Dados do Trabalho

Título

A network approach of Insomnia and Dysfunctional Beliefs and Attitudes About Sleep

Introdução

Cognitive processes are crucial to several models of insomnia. Negatively toned cognitive activity triggers arousal and distress, channeling attention and monitoring to sleep, and creating distorted perceptions. Challenging unhelpful beliefs about sleep is a crucial element of cognitive-behavioral therapy for insomnia. Understanding how this network of beliefs connects to insomnia severity may provide leads to help targeted interventions.

Objetivo

To use a network analysis of cross-sectional data to investigate the associations of dysfunctional beliefs and attitudes about sleep with overall insomnia severity, in a sample of Brazilian adults.

Métodos

Data were collected from surveys responded by 1376 adults, aged 18 to 59 years, both with and without insomnia symptoms. Participants completed online self-report questionnaires, including, Insomnia Severity Scale (ISI) and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16). Gaussian Graphical Models were estimated using the GLASSO regularization and EBIC model selection with hyperparameter set to 0.5. We first estimated a network describing the associations among overall insomnia severity and the four factors of DBAS-16. Subsequently, we estimated a network describing the associations among insomnia severity and each of the individual items of DBAS-16. The stability of node strength was estimated using a case dropping bootstrap procedure (1000 iterations). Node centrality was assessed by strength, closeness, and betweenness – these measures indicate how important nodes are in a network.

Resultados

Worry about sleep was a highly central symptom, indicating its importance as possible target for cognitive-behavioral therapy for insomnia. Nodes with high centrality indices are important in the flow of information through the network. Surprisingly, we found a negative partial correlation between sleep expectations and insomnia severity. Belief that a poor night of sleep would ruin functioning on the next day emerged as the item with highest strength, closeness and betweenness. Another item with high centrality indices referred to feelings that insomnia is ruining one’s ability to enjoy life.

Conclusões

This network analysis of insomnia severity and beliefs about sleep provides important insights as to which beliefs may be the most important targets for cognitive-behavioral interventions. This analysis may also provide some useful preliminary data to estimate causal effects.

Palavras -chave

Network analysis, insomnia, beliefs