Do changes in beliefs and behaviours moderate improvement in insomnia after acquired brain injury?

Key mechanisms of change in cognitive behavioural therapy for insomnia in the general population encompass changing sleep-related beliefs and behaviours. In a population with acquired brain injury, cognitive behavioural therapy for insomnia is effective as well, but little is known about the mechanisms of change. The aim of this study was to evaluate how changing sleep-related beliefs and behaviours were associated with improvement in insomnia following blended cognitive behavioural therapy for insomnia in a population with acquired brain injury. A secondary analysis was performed on data of a randomized-controlled trial, including 24 participants that received blended cognitive behavioural therapy for insomnia, and 24 participants that received treatment as usual. Results showed that following blended cognitive behavioural therapy for insomnia, significantly more participants improved on dysfunctional beliefs and sleep-related behaviours and this was associated to improvement in insomnia severity. For sleep-related behaviours, the association between improvement on behaviour and improvement on insomnia was significantly moderated by blended cognitive behavioural therapy for insomnia. However, the relation between dysfunctional beliefs and insomnia was not moderated by type of treatment. Similar results were found for acquired brain injury-adapted versions of the questionnaires in which up to half of the items were excluded as they could be regarded as not dysfunctional for people with acquired brain injury. These results show that improvement on insomnia severity is related to improvement in dysfunctional beliefs and behaviours, and cognitive behavioural therapy for insomnia efficacy may be moderated by the improvement in behaviours in particular. A focus on these behaviours can enhance treatment efficacy, but caution is needed regarding the behaviours that may reflect adequate coping with the consequences of the acquired brain injury.

Validation of an Arabic version of the female version of The Sexual Dysfunctional Beliefs Questionnaire: a factor analysis study.

Several questionnaires have been developed to evaluate female sexual dysfunction (FSD) and sexual health problems. However, there is a lack of validated versions of these questionnaires in Arabic. One of the most used instruments is the female version of The Sexual Dysfunctional Beliefs Questionnaire (SDBQ). The current study aimed to validate an Arabic version of the SDBQ. The Arabic version of SDBQ-Female was incorporated into an online questionnaire using and distributed among Jordanian Facebook groups and women-only groups. Factor analysis was performed to investigate evidence for the validity of the questionnaire. 530 females (mean age 30 years, SD = 9) completed the questionnaire. Principal component analysis produced the final model composed of 24 items distributed across four factors: Sexual Desire & Pleasure, Affection Primacy, Sexual Conservatism and Age-Related Beliefs. Confirmatory factor analysis was conducted, and fit indices were acceptable (CMIN/DF = 2.52, GFI = 0.91, AGFI = 0.89, CFI = 0.90, SRMR = 0.05 and RMSEA = 0.05). Income level and marital status both influenced FSD beliefs, with higher scores associated with higher income and being single. The Arabic version of the SDBQ-female demonstrated evidence of validity and reliability. Additional research is necessary to explore beliefs related to FSD within an Arabic context.

This study provides evidence for the validity and reliability of an Arabic questionnaire for assessing female sexual dysfunction (FSD) among Jordanian women recruited through Facebook. Women's income level and marital status influenced their FSD beliefs. Further research is needed to explore these beliefs in an Arabic context.

Are sleep-related beliefs and behaviours dysfunctional in people with insomnia after acquired brain injury? A cross-sectional study.

Inappropriate sleep-related beliefs and behaviours are considered key maladaptive mechanisms in the development and maintenance of insomnia in the otherwise healthy population. The aim of this study was to evaluate critically the role of sleep-related beliefs and behaviours in insomnia after acquired brain injury. Cross-sectional data of 51 outpatients with insomnia disorder and acquired brain injury were used to evaluate associations of the insomnia severity index with the dysfunctional beliefs and attitudes about sleep scale and sleep-related behaviours questionnaire. Seven (44%) of the dysfunctional beliefs and attitudes about sleep scale items and 10 (31%) of the sleep-related behaviours questionnaire items correlated significantly with insomnia severity. Ten experts were consulted on whether they considered the questionnaire items maladaptive or accurately reflecting coping with conditions experienced by people with acquired brain injury. Although multiple linear regression showed that the total scores of the questionnaires explained a significant part of interindividual differences in insomnia severity (R2 = 0.27, F(2,48) = 8.72, p < 0.01), the experts unanimously rated only four (25%) of the dysfunctional beliefs and attitudes about sleep scale items as dysfunctional beliefs and three (9%) of the sleep-related behaviours questionnaire items as safety behaviours. In people with brain injury, sleep related beliefs and behaviours may also play a role in insomnia, especially a diminished perception of control and worry about sleep. However, more than half of the questionnaire items on sleep-related beliefs and behaviours may not be considered inappropriate and maladaptive for the acquired brain injury population, and may reflect adequate observations and efforts in coping with consequences of the brain damage.

The relationship between sleep quality and depression: Critical roles of reflective and brooding rumination and sleep-related cognition.

There is a complex interplay between sleep problems and depression. This study explored the possible effects of rumination and dysfunctional beliefs about sleep on the relationship between sleep quality and depression. A cross-sectional survey of 1240 Chinese adults was conducted to assess the possible relationships. The results showed a chain mediating effect of reflection rumination and brooding rumination on the relationship between sleep quality and depression, accounting for 38.91% of the total variance. A moderating role of unreasonable attitudes about sleep was also discovered among the study participants, which enhanced the relationship between reflection and brooding, leading to a further increase in this relationship. Individually-tailored approaches targeting rumination and cognition may more effectively alleviate depression or co-morbid sleep problems and depression than the current standards of care.

[Does a short telemedicine-based CBT programme for insomnia lead to changes in dysfunctional beliefs about sleep?] / Un programme court de TCCi en groupe par visioconférence dans l'insomnie modifie-t-il les croyances erronées ?

INTRODUCTION: The Morphee Sleep network runs a short group CBT programme. During the pandemic, the programme was administered by videoconference. The programme focuses on behavioral modification. The objective of our study was to evaluate whether the videoconference programme produced changes in dysfunctional beliefs about sleep and whether these changes were linked to improvements in insomnia. METHODS: Observational study of 3×90minute sessions of group CBT by videoconference over one month delivered by experienced psychologists. The outcome measures : insomnia severity scale (ISI), dysfunctional beliefs and attitudes about sleep short version (DBAS 16), hospital anxiety and depression scale (subscales depression HADD and anxiety HADA), and epworth sleepiness scale (ESS) completed before session 1 and at the end of session 3. The effectiveness of the programme on insomnia was evaluated by the decrease in the ISI score : full response R+ (>7 points), partial response, R- (4 - 6 points) non response, NR (<3 points). The effect on dysfunctional beliefs and attitudes about sleep were measured by the decrease in the DBAS 16 with response CR (>9 points) and no response CNR (<9 points). RESULTS: There were fifty-five participants, 64 % women with a mean age of 49.1±16.1 years. The DBAS 16 was reduced by 6.12±1.29 to 5.09±1.57 (P< 0.0001) with 67 % of participants showing a response CR. The ISI score reduced from 17.7±3.6 to 14.0±4.9 (P< 0.0001) with 49 % showing at least a partial response (R+ and R-). A significant correlation (0.327, P=0.015) between the CBT response and dysfunctional beliefs about sleep was observed with a significant reduction in the DBAS 16 between responders R+ and non-responders (R+ vs. NR 1.67±1.3 vs. 0.57±1.28 P=0.012). Seventy-nine of R+ showed improvements in the DBAS 16 vs. 69 % of R- and 61 % of non-responders NR. CONCLUSION: A short group CBT programme by videoconference focused on behavioral modification can reduce dysfunctional beliefs about sleep.

The role of reassurance seeking in obsessive compulsive disorder: the associations between reassurance seeking, dysfunctional beliefs, negative emotions, and obsessive- compulsive symptoms.

BACKGROUND: This study investigates the association of reassurance seeking with obsessive compulsive (OC) symptoms, dysfunctional beliefs, and negative emotions. METHODS: Reassurance Seeking Questionnaire, Obsessive-Compulsive Inventory, Obsessive Beliefs Questionnaire, Trait Anger Expression Inventory, and Guilt Inventory were applied to 53 obsessive compulsive disorder (OCD) patients and 591 non-clinical participants. RESULTS: The results showed that the severity of the OC symptoms significantly predicted the carefulness of OCD patients during reassurance seeking, indicating increased carefulness during reassurance seeking as the severity of OC symptoms increased. Moreover, feelings of guilt increased with increasing intensity of reassurance seeking. In addition, carefulness during reassurance seeking significantly predicted the level of anxiety. Responsibility/threat estimation, perfectionism/need for certainty, and importance/control of thoughts significantly predicted the OC symptoms. Moreover, the dysfunctional beliefs directly associated with an increased need to seek reassurance from different sources and seek reassurance more carefully. In terms of mediational effect, the results revealed that the individuals who had distorted beliefs were more likely to have OC symptoms and, in turn, the OC symptoms increased carefulness during reassurance seeking. The analysis of the model test revealed mostly similar results to those obtained for the clinical sample. CONCLUSIONS: The findings revealed a close relationship between OC symptoms and reassurance-seeking behaviors.

I am a total failure: associations between beliefs and anxiety and depression in patients with inflammatory bowel disease with poor mental quality of life.

BACKGROUND: According to cognitive behavioural theory, cognitive factors (i.e. underlying general dysfunctional beliefs and (situation) specific illness beliefs) are theorized to lead to outcomes like anxiety and depression. In clinical practice, general dysfunctional beliefs are generally not tackled directly in short-term-therapy. AIMS: The goal of the present study was to investigate the associations of general versus specific illness beliefs on anxiety and depressive symptoms and psychiatric disorders among a subgroup of patients with inflammatory bowel disease (IBD) with poor mental quality of life (QoL). METHOD: This study concerns cross-sectional data, collected at baseline from a randomized clinical trial. One hundred and eighteen patients, recruited at four Dutch hospitals, with poor QoL (score ≤23 on the mental health subscale of the Short-Form 36-item Health-Survey; SF-36) were included. General dysfunctional beliefs were measured by the Dysfunctional Attitude Scale (DAS), specific illness beliefs by the Illness Perceptions Questionnaire-Revised (IPQ-R), anxiety and depressive symptoms by the Hospital Anxiety and Depression Scale (HADS), and psychiatric disorders by the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I). RESULTS: Univariate analyses showed associations between the level of anxiety and/or depression and general dysfunctional beliefs and four specific illness beliefs (consequences, personal control, emotional representations and treatment control). Among patients with IBD with psychiatric disorders, only the DAS was significantly associated with anxiety and depression (DAS added to IPQ-R and IPQ-R added to DAS). CONCLUSIONS: Psychological interventions may have to target general dysfunctional beliefs of patients with IBD with co-morbid psychiatric disorders to be effective. These patients with IBD are especially in need of psychological treatment.

Spanish version of the Inferential Confusion Questionnaire-Expanded Version: Further support for the role of inferential confusion in obsessive-compulsive symptoms.

The purposes of this research were (1) to analyse the psychometric properties of the Inferential Confusion Questionnaire-Expanded Version (ICQ-EV) in a Spanish population; (2) to explore the role of inferential confusion in obsessive-compulsive disorder (OCD); and (3) to compare the inferential confusion construct in nonclinical and clinical samples. A sample of 342 nonclinical participants and 66 patients with OCD completed the ICQ-EV Spanish adaptation as well as a set of questionnaires. Results confirmed a good fit of the ICQ-EV Spanish version to the original unifactorial structure and excellent internal consistency and test-retest reliability. Moreover, results confirmed that the ICQ-EV predicts Obsessing, Checking, Washing, and Hoarding symptoms, independently of the contribution of dysfunctional beliefs. In addition, OCD patients scored significantly higher on the ICQ-EV than nonclinical participants. The Spanish version of the ICQ-EV is a reliable instrument to assess inferential confusion, and further support is provided for the relevance of the inferential confusion construct in OCD.

Cognitive correlates of women's postpartum depression risk and symptoms: the contribution of dysfunctional beliefs and negative thoughts.

Background: Despite the extensive research on interpersonal and clinical risk factors for postpartum depression (PPD), there is a paucity of research on the potential role of cognitive variables (dysfunctional beliefs and negative thoughts) as correlates of PPD symptoms.Aims: This exploratory study aimed to understand the cognitive processes of women at a higher risk (i.e. presenting well-established interpersonal and clinical risk factors) for PPD by: (a) comparing women's dysfunctional motherhood-related beliefs and frequency of automatic thoughts, as a function of their levels of PPD risk and symptoms; (b) examining the cognitive correlates of PPD symptoms, controlling for the presence of well-established risk factors.Method: A cross-sectional internet survey comprising 441 postpartum women was conducted.Results: Women presenting high-risk for PPD showed more dysfunctional motherhood-related attitudes (p < 0.001), more frequent negative thoughts (p < 0.001) and less frequent positive thoughts (p < 0.001) than low-risk women. More dysfunctional beliefs related to maternal responsibility, more frequent negative thoughts related with personal maladjustment and with the metacognitive appraisal of the thoughts' content, and less frequent positive thoughts were found to be significantly associated with PPD symptoms.Conclusion: The inclusion of cognitive variables in risk assessment and preventive efforts for PPD may hold potential to increase its clinical efficacy.

Dysfunctional beliefs about sleep and insomnia symptoms in early adulthood: A twin and sibling study.

This study examines the associations between dysfunctional belief about sleep (DBAS), its subtypes and insomnia symptoms and estimates the relative contribution of genetic and environmental influences to these variables and the associations between them. The data came from G1219, a twin/sibling study that comprises 862 individuals (aged 22-32 years, 34% male). The Insomnia Symptoms Questionnaire was used to measure insomnia symptoms and a 10-item version of the Dysfunctional Beliefs and Attitudes about Sleep Scale was used to assess DBAS. A higher DBAS score was associated with more insomnia symptoms. Overall DBAS showed a mainly non-shared environmental influence (86%). The genetic correlation between overall DBAS and insomnia symptoms was large but not significant, the shared environmental correlation was very small, negative and not significant, whereas a moderate, significant overlap in the non-shared environmental influences was evident (non-shared environmental correlation = 0.32). For the association between the subscales of DBAS and insomnia symptoms no significant overlap for genetic (weak to strong associations) or shared environmental factors (very weak negative to strong associations) was indicated. Most of the non-shared environmental influences on the four variables were significantly moderately correlated (non-shared environmental correlation = 0.24-0.46). These findings help to deepen our understanding of cognitive theories of insomnia by dissecting one of its crucial elements and illuminating the factors involved in its association with insomnia symptoms.

Psychometric validation of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV).

AIM: The aim of the study was to examine the psychometric properties of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV). The OBQ-CV assesses dysfunctional beliefs concerning responsibility/threat estimation, perfectionism/uncertainty, and importance/control of thoughts, which according to cognitive theories are important in the development and maintenance of obsessive-compulsive disorder (OCD). METHODS: The study included a pediatric sample (age 7-17 years) consisting of 57 children and adolescents with OCD, 49 children and adolescents with an anxiety disorder (AD), and 58 typically developing (TD) children and adolescents without a psychiatric diagnosis. All participants completed the OBQ-CV and the Child Behavior Checklist - the School Age Scales (CBCL/6-18). The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to assess OCD symptom severity in the OCD group. RESULTS: Confirmatory factor analyses supported the three-factor structure and thereby the construct validity of the OBQ-CV. Gender was not associated with subscale scores, whereas age influenced the subscale scores differently in the three groups. Reliability analyses showed acceptable to excellent internal consistency and acceptable test-retest reliability of the instrument. There were significant differences between the OCD group and the TD group, supporting the criterion validity. Results on convergent validity were mixed. CONCLUSIONS: Overall, results supported the reliability and validity of the Danish OBQ-CV and thus the use of the questionnaire for future clinical and research purposes.

Dysfunctional beliefs towards motherhood and postpartum depressive and anxiety symptoms: Uncovering the role of experiential avoidance.

OBJECTIVE: This study aimed to examine the relationship between dysfunctional motherhood-related beliefs and postpartum anxiety and depression symptoms, and whether experiential avoidance may be a potential mechanism in explaining these relationships. METHOD: A sample of 262 postpartum women participated in a cross-sectional online survey. RESULTS: The model presented a good fit (CFI = 0.96, RMSEA = 0.077) suggesting that more dysfunctional motherhood-related beliefs related with maternal responsibility and with others' judgments were associated with higher postpartum anxiety and depressive symptoms. Indirect effects through experiential avoidance were also found. CONCLUSIONS: Dysfunctional motherhood-related beliefs are cognitive vulnerabilities for postpartum psychological disorders and should be assessed to identify women that may be prone to early interventions. Moreover, dysfunctional beliefs seem to affect psychopathological symptoms by activating experiential avoidance strategies (e.g., rumination), which may accentuate the frequency of women's negative thoughts and emotions. Early interventions should target the promotion of acceptance of private negative experiences (psychological flexibility).

Exploring the paths between dysfunctional attitudes towards motherhood and postpartum depressive symptoms: The moderating role of self-compassion.

Better understanding how cognitive processes operate to influence women's depressive symptoms during the postpartum period is crucial for informing preventive and treatment approaches. The present study aimed to examine the relationship between women's dysfunctional attitudes towards motherhood and depressive symptoms, considering the mediating role of negative automatic thoughts and the moderating role of self-compassion. A sample of 387 women in the postpartum period cross-sectionally answered a set of questionnaires to assess dysfunctional attitudes towards motherhood, negative automatic thoughts (general and postpartum-specific), depressive symptoms, and self-compassion. Women with clinically significant depressive symptoms presented more dysfunctional attitudes towards motherhood, more frequent negative thoughts, and lower self-compassion. More dysfunctional beliefs about others' judgments and about maternal responsibility were associated with higher depressive symptoms, and this effect occurred through both general and postpartum-specific thoughts related to the metacognitive appraisal of the thought content. Moreover, these relationships occurred only when women presented low or moderate levels of self-compassion. These results highlight the need to comprehensively assess women's cognitive variables during the postpartum period with appropriate measures, for the early identification of women with more dysfunctional beliefs about motherhood, who may be at higher risk of depression. Moreover, preventive/treatment approaches should aim not only to challenge women's preexisting dysfunctional beliefs but also to promote a more self-compassionate attitude towards themselves.

Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample.

Research has supported the specific role that anxiety sensitivity, health-related dysfunctional beliefs, and metacognitive beliefs may play in the development and maintenance of health anxiety symptoms. However, the role of metacognitive beliefs in health anxiety has only been explored in analogue samples. The aim of this study was to explore for the first time the association between metacognitive beliefs and health anxiety symptoms in a sample of participants who reported having received a diagnosis of severe health anxiety (hypochondriasis) or illness anxiety disorder and test whether these beliefs are significant predictors of health anxiety after controlling for anxiety, depression, anxiety sensitivity, and dysfunctional beliefs. A series of dimensional self-report measures were administered to a large Italian sample (N = 458). At a bivariate level, Beliefs that Thoughts are Uncontrollable had a stronger association with health anxiety than any of the dysfunctional beliefs and anxiety sensitivity subscales. Results from hierarchical multiple regression analysis indicated that Beliefs that Thoughts are Uncontrollable predicted health anxiety symptoms over-and-above depression, general anxiety, anxiety sensitivity, and health-related dysfunctional beliefs. Despite many important limitations, this study supported the hypothesis that metacognition may have an important role in health anxiety in clinical samples.

A "Sleep 101" Program for College Students Improves Sleep Hygiene Knowledge and Reduces Maladaptive Beliefs about Sleep.

Sensitizing young adults about sleep hygiene knowledge and helpful sleep attitudes may have the potential to instill long-lasting healthy sleep practices. Towards these ends, evaluation of psychoeducational program "Sleep 101" tailored to college students was undertaken. Following two weeks of sleep-log recordings, participants were randomly assigned to a Sleep 101 (experimental) condition or a sleep monitoring (control) condition. The Sleep 101 condition was comprised of two 90-minute workshops aimed to educate students about healthy sleep practices, helpful thoughts about sleep, and ways to improve sleep. The sleep monitoring group received a sleep hygiene handout and completed sleep logs for the study duration. Sleep 101 participants endorsed fewer maladaptive beliefs and attitudes about sleep, increased sleep hygiene knowledge, and reduced sleep onset latency compared to the sleep monitoring participants. Brief psychoeducational courses may be a cost-effective way to alleviate current, and/or prevent future, sleep problems in young adults.

The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography-determined sleep.

Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent, particularly in patients with primary insomnia, indicating that the two measures are partially independent. To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG-determined sleep. The aim of this study was to investigate to what extent three major components of insomnia models, i.e., sleep effort, dysfunctional beliefs and attitudes about sleep, and presleep arousal, are associated with subjective insomnia severity and PSG-determined sleep. A sample of 47 patients with primary insomnia according to DSM-IV criteria and 52 good sleeper controls underwent 2 nights of PSG and completed the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time. All analyses were adjusted for age, gender, depressive symptoms and group status. The results showed that subjective insomnia severity was associated positively with sleep effort. PSG-determined total sleep time was associated negatively with somatic presleep arousal and dysfunctional beliefs and attitudes about sleep. This pattern of results provides testable hypotheses for prospective studies on the impact of distinct cognitive and somatic variables on subjective insomnia severity and PSG-determined total sleep time.

Health-related dysfunctional beliefs and health anxiety: further evidence of cognitive specificity.

OBJECTIVE: The specificity of Salkovskis and Warwick's (2001) 4 health-related dysfunctional beliefs to health anxiety was examined. METHOD: Specificity was examined using a medically healthy sample of community members recruited through the Internet (N = 410, mean age = 32.9 years, 55.4% female). Structural equation modeling was used to compare the equivalence of latent correlations and partial path coefficients that controlled for the overlap among the targeted dysfunctional beliefs. RESULTS: Health-related dysfunctional beliefs were significantly more strongly related to health anxiety than obsessive-compulsive symptoms. Further, health-related dysfunctional beliefs continued to share robust relations with health anxiety after controlling for related dysfunctional beliefs, although anxiety sensitivity appeared particularly relevant to health anxiety as well. CONCLUSIONS: These results support the specificity of Salkovskis and Warwick's health-related dysfunctional beliefs to health anxiety, as well as the importance given to dysfunctional beliefs within cognitive-behavioral models and treatments of health anxiety.

Cognitive training via mobile app for addressing eating disorders' cognitions in adolescents: a randomized control trial protocol.

During adolescence, individuals are particularly vulnerable to developing eating disorders (EDs). To address the dysfunctional beliefs linked to these disorders, a new mobile app has been developed. This app, called GG eating disorders-Adolescents (GGED-AD), was created based on CBT to help adolescents work on their self-dialogue related to the core beliefs of eating disorders. The objective is to present the protocol for a randomized controlled trial to explore the efficacy of GGED-AD.Methods The study will be carried out in adolescents aged 13 to 16 from an educational center in the Valencian Community. The participants will be randomized into two groups: the experimental group will use the GGED-AD app during 14 consecutive days for approximately 5 min each day; and the control group will use a neutral app (GGNEUTRAL) during the same time. Both groups will complete instruments that assess dysfunctional beliefs related to eating disorders, eating symptoms, symptoms of depression and anxiety, body satisfaction and self-esteem before and after the intervention. A follow-up will be conducted one month later.Results A decrease in the degree of ascription to dysfunctional beliefs associated with eating disorders and eating symptomatology is expected, as well as an increase in body satisfaction and the self-esteem of the participants of the experimental group.Discussion The app in this study could help tackle and prevent ED-related symptoms in adolescents.Trial registration NCT06039514.

Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective.

STUDY OBJECTIVES: Various models of insomnia stress the role of cognitive components, such as dysfunctional sleep-related beliefs, in maintenance and exacerbation of insomnia. This study aimed to use network analysis to identify the particular beliefs that are central and have strong associations with insomnia severity. In addition, we aimed to use a relative importance network to map out predictive pathways between types of dysfunctional beliefs and insomnia severity. METHODS: This study was a retrospective study, with data collected from 219 patients with insomnia. Patients' responses to the Dysfunctional Beliefs about Sleep Scale-16 (DBAS-16) and Insomnia Severity Index (ISI) were collected. All network analyses were performed using R Studio to produce 3 networks: (1) DBAS-16 network, (2) DBAS-16 and ISI network, and (3) relative importance network containing DBAS-16 subscales and ISI. RESULTS: Beliefs reflecting overestimation of negative consequences of sleep (eg, "insomnia is ruining life"), loss of ability (eg, "worry about losing abilities to sleep"), and unpredictability (eg, "can't predict sleep quality") were identified as most central and strongly associated with insomnia severity. Worry/helplessness about insomnia had the largest predictive value on insomnia severity, and also acted as a mediator between other subscales and insomnia severity. CONCLUSIONS: The results of our study suggest that overestimation of negative consequences, loss of ability, and unpredictability are key beliefs that exacerbate and maintain insomnia, thus supporting existing cognitive models of insomnia. CITATION: Cha EJ, Hong S, Kim S, Chung S, Jeon HJ. Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective. J Clin Sleep Med. 2024;20(5):743-751.

Waking qEEG in older adults with insomnia and its associations with sleep reactivity and dysfunctional beliefs about sleep.

Sleep quality often deteriorates with age, and insomnia among the elderly increases the risks of both physical and psychiatric disorders. To elucidate the mechanisms and identify useful diagnostic biomarkers for insomnia in the elderly, the current study investigated the associations of waking brain activity patterns with susceptibility to stress-induced insomnia (sleep reactivity) and dysfunctional beliefs about sleep, major factors precipitating and maintaining insomnia, respectively. Forty-five participants aged 60 years or older with insomnia completed self-reported measures assessing depression, anxiety, sleep quality, dysfunctional beliefs about sleep, and sleep reactivity. Participants were then examined by quantitative electroencephalography (qEEG) during wakefulness, and spectral analysis was conducted to examine associations of regional frequency band power with these insomnia-precipitating and -maintaining factors. Dysfunctional beliefs about sleep were significantly correlated with higher beta/high-beta frequency band powers, while sleep reactivity was correlated with higher theta and delta frequency band powers. These findings suggest that sleep reactivity of older adults is associated with widespread cortical deactivation leading to poor stress coping, while their dysfunctional beliefs about sleep are associated with hyperactivation which is related to cognitive processes. These associations suggest that cognitive inflexibility and maladaptive stress-coping contribute to insomnia among the elderly.