Rethinking Safety Behaviors in Insomnia: Examining the Perceived Utility of Sleep-Related Safety Behaviors
Abstract
Harvey's cognitive model of insomnia (2002a) proposes that sleep-related safety behaviors play a central role in the maintenance of insomnia because such maladaptive coping strategies are thought to reinforce threat-based appraisals of the likelihood and consequences of poor sleep. Research to date has assessed the frequency of safety behavior use in those with insomnia only; however, in addition to the frequency of occurrence, the function of safety behaviors (i.e., a belief that they will prevent a feared outcome from occurring), may be an important consideration. The purpose of this study was to examine sleep-related safety behaviors based on an expanded theoretical understanding of such behaviors across psychological disorders; that is, by examining both their frequency and perceived utility. Undergraduate students (N=376) completed an online survey about their sleep, mood, and use of sleep-related safety behaviors. Insomnia severity was associated with a greater perceived need to use safety behaviors (i.e., utility) but not with frequency of safety behavior use. Higher perceived utility of safety behaviors was also associated with unhelpful beliefs about sleep, fear and avoidance of fatigue, and both general and sleep-specific helplessness. These results suggest that these behaviors and the associated underlying maladaptive beliefs may be important targets in cognitive behavioral therapy for insomnia. The current study extends the existing literature and refines the concept of safety behaviors in insomnia to include both the function and frequency of these behaviors.
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Metacognitive processes play an important role in maintaining sleep onset anxiety.
“Additionally, metacognitive processes, defined as beliefs about thoughts and strategies for controlling mental activity, play an important role in maintaining sleep onset anxiety [13,14].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [13]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Tabachnick, B. G., & Fidell, L. S. (1983) · Cited by 79,888 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067 · see citing works
Krupp, L. B. (1989) · Archives of Neurology · doi:10.1001/archneur.1989.00520460115022 · Cited by 6,172 · see citing works
Development and validation of the Penn State Worry Questionnaire
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990) · Behaviour Research and Therapy · doi:10.1016/0005-7967(90)90135-6 · Cited by 5,099 · see citing works
Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.262.11.1479 · Cited by 2,440 · see citing works
(1993) · Medical Entomology and Zoology · Cited by 2,324 · see citing works
Epidemiologic Study of Sleep Disturbances and Psychiatric Disorders: An Opportunity for Prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.1989.03430110069030 · Cited by 2,252 · see citing works
(2012) · Springer eBooks · doi:10.1007/springerreference_179754 · Cited by 2,095 · see citing works
Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young Adults
Breslau, N., Roth, T., Rosenthal, L., & Andreski, P. (1996) · Biological Psychiatry · doi:10.1016/0006-3223(95)00188-3 · Cited by 1,831 · see citing works
Harvey, A. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00061-4 · Cited by 1,790 · see citing works
A psychometric evaluation of the Beck Depression Inventory–II.
Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998) · Psychological Assessment · doi:10.1037/1040-3590.10.2.83 · Cited by 1,517 · see citing works
Place of chronic insomnia in the course of depressive and anxiety disorders
Ohayon, M. M., & Roth, T. (2003) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(02)00052-3 · Cited by 873 · see citing works
Dysfunctional Beliefs and Attitudes about Sleep (DBAS): Validation of a Brief Version (DBAS-16)
Morin, C. M., Vallières, A., & Ivers, H. (2007) · SLEEP · doi:10.1093/sleep/30.11.1547 · Cited by 865 · see citing works
The importance of behaviour in the maintenance of anxiety and panic: A cognitive account
Salkovskis, P. M. (1991) · Behavioural Psychotherapy · doi:10.1017/s0141347300011472 · Cited by 780 · see citing works
The Mobility Inventory for Agoraphobia
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90140-8 · Cited by 775 · see citing works
Role of Stress, Arousal, and Coping Skills in Primary Insomnia
Morin, C. M., Rodrigue, S., & Ivers, H. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000030391.09558.a3 · Cited by 739 · see citing works
Validation of the Fatigue Severity Scale in a Swiss Cohort
Valko, P. O., Bassetti, C. L., Bloch, K. E., Held, U., & Baumann, C. R. (2008) · SLEEP · doi:10.1093/sleep/31.11.1601 · Cited by 681 · see citing works
Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., & Quillian, R. E. (2001) · JAMA · doi:10.1001/jama.285.14.1856 · Cited by 625 · see citing works
Anxiety disorders: Why they persist and how to treat them
Clark, D. M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00048-0 · Cited by 556 · cited 1× · see citing works
“Safety behaviors, defined as overt or covert actions intended to prevent a feared outcome from occurring (Salkovskis, 1991), have long been considered one of the primary maintaining mechanisms of anxiety disorders (Clark, 1999).”
BackgroundSocial phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80088-7 · Cited by 548 · cited 2× · see citing works
“For example, people with social phobia may mentally rehearse a conversation and engage in excessive self-monitoring to avoid freezing up or babbling when making conversation (Wells et al., 1995).”
BackgroundKatz, D. A., & McHorney, C. A. (2002) · PubMed · Cited by 426 · see citing works
Sleep Habits and Patterns of College Students: A Preliminary Study
Buboltz, W. C., Brown, F. C., & Soper, B. (2001) · Journal of American College Health · doi:10.1080/07448480109596017 · Cited by 406 · see citing works
Sleep, sleepiness, and alcohol use.
Roehrs, T., & Roth, T. (2001) · PubMed · Cited by 326 · see citing works
Prevalence and Patterns of Problematic Sleep Among Older Adolescents
Ohayon, M. M., ROBERTS, R. E., Zulley, J., Smirne, S., & Priest, R. G. (2000) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200012000-00019 · Cited by 324 · see citing works
Stoller, M. K. (1995) · PubMed · Cited by 322 · see citing works
Morin, C. M., Blais, F., & Savard, J. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00055-9 · Cited by 313 · see citing works
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00153-3 · Cited by 310 · see citing works
McManus, F. V., Sacadura, C., & Clark, D. M. (2007) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2006.12.002 · Cited by 265 · see citing works
Comorbidity of mental and insomnia disorders in the general population
Ohayon, M. M., Caulet, M., & Lemoine, P. (1998) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(98)90059-1 · Cited by 261 · see citing works
Clinical and socioeconomic correlates of insomnia.
Walsh, J. K. (2004) · PubMed · Cited by 234 · see citing works
Effects of Cognitive Arousal and Physiological Arousal on Sleep Perception
Tang, N. K. Y., & Harvey, A. G. (2004) · SLEEP · doi:10.1093/sleep/27.1.69 · Cited by 221 · see citing works
An open trial of cognitive therapy for chronic insomnia
Harvey, A. G., Sharpley, A. L., Ree, M. J., Stinson, K., & Clark, D. M. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.04.007 · Cited by 219 · see citing works
Léger, D., & Poursain, B. (2005) · Current Medical Research and Opinion · doi:10.1185/030079905x65637 · Cited by 207 · see citing works
Cognitive-behavioral approaches to the treatment of insomnia.
Morin, C. M. (2004) · PubMed · Cited by 195 · see citing works
A Cognitive Theory and Therapy for Chronic Insomnia
Harvey, A. G. (2005) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.19.1.41.66332 · Cited by 183 · see citing works
Behavioral Treatment for Persistent Insomnia
Lacks, P. B. (1987) · Cited by 171 · see citing works
Thwaites, R., & Freeston, M. H. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001985 · Cited by 165 · see citing works
Stöber, J., & Bittencourt, J. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00031-x · Cited by 162 · see citing works
Examining maladaptive beliefs about sleep across insomnia patient groups
Carney, C. E., Edinger, J. D., Morin, C. M., Manber, R., Rybarczyk, B. D., Stepanski, E. J., Wright, H., & Lack, L. C. (2009) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2009.08.007 · Cited by 160 · see citing works
Self-citationDevelopment of a Measure Of Learned Helplessness
Quinless, F. W., & Nelson, M. A. M. (1988) · Nursing Research · doi:10.1097/00006199-198801000-00003 · Cited by 151 · see citing works
Identifying critical beliefs about sleep in primary insomnia.
Carney, C., & Edinger, J. (2006) · Sleep · doi:10.1093/sleep/29.3.342 · Cited by 136 · see citing works
Self-citationDoes Reducing Safety Behaviours Improve Treatment Response in Patients with Social Phobia?
Morgan, H., & Raffle, C. (1999) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.1999.00599.x · Cited by 128 · see citing works
Morin, C. M., & Ware, J. C. (1996) · Applied and Preventive Psychology · doi:10.1016/s0962-1849(96)80013-8 · Cited by 120 · see citing works
Johnstone, K. A., & Page, A. C. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00137-2 · Cited by 114 · see citing works
Ree, M. J., & Harvey, A. G. (2004) · Behaviour Change · doi:10.1375/bech.21.1.26.35971 · Cited by 103 · see citing works
The prevalence of self-reported sleep disturbances in young adults
Coren, S. (1994) · International Journal of Neuroscience · doi:10.3109/00207459408986068 · Cited by 97 · see citing works
MARCHETTI, L. M., Biello, S. M., Broomfield, N. M., Macmahon, K., & Espie, C. A. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00510.x · Cited by 90 · see citing works
Harvey, A. G. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801001023 · Cited by 89 · see citing works
Sleeping with the enemy: Clock monitoring in the maintenance of insomnia
Tang, N. K. Y., Schmidt, D., & Harvey, A. G. (2006) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2005.07.004 · Cited by 81 · see citing works
An investigation of monitoring for sleep-related threat in primary insomnia
Semler, C. N., & Harvey, A. G. (2003) · Behaviour Research and Therapy · doi:10.1016/j.brat.2003.09.003 · Cited by 71 · see citing works
IDENTIFYING SAFETY BEHAVIORS IN INSOMNIA
Harvey, A. G. (2002) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200201000-00004 · Cited by 67 · see citing works
Woodley, J., & Smith, S. S. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.03.002 · Cited by 63 · see citing works
Ree, M. J., Pollitt, A., & Harvey, A. G. (2006) · SLEEP · doi:10.1093/sleep/29.10.1359 · Cited by 47 · see citing works
Sleep in adolescence: a review of issues for nursing practice
Vallido, T., Peters, K., O’Brien, L., & Jackson, D. W. (2009) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2009.02812.x · Cited by 30 · see citing works
Fear and avoidance of aversive affective states: Dimensions and causal relations
Taylor, S. J., & Rachman, S. (1992) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(92)90022-y · Cited by 28 · see citing works
An experimental investigation of daytime monitoring for sleep-related threat in primary insomnia
Semler, C. N., & Harvey, A. G. (2006) · Cognition & Emotion · doi:10.1080/02699930600639462 · Cited by 25 · see citing works
Processing of phobic stimuli and its relationship to outcome
Zoellner, L. A., Echiverri, A. M., & Craske, M. G. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00129-1 · Cited by 24 · see citing works
Youngstedt, S. D. (2000) · International journal of sport psychology · Cited by 15 · see citing works
Explaining context effects: expectancy and consistency
Kirsch, I. (1996) · Contemporary Hypnosis · doi:10.1002/ch.40 · Cited by 9 · see citing works
Flagged first, then by citations
1 of the 62 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Sleep and emotion regulation: An organizing, integrative review
Palmer, C. A., & Alfano, C. A. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.12.006 · Cited by 935 · see citing works
Palmer, C. A., Oosterhoff, B. J., Bower, J. L., Kaplow, J. B., & Alfano, C. A. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.09.015 · Cited by 187 · see citing works
“The current findings suggest that sleep was related to greater avoidance, in line with research suggesting that insomnia patients are more likely to engage in safety behaviors (e.g., avoiding an uncomfortable situation that might produce anxiety; Harvey, 2002a, 2002b; Hood et al., 2011).”
ResultInsomnia Disorder is Associated with Increased Amygdala Reactivity to Insomnia-Related Stimuli
Baglioni, C., Spiegelhalder, K., Regen, W., Feige, B., Nissen, C., Lombardo, C., Violani, C., Hennig, J., & Riemann, D. W. (2014) · SLEEP · doi:10.5665/sleep.4240 · Cited by 175 · see citing works
Lancee, J., Eisma, M. C., van Straten, A., & Kamphuis, J. H. (2015) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1026386 · Cited by 93 · see citing works
Hiller, R. M., Johnston, A., Dohnt, H., Lovato, N., & Gradisar, M. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.11.006 · Cited by 90 · see citing works
Learning to feel tired: A learning trajectory towards chronic fatigue
Lenaert, B., Boddez, Y., Vlaeyen, J. W. S., & Heugten, C. M. V. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.11.004 · Cited by 44 · see citing works
“For instance, daytime fatigue represents one of the main feared outcomes in individuals with insomnia, because it interferes or is believed to interfere with daytime functioning (Hood, Carney, & Harris, 2011).”
BackgroundRichardson, C. E., Gradisar, M., & Barbero, S. C. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.05.001 · Cited by 43 · see citing works
Literature review on Insomnia (2010–2016)
Bos, S. C., & Macedo, A. (2018) · Biological Rhythm Research · doi:10.1080/09291016.2017.1413766 · Cited by 42 · see citing works
“Perceived need to use sleep-related safety behaviors (utility not frequency) has equally been related to more Insomnia severity within a sample of undergraduate students (Hood et al. 2011) and wake after sleep onset has shown to be a marker of higher activation of the hypothalamic–pituitary–adrenal system within Insom…”
BackgroundHyperarousal and failure to inhibit wakefulness in primary insomnia: “Birds of a feather”?
Marques, D. R., Gomes, A. A., Clemente, V., dos Santos, J. M., & Castelo-Branco, M. S. (2015) · Sleep and Biological Rhythms · doi:10.1111/sbr.12115 · Cited by 41 · see citing works
Sleep quality and its association with the insular cortex in emotional empathy
Guadagni, V., Burles, F., Ferrara, M., & Iaria, G. (2018) · European Journal of Neuroscience · doi:10.1111/ejn.14124 · Cited by 34 · see citing works
Yang, C., Lin, S., & Cheng, C. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.22000 · Cited by 34 · see citing works
Fairholme, C. P., & Manber, R. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.01.001 · Cited by 21 · see citing works
“It is possible that the perceived utility of the safety behaviors is what is driving this relationship [41].”
BackgroundShort, N. A., & Schmidt, N. B. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.05.012 · Cited by 22 · see citing works
Lebrun, C., Gély-Nargeot, M.-C., Maudarbocus, K. H., & Bayard, S. (2020) · Behavioral Sleep Medicine · doi:10.1080/15402002.2018.1546178 · Cited by 12 · see citing works
“In line with the findings of Hood et al., our results also indicated that the three SRBQ-20 factors are related to the concept of erroneous beliefs about sleep (Hood et al., 2011).”
ResultContribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective
Cha, E. J., Hong, S., Kim, S., Chung, S., & Jeon, H. J. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11006 · Cited by 11 · see citing works
“Loss of control may trigger feelings of help-lessness and thus decrease confidence regarding sleep, 25 which, in turn, are associated with stronger beliefs in the efficacy of safety behaviors 26 that ultimately exacerbate insomnia.”
Lebrun, C., Gély-Nargeot, M.-C., Maudarbocus, K. H., Rossignol, A., Gény, C., & Bayard, S. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7906 · Cited by 12 · see citing works
Boysan, M. (2019) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2019.1612033 · Cited by 10 · see citing works
Yıldırım, A., Boysan, M., & Yılmaz, O. (2018) · Sleep and Hypnosis · doi:10.5350/sleep.hypn.2017.19.0152 · Cited by 9 · see citing works
Yang, C., Cheng, J., Xiao, L., Tian, J., Zhang, D., & Ren, J. (2025) · BMC Nursing · doi:10.1186/s12912-025-02833-3 · Cited by 7 · see citing works
“These physiological discomforts can easily trigger worries about sleep [10, 53], and worry about sleep is itself a psychological stressor.”
Effects of Sleep Deficiency on Risk, Course, and Treatment of Psychopathology.
Atwood, M. (2022) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2022.02.010 · Cited by 6 · see citing works
Zeng, Q., Zhang, Y., Liang, H., Li, Y., Zhang, X., Wang, C., & Yuan, X. (2025) · BMC Nursing · doi:10.1186/s12912-025-04258-4 · Cited by 6 · see citing works
“Insomnia, as a core stressor, directly impairs nurses’ physical and mental recovery, leading to daytime fatigue and cognitive impairment [16].”
Jeon, S., Jeong, E. M., Bang, Y. R., Ahn, J., Yoo, S., Kim, J. K., & Chung, S. (2025) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2544975 · Cited by 4 · see citing works
“Furthermore, safety behaviors may lead to individuals experiencing difficulty learning new, nonthreatening associations between the feared stimulus (e.g., insomnia) and the feared outcome (e.g., fatigue at work and distress) (Hood et al., 2011).”
InfluentialAcceptance and Commitment Therapy (ACT) for Insomnia
Johann, A. F., & Hertenstein, E. (2022) · Wiley eBooks · doi:10.1002/9781119891192.ch18 · Cited by 4 · see citing works
Chung, H. K. S., Louie, K., & Chan, W. S. (2023) · Journal of Health Psychology · doi:10.1177/13591053231195518 · Cited by 3 · see citing works
“People with insomnia use safety behaviors to prevent or avoid the consequences of sleep disturbances (Harvey, 2002b; Hood et al., 2011; Lancee et al., 2015).”
BackgroundMethodKokubun, K., Nemoto, K., & Yamakawa, Y. (2025) · Brain and Behavior · doi:10.1002/brb3.70576 · Cited by 2 · see citing works
Lebrun, C., Gély-Nargeot, M.-C., & Bayard, S. (2019) · Journal of Sleep Research · doi:10.1111/jsr.12973 · Cited by 2 · see citing works
Vorstenbosch, V., Newman, L., & Antony, M. M. (2013) · doi:10.1002/9781118528563.wbcbt03 · Cited by 2 · see citing works
Effects of Sleep Deficiency on Risk, Course, and Treatment of Psychopathology.
Atwood, M. E. (2024) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2024.07.010 · Cited by 1 · see citing works
Hertenstein, E., Voinescu, B., & Riemann, D. W. (2017) · Wiley eBooks · doi:10.1002/9781119462996.ch17 · Cited by 1 · see citing works
An investigation of fear of the dark in individuals with insomnia disorder
Maich, K. H. G. (2021) · doi:10.32920/ryerson.14664957.v1 · Cited by 1 · see citing works
Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice.
Song, S., Irfan, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00370-2
The Roles of Safety Behaviour in the Cognitive-Behavioural Treatment of Anxiety Disorders
Milosevic, I. (2011) · Spectrum Research Repository (Concordia University)
Verbesserung der Lebensqualität durch Akzeptanz und CommitmentTherapie
Hertenstein, E., Johann, A. F., Spiegelhalder, K., Riemann, D. W., & Nissen, C. (2015) · NeuroTransmitter · doi:10.1007/s15016-015-5375-5
Schneider, M. N. (2017) · Goldsmiths (University of London) · doi:10.25602/gold.00022340
Miguel, G. G. S., Woolley, M. G., Lee, E. B., Smith, B. M., Culianos, D., Levin, M. E., & Twohig, M. P. (2024) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2024-0002 · Cited by 1 · see citing works
Shang, X., Wang, F., Gao, S., Li, L., Gu, X., & Li, S. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07642-1
“However, these behaviors disrupt natural sleep-regulatory processes and reinforce mal-adaptive sleep patterns [17, 43].”
Hu, J., Yang, Z.-Z., Zhang, X., Sun, X.-Y., Hou, Y., & Zhang, X.-Y. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.109011
- Authors
- Hood, H. K., Carney, C. E., & Harris, A. L.
- Affiliations
- Toronto Metropolitan University (CA)
- Corresponding author
- Carney, Colleen E.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2011-12
- Volume
- 42
- Issue
- 4
- Pages
- 644-654
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W2072455671
- Cited by
- 41
- References
- 62
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 4 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 1 · 2015: 4 · 2014: 3 · 2013: 2
- FWCI
- 2.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- insomnia, perceived usefulness, threat appraisal, helplessness, avoidance, cognitive behavioral therapy for insomnia, undergraduate students, insomnia severity
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Fatigue, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Motivation, Perception, Surveys and Questionnaires, Safety, Severity of Illness Index, Sleep
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