Cognitive and psychological factors associated with severe insomnia in Brazilian women: a cross-sectional study
Open accessAbstract
Insomnia is the most prevalent sleep disorder in women. Sociodemographic, cognitive, and psychological factors may contribute to its severity. This study evaluated factors associated with severe insomnia in women with insomnia complaints. We evaluated 530 women aged 18–59 (mean = 40.5,SD= 10.2), who experienced insomnia complaints, using self-report instruments. Severe insomnia was defined as a score above 21 on the Insomnia Severity Index. Age, marital status, educational level, depression and anxiety, psychological inflexibility, and beliefs about sleep were assessed as potential factors associated with severe insomnia. Simple and multivariate analyses were conducted using binary logistic regression. Low education level (odds ratio;OR= 1.85 [1.27–2.69]), depression (OR= 2.17 [1.27–3.81]), psychological inflexibility (OR= 1.05 [1.02–1.08]), and dysfunctional beliefs about sleep (OR= 1.04 [1.02–1.06]) were factors associated with severe insomnia scores in the multiple logistic regression model. These findings are important from a public health perspective, because behavioral strategies designed to treat insomnia with a focus on cognitive and psychological factors are low-cost treatments and may help improve sleep quality in women, which also influences mental health.
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Psychological inflexibility was found as a predictor of higher levels of insomnia severity.
“Psychological inflexibility was found as a predictor of higher levels of insomnia severity (Daly-Eichenhardt et al., 2016;El Rafihi-Ferreira et al., 2022;McCracken et al., 2011;McCracken et al., 2021;McCracken et al., 2022;McCracken et al., 2023;Zakiei et al., 2022), whereas psychological flexibility was found as a predictor of lower levels of insomnia severity (McCracken et al., 2022;McCracken et”
From Psychological inflexibility as a predictor associated with insomnia (2024) · cites this paper as El Rafihi-Ferreira et al., 2022
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Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · cited 7× · see citing works
“A CFA of the singlefactor model produced an acceptable fit [χ2 (14) = 57.27, p < .001; RMSEA = 0.086, 95% CI [0.066–0.107]; CFI = 0.978; RNI = 0.978; TLI = 0.967].”
InfluentialThe Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · cited 1× · see citing works
“The global score in each subscale ranges from 0 to 21; the cutoff point most used and recommended by Zigmond and Snaith (1983) ranges from 0 to 8 (anxiety/ depression absence) and 9 or greater (anxiety/depression presence).”
Method<b>lavaan</b> : An <i>R</i> Package for Structural Equation Modeling
Rosseel, Y. (2012) · Journal of Statistical Software · doi:10.18637/jss.v048.i02 · Cited by 27,955 · cited 1× · see citing works
“CFAs were performed using lavaan version 0.6.11 (Rosseel, 2012) and the diagonally weighted least squares (DWLS) estimator.”
MethodInfluentialDepression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · 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 · cited 1× · see citing works
“Insomnia severity was classified based on the ISI score, and participants were divided into mild or moderate insomnia (≤ 21 points) and severe insomnia (> 21 points) (Bastien et al., 2001; Castro, 2011).”
MethodAcceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 1× · see citing works
“Psychological inflexibility is the focus of acceptance and commitment therapy (ACT) that aims to increase psychological flexibility, that is, the ability to contact the present moment more fully in a way that allows individuals to adjust their behavior more consistently with their goals and values (Hayes et al., 2006).”
BackgroundBond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Epidemiology of insomnia: what we know and what we still need to learn
Ohayon, M. M. (2002) · Sleep Medicine Reviews · doi:10.1053/smrv.2002.0186 · Cited by 3,743 · cited 2× · see citing works
“…in individuals with lower incomes and lower education; however, these results were contradictory if the same factors were analyzed as independent risk factors for insomnia symptomatology, thus leading to the belief that other parallel aspects such as age may influence these results (Ohayon, 2002).”
ResultOhayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004) · Sleep · doi:10.1093/sleep/27.7.1255 · Cited by 3,349 · cited 1× · see citing works
“…associated with sleep fragmentation, insomnia symptoms, circadian derangements, and sleep architectural changes such as lighter sleep, reduced sleep efficiency, increased wake after sleep onset (WASO), decreased slow wave sleep (SWS), and rapid eye movement (REM) sleep (Ohayon et al., 2004).”
BackgroundThe Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology
Aziz, F., & Chaudhary, K. R. (2016) · Cardiorenal Medicine · doi:10.1159/000450796 · Cited by 3,285 · see citing works
Psychological flexibility as a fundamental aspect of health
Kashdan, T. B., & Rottenberg, J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.001 · Cited by 3,054 · cited 1× · see citing works
“Higher AAQ-II scores were associated with higher levels of psychological inflexibility, which, in turn, may serve as a risk factor for psychopathology (Hayes et al., 2012; Kashdan & Rottenberg, 2010).”
BackgroundBaglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., Lombardo, C., & Riemann, D. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.01.011 · Cited by 2,779 · cited 1× · see citing works
“, 2007), and that insomnia results in nearly two times greater risk for developing depression (Baglioni et al., 2011).”
BackgroundHarvey, A. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00061-4 · Cited by 1,790 · see citing works
(2015) · Cited by 1,629 · see citing works
Acceptance and commitment therapy.
Hayes, S. C., & Lillis, J. (2012) · American Psychological Association eBooks · doi:10.1037/17335-000 · Cited by 1,543 · see citing works
Sex Differences in Insomnia: A Meta-Analysis
Zhang, B., & Wing, Y.-K. (2006) · Sleep · doi:10.1093/sleep/29.1.85 · Cited by 1,286 · cited 1× · see citing works
“Studies consistently report a higher prevalence of insomnia in women, with an incidence of nearly two-fold compared to men (Mallampalli & Carter, 2014; Sidani et al., 2019; Zhang & Wing, 2006).”
ResultDepression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment
Fang, H., Tu, S., Sheng, J., & Shao, A. (2019) · Journal of Cellular and Molecular Medicine · doi:10.1111/jcmm.14170 · Cited by 1,152 · see citing works
Edinger, J. D., Bonnet, M. H., Bootzin, R. R., Doghramji, K., Dorsey, C. M., Espie, C. A., Jamieson, A. O., McCall, W. V., Morin, C. M., & Stepanski, E. J. (2004) · Sleep · doi:10.1093/sleep/27.8.1567 · Cited by 1,039 · see citing works
Epidemiology of Insomnia, Depression, and Anxiety
Taylor, D. J., Lichstein, K. L., Durrence, H. H., Reidel, B. W., & Bush, A. J. (2005) · Sleep · doi:10.1093/sleep/28.11.1457 · Cited by 988 · see citing works
Morin, C. M., & Benca, R. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60750-2 · Cited by 976 · see citing works
Buysse, D. J. (2013) · JAMA · doi:10.1001/jama.2013.193 · Cited by 965 · see citing works
Tjur, T. (2009) · The American Statistician · doi:10.1198/tast.2009.08210 · Cited by 916 · cited 2× · see citing works
“The model to predict severe insomnia with age, marital status, educational level, anxiety, depression, psychological inflexibility, and dysfunctional beliefs was statistically significant [χ2 (8) = 100.43, p < .001] and had a moderate explanatory power [D = 0.18; Tjur, 2009].”
BackgroundInfluentialDysfunctional 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
Sleep, insomnia, and depression
Riemann, D. W., Krone, L. B., Wulff, K., & Nissen, C. (2019) · Neuropsychopharmacology · doi:10.1038/s41386-019-0411-y · Cited by 863 · see citing works
Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia Jr, C., & Pereira, W. A. B. (1995) · Revista de Saúde Pública · doi:10.1590/s0034-89101995000500004 · Cited by 826 · see citing works
Espie, C. A. (2002) · Annual Review of Psychology · doi:10.1146/annurev.psych.53.100901.135243 · Cited by 596 · cited 2× · see citing works
“Conversely, the sleep interference process encompasses physiological and cognitive arousal, which can arise with emotional experience activation or the effect of cognitive stress responses (Espie, 2002).”
BackgroundMethodEpidemiology of Insomnia: a Longitudinal Study in a UK Population
(2007) · Sleep · doi:10.1093/sleep/30.3.274 · Cited by 583 · see citing works
Exploring Sex and Gender Differences in Sleep Health: A Society for Women's Health Research Report
Mallampalli, M. P., & Carter, C. L. (2014) · Journal of Women's Health · doi:10.1089/jwh.2014.4816 · Cited by 504 · cited 1× · see citing works
“Studies consistently report a higher prevalence of insomnia in women, with an incidence of nearly two-fold compared to men (Mallampalli & Carter, 2014; Sidani et al., 2019; Zhang & Wing, 2006).”
ResultRolffs, J. L., Rogge, R. D., & Wilson, K. G. (2018) · Assessment · doi:10.1177/1073191116645905 · Cited by 504 · cited 2× · see citing works
“New instruments have been built to measure the six processes of psychological inflexibility, such as the Multidimensional Psychological Flexibility Inventory (Rolffs et al., 2016) and the comprehensive assessment of acceptance and commitment therapy (Francis et al., 2016).”
MethodFrancis, A. W., Dawson, D. L., & Golijani-Moghaddam, N. (2016) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.05.003 · Cited by 496 · cited 1× · see citing works
“, 2016) and the comprehensive assessment of acceptance and commitment therapy (Francis et al., 2016).”
BackgroundMorin, C., Stone, J., Trinkle, D., Mercer, J., & Remsberg, S. (1993) · Psychology and Aging · doi:10.1037/0882-7974.8.3.463 · Cited by 492 · cited 1× · see citing works
“They corroborate previous studies that demonstrated an association between dysfunctional beliefs about sleep and insomnia (Eidelman et al., 2016; Morin et al., 1993), thereby validating the theory of Morin et al.”
ResultMorin, C. M., Stone, J., Trinkle, D. B., Mercer, J., & al, E. (1993) · Psychology and Aging · doi:10.1037//0882-7974.8.3.463 · Cited by 490 · see citing works
Comorbidity of insomnia and depression
Staner, L. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.09.003 · Cited by 481 · cited 1× · see citing works
“Psychological conditions such as anxiety, depression, and stress may also be present in patients with insomnia (Staner, 2010).”
BackgroundWhat Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?
Wolgast, M. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.07.002 · Cited by 421 · cited 1× · see citing works
“Walgost (2014) suggested that the AAQ-II measured more psychological distress than psychological inflexibility.”
BackgroundThe Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis
Norton, S., Cosco, T. D., Doyle, F., Done, J., & Sacker, A. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.10.010 · Cited by 407 · cited 1× · see citing works
“A bifactor model with two group factors (Norton et al., 2013) provided excellent goodness-of-fit indices [χ2 (60) = 69.2, p < .001; RMSEA = 0.017, 95% CI [0–0.033]; CFI = 0.999; RNI = 0.999; TLI = 0.999].”
InfluentialInsomnia: A Clinical Guide to Assessment and Treatment
Morin, C. M., & Espie, C. A. (2007) · Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) · doi:10.1007/b105845 · Cited by 406 · see citing works
Examining psychological inflexibility as a transdiagnostic process across psychological disorders
Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.06.003 · Cited by 400 · cited 3× · see citing works
“Psychological inflexibility is characterized by a rigid pattern of behaviors based on the avoidance of internal experiences (thoughts, feelings, sensations) to the detriment of value-based behaviors (Levin et al., 2014).”
BackgroundInfluentialA Handbook of Test Construction (Psychology Revivals)
Kline, P. (2015) · Routledge eBooks · doi:10.4324/9781315695990 · Cited by 395 · cited 2× · see citing works
“70 for adequate internal consistency reliability (Kline, 2015).”
BackgroundInfluentialSleep disturbance is associated with cardiovascular and metabolic disorders
Grandner, M. A., JACKSON, N. J., Pak, V. M., & Gehrman, P. (2011) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2011.00990.x · Cited by 338 · 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 · cited 1× · see citing works
“Such beliefs can lead to problematic behaviors that can worsen sleep quality, such as staying in bed for extra sleep time, changes in daily routine, cancellation of activities during the day, and feelings of hopelessness (Eidelman et al., 2016; Morin et al., 2002).”
BackgroundFoley, D. J., Monjan, A. A., Simonsick, E. M., Wallace, R. B., & Blazer, D. G. (1999) · PubMed · Cited by 254 · see citing works
Associations between sex hormones, sleep problems and depression: A systematic review
Morssinkhof, M. W. L., van Wylick, D. W., Priester-Vink, S., van der Werf, Y. D., den Heijer, M., van den Heuvel, O. A., & Broekman, B. F. P. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.08.006 · Cited by 210 · cited 1× · see citing works
“, 2019), mainly among women (Morssinkhof et al., 2020), and our findings confirm it.”
ResultMcCracken, L. M., Badinlou, F., Buhrman, M., & Brocki, K. C. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.11.003 · Cited by 146 · cited 2× · see citing works
“These results are in line with those of previous studies that reported an association between emotional avoidance and the presence and severity of insomnia (Daly-Eichenhardt et al., 2016; McCracken et al., 2011; McCracken et al., 2021; Zakiei et al., 2020).”
BackgroundResultWalther, B., Hossin, S., Townend, J., Abernethy, N. F., Parker, D., & Jeffries, D. J. (2011) · PLoS ONE · doi:10.1371/journal.pone.0025348 · Cited by 141 · cited 1× · see citing works
“REDCap is a web application that can facilitate clinical research development, mainly in the health field, and reduce the costs of conducting research (Garcia & Abrahão, 2021; Walther et al., 2011).”
MethodKronholm, E., Puusniekka, R., Jokela, J., Villberg, J. J., Urrila, A. S., Paunio, T., Välimaa, R. S., & Tynjälä, J. (2014) · Journal of Sleep Research · doi:10.1111/jsr.12258 · Cited by 130 · cited 1× · see citing works
“The prevalence of chronic insomnia in the general population is 10% (Kronholm et al., 2015).”
BackgroundSarsour, K., Morin, C. M., Foley, K., Kalsekar, A., & Walsh, J. K. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2009.02.008 · Cited by 121 · cited 1× · see citing works
“Insomnia is commonly comorbid with several psychiatric disorders, particularly anxiety and depression, and the literature indicates that sleep disturbances are more severe in the presence of comorbid conditions (Sarsour et al., 2010).”
BackgroundThakral, M., Von Korff, M., McCurry, S. M., Morin, C. M., & Vitiello, M. V. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2019.101230 · Cited by 117 · cited 4× · see citing works
“Several studies have shown a reduction in dysfunctional beliefs about sleep, with a concomitant reduction in the severity of insomnia (Lance et al., 2019; Thakral et al., 2020).”
BackgroundInfluentialThe Role of Acceptance and Mindfulness in the Treatment of Insomnia
Lundh, L.-G. (2005) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.19.1.29.66331 · Cited by 112 · cited 6× · see citing works
“Emotional avoidance, which refers to the attempt to change the form, frequency, and sensitivity of aversive private events (memories, thoughts, feelings considered negative), can promote increased physiological and cognitive arousal, thus impairing the automatic process of falling asleep (Lundh, 2005).”
BackgroundInfluentialMcCall, W. V., Blocker, J. N., D’Agostino, R., Kimball, J. N., Boggs, N., Lasater, B., Haskett, R. F., Krystal, A. D., McDonald, W. M., & Rosenquist, P. B. (2010) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27872 · Cited by 101 · see citing works
McCracken, L. M., Williams, J. L., & Tang, N. K. Y. (2011) · Pain Medicine · doi:10.1111/j.1526-4637.2011.01115.x · Cited by 96 · see citing works
Insomnia and its correlates in a representative sample of the Greek population
Paparrigopoulos, T. J., Tzavara, C. K., Theleritis, C. G., Psarros, C., Soldatos, C. R., & Tountas, Y. (2010) · BMC Public Health · doi:10.1186/1471-2458-10-531 · Cited by 93 · cited 1× · see citing works
“However, epidemiological research shows that sleep dissatisfaction is even more frequent and ranges from 10 to 48% (Paparrigopoulos et al., 2010).”
BackgroundEidelman, P., Talbot, L. S., Ivers, H., Bélanger, L., Morin, C. M., & Harvey, A. G. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.10.002 · Cited by 89 · cited 5× · see citing works
“Such beliefs can lead to problematic behaviors that can worsen sleep quality, such as staying in bed for extra sleep time, changes in daily routine, cancellation of activities during the day, and feelings of hopelessness (Eidelman et al., 2016; Morin et al., 2002).”
BackgroundResultInfluentialResearch Development Using REDCap Software
Garcia, K. K. S., & Abrahão, A. A. (2021) · Healthcare Informatics Research · doi:10.4258/hir.2021.27.4.341 · Cited by 87 · cited 2× · see citing works
“The utilization of electronic data capture (EDC) systems is recommended to optimize research data through proper management (Garcia & Abrahão, 2021).”
MethodZakiei, A., Khazaie, H., Rostampour, M., Lemola, S., Esmaeili, M., Dürsteler, K., Brühl, A., Sadeghi-Bahmani, D., & Brand, S. (2021) · Life · doi:10.3390/life11020133 · Cited by 84 · cited 1× · see citing works
“Interestingly, even though ACT does not have a therapeutic focus on dysfunctional beliefs about sleep, studies have reported reduced DBAS scores after ACT-I-based treatment (El Rafihi-Ferreira et al., 2020; Päivi et al., 2019; Zakiei et al., 2021; Zakiei & Khazaie, 2019).”
BackgroundAssociations between insomnia, sleep duration and poor work ability
Lian, Y., Xiao, J., Liu, Y., Li, N., Guan, S., Ge, H., Li, F., & Liu, J. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.09.009 · Cited by 83 · cited 1× · see citing works
“The literature reports adverse effects of insomnia on mental and physical health, including metabolism and productivity; the condition is also strongly associated with an increase in health spending (Lian et al., 2015).”
BackgroundRocha, F. L., Guerra, H. L., & Lima‐Costa, M. F. (2002) · Sleep Medicine · doi:10.1016/s1389-9457(01)00119-8 · Cited by 80 · cited 1× · see citing works
“…supported this hypothesis under the justification of the association between low education and low income, which would make healthcare difficult (higher prevalence of comorbidities) and result in complex family contexts (double or triple shift, inadequate sleep environment) (Rocha et al., 2002).”
BackgroundDaly-Eichenhardt, A., Scott, W., Howard-Jones, M., Nicolaou, T., & McCracken, L. M. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01326 · Cited by 69 · see citing works
Sleep complaints in the Brazilian population: Impact of socioeconomic factors
Hirotsu, C., Bittencourt, L., Garbuio, S., Andersen, M. L., & Tufik, S. (2014) · Sleep Science · doi:10.1016/j.slsci.2014.08.001 · Cited by 68 · cited 2× · see citing works
“Less schooling (not having a college degree) increased the chance of severe insomnia, and this finding agreed with some of the previously mentioned studies (Hirotsu et al., 2014).”
BackgroundResultEdinger, J., & Wohlgemuth, W. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(01)00078-8 · Cited by 63 · cited 1× · see citing works
“This study used the short version of the DBAS-30 questionnaire, which comprises 10 questions aimed at identifying and evaluating various insomnia-related sleep cognitions (Edinger & Wohlgemuth, 2001; Espie, 2002).”
MethodKato, T. (2016) · SpringerPlus · doi:10.1186/s40064-016-2393-0 · Cited by 63 · cited 3× · see citing works
“Recent studies have demonstrated the association between psychological inflexibility and the severity of insomnia and sleep problems (Kato, 2016; Kato, 2020; McCracken et al., 2021).”
BackgroundResultKaufmann, C. N., Orff, H. J., Moore, R. C., Delano‐Wood, L., Depp, C. A., & Schiehser, D. M. (2017) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1266490 · Cited by 62 · cited 1× · see citing works
“011), as also reported by previous studies (Ahmed, 2015; Dragioti et al., 2015; Kaufmann et al., 2017).”
ResultLappalainen, P., Langrial, S., Oinas-Kukkonen, H., Muotka, J., & Lappalainen, R. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.04.001 · Cited by 57 · cited 1× · see citing works
“Interestingly, even though ACT does not have a therapeutic focus on dysfunctional beliefs about sleep, studies have reported reduced DBAS scores after ACT-I-based treatment (El Rafihi-Ferreira et al., 2020; Päivi et al., 2019; Zakiei et al., 2021; Zakiei & Khazaie, 2019).”
BackgroundDragioti, E., Wiklund, T., Alföldi, P., & Gerdle, B. (2015) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2015.06.001 · Cited by 55 · see citing works
The Acceptance and Action Questionnaire – II: an Item Response Theory Analysis
Ong, C. W., Pierce, B. G., Woods, D. W., Twohig, M. P., & Levin, M. E. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9694-2 · Cited by 50 · cited 1× · see citing works
“The use of these instruments alongside the AAQ-II can collectively provide a more accurate measure of psychological inflexibility (Ong et al., 2018) and detect which dimensions of psychological inflexibility are most associated with the severity of insomnia.”
MethodPaulos-Guarnieri, L., Linares, I. M. P., & El Rafihi-Ferreira, R. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.11.001 · Cited by 48 · cited 2× · see citing works
“…dysfunctional beliefs about sleep such as cognitive behavior therapy for insomnia (CBT-I) (Eidelman et al., 2016; Thakral et al., 2020) and on expanding psychological flexibility such as ACT-I (El Rafihi-Ferreira et al., 2020; El Rafihi-Ferreira et al., 2022; Paulos-Guarnieri et al., 2022).”
BackgroundChapoutot, M., Peter‐Derex, L., Schoendorff, B., Faivre, T., Bastuji, H., & Putois, B. (2021) · Journal of Sleep Research · doi:10.1111/jsr.13199 · Cited by 47 · cited 1× · see citing works
“More recently, a reduction in psychological inflexibility and parallel improvement in sleep quality has also been observed in participants with insomnia (Chapoutot et al., 2021; El Rafihi-Ferreira et al., 2020; Paulos-Guarnieri et al., 2022).”
BackgroundLancee, J., Effting, M., van der Zweerde, T., van Daal, L., van Straten, A., & Kamphuis, J. H. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.09.029 · Cited by 43 · cited 1× · see citing works
“Several studies have shown a reduction in dysfunctional beliefs about sleep, with a concomitant reduction in the severity of insomnia (Lance et al., 2019; Thakral et al., 2020).”
BackgroundEl Rafihi-Ferreira, R., Morin, C. M., Toscanini, A. C., Lotufo Neto, F., Brasil, I. S., Gallinaro, J. G., Borges, D. S., Conway, S. G., & Hasan, R. (2021) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2020-0947 · Cited by 38 · see citing works
Self-citationGender differences in perpetuating factors, experience and management of chronic insomnia
Sidani, S., Guruge, S., Fox, M., & Collins, L. (2019) · Journal of Gender Studies · doi:10.1080/09589236.2018.1491394 · Cited by 37 · see citing works
Kawata, Y., Maeda, M., Sato, T., Maruyama, K., Wada, H., Ikeda, A., & Tanigawa, T. (2019) · European Journal of Public Health · doi:10.1093/eurpub/ckz119 · Cited by 36 · see citing works
El Rafihi-Ferreira, R., Morin, C. M., Hasan, R., Brasil, I. S., Zago Ribeiro, J. H., & Cecília Toscanini, A. (2023) · Behavioral Sleep Medicine · doi:10.1080/15402002.2022.2071272 · Cited by 31 · see citing works
Self-citationZakiei, A., Khazaie, H., Reshadat, S., Rezaei, M., & Komasi, S. (2020) · Journal of Caring Sciences · doi:10.34172/jcs.2020.013 · Cited by 27 · see citing works
Propriedades psicométricas iniciais do Acceptance and Action Questionnaire - II - versão brasileira
Barbosa, L. M., & Murta, S. G. (2015) · Psico-USF · doi:10.1590/1413-82712015200107 · Cited by 24 · cited 1× · see citing works
“The Brazilian version, translated and validated by Barbosa and Murta (2015), demonstrated satisfactory reliability and suitability for study use, both in terms of behavior and therapeutic change.”
Kato, T. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17207426 · Cited by 22 · cited 4× · see citing works
“Recent studies have demonstrated the association between psychological inflexibility and the severity of insomnia and sleep problems (Kato, 2016; Kato, 2020; McCracken et al., 2021).”
BackgroundResultInfluentialTorrens, I., Argüelles, R., Lorente, P., Molero-Alfonso, C., & Esteva, M. (2019) · Atención Primaria · doi:10.1016/j.aprim.2018.02.014 · Cited by 21 · see citing works
Validation of Arabic versions of three sleep surveys
Ahmed, A. E. (2015) · Qatar medical journal · doi:10.5339/qmj.2014.20 · Cited by 19 · cited 2× · see citing works
“In the present sample, we achieved a better fit by loading all items in a single factor, compared to the threefactor solution (Δχ2 = 29.52, Δd.f. = 5, p = 0.011), as also reported by previous studies (Ahmed, 2015; Dragioti et al., 2015; Kaufmann et al., 2017).”
ResultInfluentialZakiei, A., & Khazaie, H. (2019) · Journal of Turkish Sleep Medicine · doi:10.4274/jtsm.galenos.2019.74745 · Cited by 15 · cited 1× · see citing works
“Interestingly, even though ACT does not have a therapeutic focus on dysfunctional beliefs about sleep, studies have reported reduced DBAS scores after ACT-I-based treatment (El Rafihi-Ferreira et al., 2020; Päivi et al., 2019; Zakiei et al., 2021; Zakiei & Khazaie, 2019).”
Background
Flagged first, then by citations
Research works printed but not linked: 2
- Castro, L. S. (2011). Adaptação e validação do Índice de Gravidade de Insônia (IGI) [Adaptation and validation of the Insomnia Severity Index (IGI)]. [Master’s dissertation, Universidade Federal de São Paulo]. UNIFESP Campus Repository. https://repositorio.unifesp.br/handle/11600/23193
- Kryger, M. H., Roth, T., & Dement, W. C. (2010). Principles and practice of sleep medicine. Philadelphia: Elsevier.
Cited by
Sorted by citations
Sleep health challenges among women: insomnia across the lifespan
Benge, E., Pavlova, M. K., & Javaheri, S. (2024) · Frontiers in Sleep · doi:10.3389/frsle.2024.1322761 · Cited by 22 · see citing works
Psychological inflexibility as a predictor associated with insomnia
El Rafihi‐Ferreira, R., Linares, I. M. P., Paulos‐Guarnieri, L., & Zakiei, A. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14232 · Cited by 14 · see citing works
“…studies, only one other study evaluated the association of psychological inflexibility with different levels of insomnia (mild and severe insomnia), finding that psychological inflexibility predicts severe insomnia (El Rafihi-Ferreira et al., 2022), according to the results of the current study.”
InfluentialMuthuraman, K., Sankaran, A., & Subramanian, K. (2024) · Indian Journal of Psychological Medicine · doi:10.1177/02537176231223304 · Cited by 14 · see citing works
Zakiei, A., Khazaie, H., Rostampour, M., Moradi, M.-T., Rezaie, L., Komasi, S., & Rafihi-Ferreira, R. E. (2024) · Current Sleep Medicine Reports · doi:10.1007/s40675-024-00293-w · Cited by 10 · see citing works
Ahn, M. H., Suh, S. A., & Chung, S. (2024) · Psychiatric Quarterly · doi:10.1007/s11126-024-10097-4 · Cited by 6 · see citing works
“In this study, psychological inflexibility was correlated with insomnia among nurses in accordance with previous studies [ 17 , 29].”
Sleep hygiene: foundations, implications, and strategies for enhancing sleep health
Roy, A., Maiti, D. K., & Banik, B. K. (2026) · Sleep Science and Practice · doi:10.1186/s41606-025-00151-w · Cited by 3 · see citing works
Ahn, J., Cho, E., Cho, I., Lee, D., Kim, J., & Chung, S. (2024) · Sleep And Breathing · doi:10.1007/s11325-024-03128-8 · Cited by 3 · see citing works
Personality traits and insomnia: direct and anxiety‐mediated associations
Conway, B. A., do Carmo, M. M. I. D. B., Filho, H. S. L. S., Toscanini, A. C., Hasan, R., Mansur‐Alves, M., & Ferreira, R. E. R. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70003 · Cited by 3 · see citing works
“In fact, studies have reported a relationship between psychological inflexibility and insomnia (El Rafihi-Ferreira et al., 2022).”
Self-citationPredictors and Factors Associated with Insomnia in a Brazilian Sample: A Cross-Sectional Study
Aizawa, I. M. N., Alckmin-Carvalho, F., Filho, H. S. L. S., Hasan, R., Toscanini, A. C., & Ferreira, R. E. R. (2025) · Sleep Science · doi:10.1055/s-0045-1806953 · Cited by 1 · see citing works
Self-citationZhao, Z., Liang, J., Hou, S., Zhu, G., Liu, N., Wei, H., & Xu, Z. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1513395 · Cited by 1 · see citing works
Evidence of Acceptance and Commitment Therapy-Based Therapies for Insomnia
Paulos‐Guarnieri, L., Linares, I. M. P., & Ferreira, R. E. R. (2024) · Springer eBooks · doi:10.1007/978-3-031-50710-6_14 · Cited by 1 · see citing works
Insônia e traços de personalidade
Conway, B. A. (2024) · doi:10.11606/d.5.2024.tde-19062024-163230
Alckmin-Carvalho, F., Lapietra, S., Filho, H. S. L. S., Oliveira, A., Pereira, H., & Ferreira, R. E. R. (2025) · Psychiatry International · doi:10.3390/psychiatryint6020037
Kalav, S., Bulut, E., & Boyraz, S. (2025) · İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi · doi:10.33715/inonusaglik.1575945
The Sleep Acceptance Scale (SAS): Development, psychometric properties, and applications
Ferreira, R. E. R., Carmo, M., Paulos‐Guarnieri, L., & Pires, M. L. N. (2025) · Behavioral Sleep Medicine · doi:10.1080/15402002.2025.2555864
“Studies have reported the roles of psychological inflexibility and experiential avoidance in the development and maintenance of insomnia (El rafihi-Ferreira et al., 2022; El Rafihi-Ferreira, Linares, et al., 2024; Zakiei et al., 2024).”
Ahn, M. H., & Chung, S. (2025) · BMC Psychology · doi:10.1186/s40359-025-03866-8
Paulos‐Guarnieri, L., Linares, I. M. P., & Rafihi‐Ferreira, R. E. (2025) · CBT: science into practice · doi:10.1007/978-3-031-92265-7_7
- Authors
- El Rafihi-Ferreira, R., do Brasil do Carmo, M. M. I., Bassolli, L., Hasan, R., Aizawa, I. M. N., & Toscanini, A. C.
- Affiliations
- Universidade de São Paulo (BR)
- Venue
- Psicologia: Reflexão e Crítica
- Published
- 2022-12-23
- Volume
- 35
- Issue
- 1
- Pages
- 39-39
- ISSN
- 0102-7972 (ISSN-L)
- 1678-7153
- PMC
- PMC9780099
- OpenAlex
- W4312179111
- Cited by
- 17
- References
- 80
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 8
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Psicologia Reflexão e Crítica (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/19506-5 and 2019/25537-3, 2021/01872-8, 21/05573-5)
- 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
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- insomnia, women, cognitive factors, psychological inflexibility, dysfunctional beliefs about sleep, depression, anxiety, educational attainment, sleep quality, Insomnia Severity Index
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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