Development And Preliminary Application Of The Dysfunctional Beliefs And Attitudes About Sleep Scale-chinese Folk Custom Version

Objective:To develop a Chinese folklore-related sleep beliefs and attitudes scale for measuring dysfunctional sleep beliefs specific to Chinese patients with chronic insomnia and to test its psychometric properties.To conduct a preliminary application of this scale after brief behavioral treatment of chronic insomnia patients to examine changes in folk sleep beliefs and to investigate their relationship with treatment effects.Methods:Through literature review and patient interviews,the scale items were prepared according to the suggestions of relevant experts.The first version of the scale contained 16 items.202 patients with chronic insomnia were recruited from the Sleep Clinic of First Affiliated Hospital of Dalian Medical University to pretest the first version of the Dysfunctional Beliefs and Attitudes about Sleep Scale-Chinese Folk Custom Version(DBAS-CFC).Two weeks later,135 scale data were retested.Item analysis,exploratory factor analysis and reliability and validity tests were carried out on the scale.90 patients with chronic insomnia were recruited according to the diagnostic criteria of chronic insomnia in DSM-5,and were treated with a 4-week brief behavioral treatment for insomnia.At three time points(before treatment,at the end of treatment and 3 months after treatment),the subjects were measured with sleep scales,and sleep diaries completed by patients during treatment were collected as indicators for assessing sleep.Results:1.Dysfunctional Beliefs and Attitudes about Sleep Scale-Chinese Folk Custom Version finally retained 15 items,and exploratory factor analysis yielded 2factors,which cumulatively explained 47.96%of the variance.Internal consistency reliability:the total Cronbach’s alpha coefficient of the scale is 0.88,and the Cronbach’s alpha coefficient of factor 1 is 0.84;the Cronbach’s alpha coefficient of factor 2 is 0.82.Split-half reliability:Guttman Split-Half Coefficient is 0.82.Test-retest coefficient is0.68(p<0.01).The correlation coefficient with the Dysfunctional Beliefs and Attitudes about Sleep(DBAS-16)is 0.59(p<0.01);the correlation coefficient with the Insomnia Severity Index(ISI)was-0.17(p<0.05).2.The result of repeated measure ANOVA revealed that the ISI scores at three time points(before treatment,at the end of treatment and 3 months after treatment)were significantly different(F=109.62,p<0.01,η~2=0.67),multiple comparison showed before treatment(17.60±4.76)was significantly higher than at the end of treatment(9.02±3.68)and 3 months after treatment(8.16±4.48),and the difference between the end of treatment and the 3 months after treatment was not significant;PSQI scores were significantly different at three time points(before treatment,at the end of treatment and3 months after treatment)(F=87.73,p<0.01,η~2=0.62),multiple comparison found that before treatment(13.80±2.77)was significantly higher than at the end of treatment(9.67±2.37)and 3 months after treatment(8.09±3.40),and at the end of treatment was also significantly higher than 3 months after treatment.3.2-factor repeated measure ANOVA revealed that the time main effect of the two sleep beliefs was significant(F=19.96,p<0.01,η~2=0.27),the difference between CFC and DBAS-16 is not significant,and the interaction effect is not significant.The CFC scores at three time points were significantly different(F=5.19,p<0.05,η~2=0.09),multiple comparison showed that before treatment(38.00±9.57)was significantly lower than after treatment(41.62±11.72)and 3 months after treatment(41.33±11.56),and the difference between the end of treatment and 3 months after treatment was not significant;DBAS-16 scores at three time points also showed differences(F=19.22,p<0.01,η~2=0.26),multiple comparison found that before treatment(37.96±1.27)was significantly lower than that after treatment(44.60±1.46)and 3 months after treatment(44.76±1.55),and the difference between the end of treatment and 3 months after treatment was not significant.4.The improvement of CFC at the end of treatment was significantly negatively correlated with the change of ISI(r=-0.27,p<0.05)and the improvement of CFC at 3months after treatment was significantly positively correlated with the change of DBAS-16(r=0.36,p<0.01).5.DBAS-16 before treatment can significantly predict the change of ISI scores from before treatment to the end of treatment(accounting for 6.6%of the variance)and3 months after treatment(accounting for 7.2%of the variance);ESS before treatment can significantly predict the improvement of total sleep time(5.7%of the variance)and sleep efficiency(7.5%of the variance)from before treatment to 3 months after treatment.Conclusions:1.The internal consistency,temporal stability,and split-half reliability of the DBAS-CFC were adequate;the construct validity was adequate,and exploratory factor analysis obtains 2 factors;and the correlation with DBAS-16 and ISI was significant.2.After simple behavior treatment for chronic insomnia patients,significant therapeutic effects were observed at the end of treatment and 3 months after treatment,and both dysfunctional sleep beliefs were significantly improved.At the end of treatment and 3 months after treatment,both were significantly stronger than before treatment,but there was no significant difference between the two sleep beliefs.There is a significant correlation between the improvement of folk sleep beliefs and the improvement of insomnia.Sleep beliefs and daytime sleepiness before treatment can predict the treatment results of BBTI.