The positive and negative sleep appraisal measure: Towards a clinical validation of sleep spectrum cognitions

Abstract

Background Sleep disturbance is considered a transdiagnostic process due to high comorbidity with mental health difficulties. In particular, sleep disturbances are a feature of mood disorders. To advance transdiagnostic psychological interventions targeting sleep, the Positive and Negative Sleep Appraisal Measure (PANSAM) was developed. The PANSAM is a theory‐driven measure based on an Integrative Cognitive Sleep Model and proposes that positive and negative sleep appraisals for excessively long and short sleep durations play a key role in the development of insomnia, hypersomnia, and reduced need for sleep. This study evaluated clinical validity of this new measure. Methods Participants were those who met bipolar at risk criteria and bipolar diagnoses (bipolar spectrum group) (N = 22), major depressive disorder (unipolar depression group) (N = 18), and a nonclinical group (N = 22). To compare against previous insomnia and bipolar disorder relevant research, administered measures included the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and the Hypomanic and Positive Predictions Inventory (HAPPI). Results Analysis of variance (ANOVA) tests revealed that the clinical groups scored significantly higher on the PANSAM. The same was shown for the DBAS and HAPPI. Post hoc analyses showed that the PANSAM scale and subscales had significant correlations with all clinical measures. Effect sizes are reported due to sample size limitations. Conclusion This study has initially validated the PANSAM with clinical populations and highlighted its applicability to a transdiagnostic approach.

Validation of the Korean Version of the Positive and Negative Sleep Appraisal Measure (PANSAM) as a Tool for Evaluating Dysfunctional Beliefs about Sleep among the General Population

“…Data were suitable, and sampling was adequate for CFA based on the KMO measure (0.945) and Bartlett’s test of sphericity ( p < 0.001). According to the original paper [ 11 ], we conducted the CFA using items for Subscale 1 (Items 8, 12, 15, 16, 20, 24, and 32), Subscale 2 (Items 2, 6, 10, 14, 18, and 21), Subscale 3 (Items 3, 7, 11, and 19), and Subscale 4 (Items 1, 5, 13, 25, and 29). However, we observed the factor loading of Item 29 in Subscale 4 was too low (0.29), and thus, we excluded Item 29 from the final four-factor model ( Table 2 ).…”

“…PANSAM development was informed by a Delphi method approach [ 10 ]. It consists of 33 items, and an exploratory factor analysis confirmed four theoretically derived subscales [ 11 , 14 ]: Subscale 1 (positive appraisals of sleeping less than usual; Items 8, 12, 15, 16, 20, 24, and 32), Subscale 2 (negative appraisals of sleeping less than usual; Items 2, 6, 10, 14, 18, and 21), Subscale 3 (positive appraisals of sleeping more than usual; Items 3, 7, 11, and 19), and Subscale 4 (negative appraisals of sleeping more than usual; Items 1, 5, 13, 25, and 29). Higher full-scale average scores could be indicative of a person having multiple, conflicting appraisals about sleep, and each subscale’s average scores could be indicative of a person endorsing more positive beliefs about sleeping less (reduced need for sleep) compared to negative beliefs about sleeping less (insomnia).…”

“…The Positive and Negative Sleep Appraisal Measure (PANSAM) [ 10 ] has been recently developed as a theory-driven measure based on an Integrative Cognitive Sleep Model (ICSM) [ 11 ]. The ICSM explains that contradictory appraisals that enter one’s awareness result in engaging in ascent or descent behaviors to control the change of internal state.…”