Summer 2022 (Volume 32, Number 2)
Maladaptive Sleep Beliefs and
Attitudes Are Associated with Insomnia
Among Individuals with Arthritis
By Deborah Da Costa, MA, PhD; and Emilie McGuire
Sleep disturbances, including difficulty initiating
sleep, maintaining sleep, and/or early morning
awakenings, are all types of insomnia, reported in up
to 70% of persons with arthritis.1 Rigid beliefs and unrealistic
expectations about sleep are viewed as important to
the maintenance of insomnia.2,3 In the general population
and in other clinical populations, individuals with insomnia
exhibit higher levels of unhelpful sleep beliefs compared
to good sleepers.4,5 Cognitive behavioural therapy
for insomnia (CBT-I) has been shown to reduce dysfunctional
beliefs about sleep, and improve insomnia symptoms.6
Little is known about the presence and types of maladaptive
sleep beliefs among individuals with arthritis. To
guide the tailoring of an internet-delivered CBT-I intervention,
we examined unhelpful sleep beliefs and their association
to insomnia severity among persons with arthritis.
A total of 254 individuals with arthritis recruited via social
media and arthritis patient organizations (mean age 61.6,
SD 13.2, 84.3% women) completed an online survey assessing
sociodemographics, disease-related factors, depression,
and stress. The Insomnia Severity Index (ISI)7 and the
10-item Dysfunctional Beliefs About Sleep Scale (DBAS)8
were also administered. DBAS scores were significantly
higher for individuals with inflammatory arthritis (IA)
with clinical insomnia and subthreshold insomnia compared
to those with no insomnia symptoms. The top three
most commonly rated dysfunctional sleep beliefs among
individuals with arthritis experiencing clinical insomnia
were as follows:
1) I am concerned that chronic insomnia
may have serious consequences on my physical health;
2) After a poor night’s sleep, I know that it will interfere
with my daily activities on the next day; and 3) When I
feel tired, have no energy or just seem to not function well
during the day, it is generally because I did not sleep well
the night before.
After adjusting for relevant sociodemographic, disease-related, and psychosocial factors, higher DBAS
scores remained independently associated with higher
ISI scores, explaining an additional 15% of the variance.
Dysfunctional sleep beliefs are associated with the severity
of insomnia in individuals with arthritis. Individuals with
arthritis experiencing clinical insomnia report unhelpful
beliefs in particular both about the immediate and the
long-term negative consequences of insomnia. Given that
changes to unhelpful sleep beliefs following CBT-I are associated
with improved sleep, it is imperative to address
these rigid sleep beliefs in order to improve the effectiveness
of behavioural interventions for individuals with
Deborah Da Costa, MA, PhD
Associate Professor, Department of Medicine
Scientist, Research Institute of the
McGill University Health Centre
BA Candidate, Department of Psychology,
University of British Columbia
Vancouver, British Columbia
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3. Morin CM. Insomnia: psychological assessment and management. New York: Guilford Press. 1993.
4. Da Costa D, Allman AA, Libman E, et al. Prevalence and determinants of insomnia after a myocardial
infarction. Psychosomatics. 2017; 58(2):132-40.
5. Carney CE, Edinger JD, Morin CM, et al. Examining maladaptive beliefs about sleep across insomnia
patient groups. Journal of psychosomatic research. 2010; 68(1):57-65.
6. Morin CM, Blais F, Savard J. Are changes in beliefs and attitudes related to sleep improvements in
the treatment of insomnia? Behav Res Ther. 2002; 40.
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for insomnia research. Sleep Med. 2001; 2(4):297-307.
8. Espie CA, Inglis SJ, Harvey L, Tessier S. Insomniacs' attributions: psychometric properties of the
Dysfunctional Beliefs and Attitudes about Sleep Scale and the Sleep Disturbance Questionnaire.
J Psychosom Res. 2000; 48:141-8.
You are invited to submit abstracts for presentation during the 2023 CRA & AHPA Annual Scientific
Meeting! Deadline for submissions is October 3, 2022. Details will be available at