Identifying critical beliefs about sleep in primary insomnia

Subject Objective: Maladaptive beliefs about sleep are associated with insomnia and are assessed with the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS). Three studies explored which DBAS items (1) maximally differentiated people with insomnia from good sleepers, (2) declined with cognitive behavior therapy (CBT), and (3) were related to other clinical improvement indexes. Design: Data from previous studies were analyzed to evaluate the above 3 hypotheses. Participants: The total sample (N = 332) was comprised of experimental and treatment-seeking people with insomnia and good sleepers ranging from 20 to 79 years of age (mean +/- SD 51.3 +/- 14.7). Results: The analyses of variance of the 30 items of the DBAS in Study 1 suggested that 16 items differentiated insomnia sufferers from good sleepers. In Study 2, 8 items showed significantly greater changes in response to CBT than alternate therapies. However, only 2 of these items were among the 16 items that discriminated insomnia sufferers from good sleepers in Study 1. In Study 3, declining scores on 15 of 30 DBAS items in response to CBT were related to 1 or more indexes of clinical improvement. Conclusion: The 16 beliefs of the DBAS-30 that best discriminated insomnia sufferers from good sleepers related to helplessness and hopelessness in the insomnia group. CBT addressed some of these beliefs, although some beliefs relating to helplessness remained relatively elevated. These residual beliefs should be investigated further, as they may confer cognitive risk for future insomnia and imply ways to improve current CBT strategies.