Afolalu Esther F, Moore Corran, Ramlee Fatanah, Goodchild Claire E, Tang Nicole K Y
Department of Psychology, University of Warwick, Coventry, UK.
Department of Psychology, Institute of Psychiatry, London, UK.
J Clin Sleep Med. 2016 Sep 15;12(9):1269-77. doi: 10.5664/jcsm.6130.
Dysfunctional beliefs and attitudes about sleep is a cognitive-behavioral factor central to the development and perpetuation of insomnia. Previous works to unravel the complex interrelationship between pain and insomnia have not explored the role of inflexible beliefs about the sleep-pain interaction, possibly due to a lack of a valid instrument for doing so. The current study evaluated the psychometric and functional properties of a 10-item Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale.
The PBAS scale was administered to four clinical samples of chronic pain patients with comorbid insomnia: to examine the scale's psychometric properties (n = 137), test-retest reliability (n = 26), sensitivity to treatment (n = 20), and generalizability (n = 62). All participants completed the PBAS together with validated measures of pain interference, insomnia severity, and cognitive-behavioral processes hypothesized to underpin insomnia.
The PBAS scale was found to be reliable, with adequate internal consistency and temporal stability. Factor analysis suggested a 2-factor solution representing beliefs about "pain as the primary cause of insomnia" and the "inevitable consequences of insomnia on pain and coping." The PBAS total score was positively correlated with scores from the Insomnia Severity Index (ISI) scale, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale, and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ). It was a significant predictor of insomnia severity and pain interference. A significant reduction in PBAS was also observed in patients after receiving a hybrid cognitive-behavioral intervention for both pain and insomnia.
Pain-related sleep beliefs appear to be an integral part of chronic pain patients' insomnia experience. The PBAS is a valid and reliable instrument for evaluating the role of these beliefs in chronic pain patients.
对睡眠的功能失调信念和态度是失眠发生及持续存在的核心认知行为因素。此前为揭示疼痛与失眠之间复杂的相互关系所做的研究，尚未探讨关于睡眠 - 疼痛相互作用的僵化信念的作用，这可能是由于缺乏有效的评估工具。本研究评估了一个包含10个条目的关于睡眠的疼痛相关信念与态度（PBAS）量表的心理测量学特性和功能特性。
将PBAS量表施用于四组共病失眠的慢性疼痛患者临床样本：以检验量表的心理测量学特性（n = 137）、重测信度（n = 26）、对治疗的敏感性（n = 20）和可推广性（n = 62）。所有参与者在完成PBAS量表的同时，还完成了用于评估疼痛干扰、失眠严重程度以及被认为是失眠基础的认知行为过程的有效测量工具。
发现PBAS量表具有可靠性，具有足够的内部一致性和时间稳定性。因子分析表明存在一个双因子结构，分别代表关于“疼痛是失眠的主要原因”的信念以及“失眠对疼痛和应对的必然影响”。PBAS总分与失眠严重程度指数（ISI）量表、对睡眠的功能失调信念与态度（DBAS）量表以及睡眠焦虑和关注问卷（APSQ）的得分呈正相关。它是失眠严重程度和疼痛干扰的显著预测指标。在接受针对疼痛和失眠的综合认知行为干预后，患者的PBAS得分也显著降低。
与疼痛相关的睡眠信念似乎是慢性疼痛患者失眠体验的一个组成部分。PBAS是评估这些信念在慢性疼痛患者中作用的有效且可靠的工具。
