Sleep and emotion regulation: An organizing, integrative review.
The aim of the present study was to systematically elicit the safety behaviors employed by people with insomnia. Safety behaviors have been identified as contributing to the maintenance of anxiety disorders. They include overt or covert strategies designed to prevent a feared outcome. However, they contribute to the maintenance of the disorder because they prevent unambiguous disconfirmation of unrealistic beliefs and they increase the likelihood that the fear would actually occur. A questionnaire based on the Dysfunctional Beliefs and Attitudes about Sleep Scale was developed to elicit safety behaviors and was administered to 33 people meeting criteria for primary insomnia and 33 nonpatient controls. The data indicated that people with insomnia use a wide range of safety behaviors to prevent feared outcomes. Blind raters determined that the safety behaviors reported included those that: interfere with the regularity of the sleep cycle, interfere with sleep directly, cause paradoxical fuelling of presleep cognitive activity, exacerbate day-time sleepiness, contribute to the day being unpleasant or boring, and those that increase preoccupation with sleep. The clinical implications of these findings and areas for further research are discussed.