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

Patrick Faaland; Øystein Vedaa; Knut Langsrud; Børge Sivertsen; Stian Lydersen; Simen Berg Saksvik; Cecilie L Vestergaard; Kaia Kjørstad; Daniel Vethe; Lee M Ritterband; Allison G Harvey; Tore C Stiles; Jan Scott; Håvard Kallestad

doi:10.1016/j.sleep.2023.07.018

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

Sleep Med. 2023 Oct:110:1-6. doi: 10.1016/j.sleep.2023.07.018. Epub 2023 Jul 21.

Authors

Affiliations

¹ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway. Electronic address: [email protected].
² Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Psychosocial Science, University of Bergen, Norway.
³ St. Olavs University Hospital, Østmarka, Trondheim, Norway.
⁴ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway.
⁵ Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
⁶ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
⁷ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs University Hospital, Østmarka, Trondheim, Norway.
⁸ Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
⁹ Department of Psychology, University of California, Berkeley, CA, USA.
¹⁰ Department of Psychology, Norwegian University of Science and Technology, Norway.
¹¹ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; University of Newcastle, Newcastle, United Kingdom.

PMID: 37506538
DOI: 10.1016/j.sleep.2023.07.018

Abstract

Objective/background: Digital 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/methods: The 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 conclusion: sDBAS 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.

Keywords: Cognitive behavioral therapy for insomnia; DBAS; Insomnia; Mediator; RCT; dCBT-I.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Attitude
Cognitive Behavioral Therapy* / methods
Humans
Psychological Distress*
Sleep
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome