain activity changes in response to sleep-related sounds (SS) in patients with insomnia after cognitive behavioral therapy for insomnia (CBT-I). In 14 drug-free PI patients, regional brain activity in response to SS, and to white noise sound (NS) as neutral stimuli, was investigated before and after individual CBT-I using functional magnetic resonance imaging. Blood oxygen level-dependent (BOLD) signals to SS and NS were compared before and after CBT-I. In addition, the association between clinical improvement after CBT-I and changes in brain activity in response to SS and NS was analyzed. Compared with baseline, regional brain activity in response to SS after CBT-I decreased in the left middle temporal and left middle occipital gyrus. In regression analysis, a reduction in the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) Scale score after CBT-I was associated with decrease in brain activity in response to SS in both thalami. However, brain activity in response to NS showed no BOLD signal changes and no association with DBAS change. Cortical hyperactivity, which may cause hyperarousal in PI, was found to decrease after CBT-I. CBT-I targeting changes in beliefs and attitudes about sleep may induce its therapeutic effects by reducing thalamic brain activity in response to sleep-related stimuli.

Development of Dysfunctional Beliefs and Attitude about Sleep Scale for Cancer Patients

ABSTRACTStudy objectives: This study aimed to develop a scale utilizing the original Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale that measured maladaptive cognitions associated with sleep that is especially sensitive to cancer patients. In addition to the original scale, we added two additional items that reflected cancer-specific dysfunctional beliefs about sleep. Methods: Participants consisted of 337 cancer patients (mean age 54.0 ± 11.8 years, 32.0% men). All participants completed the DBAS-16, two cancer specific items, and the Insomnia Severity Index. Item-to-total-score correlations, internal consistency, item selection, and factor structure were examined. Results: The DBAS-16 was found to be reliable, and internal consistency was also adequate when adding two cancer-specific questions (Cronbach’s alpha = 0.89). A total of 14 items were selected, and a four-factor model was selected using exploratory factor analysis (Tucker-Lewis index = 0.86, root mean square error of approximation = 0.08). The four factors were (a) sleep expectations, (b) worry about insomnia, (c) perceived consequences of insomnia and medication, and (d) two cancer-related items. The modified 14 items of the Cancer-related DBAS (C-DBAS-14) well differentiated cancer patients with and without insomnia. Conclusions: The C-DBAS-14 is a promising measure that has adequate internal consistency. It is also sensitive to sleep-related cognitions in cancer patients and can discriminate patients with cancer who are experiencing insomnia from those who are good sleepers. The enhanced utility of the shortened 14-item scale tailored specifically to cancer patients may be useful in both clinical practice and research settings.Abbreviations: CBT: cognitive behavioral therapy; C-DBAS-14: Cancer-Related Dysfunctional Beliefs and Attitude about Sleep; C-DBS: Cancer-Related Dysfunctional Beliefs about Sleep; DBAS-16: Dysfunctional Beliefs and Attitudes about Sleep; ISI: Insomnia Severity Index

Cognitive mechanisms of sleep outcomes in a randomized clinical trial of internet-based cognitive behavioral therapy for insomnia

ObjectiveThe aim of this study was to investigate in a randomized clinical trial the role of sleep-related cognitive variables in the long-term efficacy of an online, fully automated cognitive behavioral therapy intervention for insomnia (CBT-I) (Sleep Healthy Using the Internet [SHUTi]). MethodThree hundred and three participants (Mage = 43.3 years; SD = 11.6) were randomly assigned to SHUTi or an online patient education condition and assessed at baseline, postintervention (nine weeks after baseline), and six and 12 months after the intervention period. Cognitive variables were self-reported internal and chance sleep locus of control, dysfunctional beliefs and attitudes about sleep (DBAS), sleep specific self-efficacy, and insomnia knowledge. Primary outcomes were self-reported online ratings of insomnia severity (Insomnia Severity Index), and sleep onset latency and wake after sleep onset from online sleep diaries, collected 12 months after the intervention period. ResultsThose who received SHUTi had, at postassessment, higher levels of insomnia knowledge (95% confidence interval [CI] = 0.10–0.16) and internal sleep locus of control (95% CI = 0.04–0.55) as well as lower DBAS (95% CI = 1.52–2.39) and sleep locus of control attributed to chance (95% CI = 0.15–0.71). Insomnia knowledge, chance sleep locus of control, and DBAS mediated the relationship between condition and at least one 12-month postassessment sleep outcome. Within the SHUTi condition, changes in each cognitive variable (with the exception of internal sleep locus of control) predicted improvement in at least one sleep outcome one year later. ConclusionOnline CBT-I may reduce the enormous public health burden of insomnia by changing underlying cognitive variables that lead to long-term changes in sleep outcomes.

Effects of Cognitive Behavioral Therapy for Insomnia on Sleep-Related Cognitions Among Patients With Stable Heart Failure

ABSTRACTObjective/Background: Cognitive behavioral therapy for insomnia (CBT-I) improves insomnia and fatigue among chronic heart failure (HF) patients, but the extent to which sleep-related cognitions explain CBT-I outcomes in these patients is unknown. We examined the effects of CBT-I on sleep-related cognitions, associations between changes in sleep-related cognitions and changes in sleep and symptoms after CBT-I, and the extent to which cognitions mediated the effects of CBT-I. Participants: Stable New York Heart Association Class II-III HF patients (total n = 51; n = 26 or 51.0% women; M age = 59.1 ± 15.1 years). Methods: HF patients were randomized in groups to group CBT-I (n = 30) or attention control (HF self-management education, n = 21) and completed actigraphy, the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Sleep Disturbance Questionnaires (SDQ), and self-reported fatigue, depression, anxiety, and sleepiness (baseline, immediately after treatment, six months). We used mixed-effects modeling, mediation analysis with a bootstrapping approach, and Pearson correlations. Results: There was a statistically significant group × mult time effect on DBAS. DBAS mediated the effects of CBT-I on insomnia severity and partially mediated CBT-I effects on fatigue. Improvements in dysfunctional cognitions were associated with improved sleep quality, insomnia severity, sleep latency and decreased fatigue, depression, and anxiety, with sustained effects at six months. Conclusions: Improvement in dysfunctional sleep-related cognitions is an important mechanism for CBT-I effects among HF patients who are especially vulnerable to poor sleep and high symptom burden.

Sleep continuity, architecture and quality among treatment-seeking cannabis users: An in-home, unattended polysomnographic study.

The objective of the study was to describe self-report and objectively measured sleep characteristics of adult treatment-seeking cannabis users. Study participants (n = 87) were adults who were screened for a 12-week outpatient cannabis treatment research program in Baltimore, MD. Participants completed objective and self-report measures of sleep quality. Data were analyzed for the sample overall and after stratifying by sex (54 men, 33 women). Participants were primarily urban, socioeconomically disadvantaged African Americans. Participants were frequent, heavy cannabis users; among a subset of participants assessed, 76.7% used cannabis on the day/night of the assessment. Participants had low rates of other substance abuse and of psychiatric comorbidities. Polysomnography indicated 19.5% of participants received the recommended 7 to 9 hr of sleep, with women averaging more sleep than men. One third (31.0%) had sleep latencies >30 min, one half spent >30 min awake after sleep onset, and more than one half of the sample (55.2%) had sleep efficiency scores of <85%. Most participants met criteria for subthreshold (36.8%) or clinical insomnia (25.3%) on the Insomnia Severity Index, 77.0% had scores of >5 on the Pittsburgh Sleep Quality Index. Most had average scores on the Dysfunctional Beliefs and Attitudes About Sleep (DBAS) questionnaire (M = 51.1, SD = 18.8) that were higher than average among clinical insomnia patients. Women had higher DBAS scores than men. Most participants exhibited characteristics of disordered sleep, and sex differences were observed on polysomnography and self-report measures. Findings extend prior research concerning the association between cannabis use and disordered sleep. Data presented in this article come from Clinical Trial NCT01685073. (PsycINFO Database Record

Validation of the German version of the short form of the dysfunctional beliefs and attitudes about sleep scale (DBAS-16).

Research shows that dysfunctional sleep-related cognitions play an important role in the development, maintenance and exacerbation of insomnia. This study examines the factorial validity, psychometric properties and both concurrent and predictive validity of the German version of the 16-item DBAS (dysfunctional beliefs and attitudes about sleep) scale. Data was collected in 864 vocational students from the German-speaking part of Switzerland (43% females, M age=17.9years). Data collection took place twice within a 10-month interval. The students completed a German translation of the DBAS-16, the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and provided information about their psychological functioning. Descriptive statistics, factorial validity, internal consistency, gender differences, concurrent, and predictive validity were examined. Confirmatory factor analysis supported the 4-factor structure of the DBAS-16. All factors (consequences, worry/helplessness, expectations, medication) were positively correlated and had acceptable psychometric properties. Females reported higher scores across all DBAS measures. Weak-to-moderate correlations were found between dysfunctional sleep-related beliefs, insomnia and poor sleep quality. Dysfunctional sleep-related beliefs were also associated with decreased psychological functioning, and consistently predicted insomnia and poor psychological functioning at follow-up, even after controlling for socio-demographic background and baseline levels. The present study provides support for the validity and psychometric properties of the German version of the DBAS-16. Most importantly, it corroborates the relevance of cognitive-emotional factors in the onset and maintenance of insomnia and psychological symptoms among young people.