PRIMARY INSOMNIA IS A PREVALENT AND OFTEN DE- BILITATING FORM OF SLEEP DIFFICULTY, TRADITION- ALLY ATTRIBUTED TO SUCH SUSTAINING FACTORS as conditioned arousal at bedtime and sleep-disruptive habits.1,2,3,4

PRIMARY INSOMNIA IS A PREVALENT AND OFTEN DEBILITATING FORM OF SLEEP DIFFICULTY, TRADITIONALLY ATTRIBUTED TO SUCH SUSTAINING FACTORS as conditioned arousal at bedtime and sleep-disruptive habits.1,2,3,4 Current cognitive-behavioral conceptualizations5-7 of primary insomnia posit that rigidly held or self-defeating beliefs and attitudes about sleep also play important roles in sustaining this form of sleep difficulty. For example, unrealistic sleep expectations or beliefs that there is little one can do about poor sleep may heighten sleep-related “performance anxiety” and make sleep more difficult to achieve. Likewise, the belief that one should try to “catch up” for lost sleep may lead to sleep-disruptive compensatory practices such as subsequent daytime napping or remaining in bed well beyond the usual rising time. Because of their putative roles in spawning sleep-related distress or arousal and practices that perpetuate primary insomnia, maladaptive beliefs and attitudes about sleep arguably can be viewed as centrally and mechanistically important to this type of insomnia. Research designed to identify the specific beliefs most critical to sustaining primary insomnia, and their response to belief-targeted treatment, is of utmost importance to our understanding and management of this condition. Recognizing the importance of such research, Morin and colleagues6,7 developed the Dysfunctional Beliefs and Attitudes about Sleep questionnaire (DBAS) to provide a systematic method for assessing sleep-disruptive cognitions. The DBAS consists of 30 rationally derived items presumed to assess the range of maladaptive or self-defeating beliefs most integral to chronic insomnia. Specifically, the DBAS includes item subsets or subscales designed to measures 5 discrete cognitive themes, including (1) maladaptive beliefs about the effects of insomnia, (2) beliefs that sleep is unpredictable and uncontrollable, (3) unrealistic expectations about sleep needs, (4) misconceptions about the causes of insomnia, and (5) erroneous beliefs about sleep-promoting practices. Although the name of the scale implies that the presence of such beliefs is inherently “dysfunctional,” it is probably more accurate to say that strong or rigid endorsement of these beliefs can be maladaptive. As such, good sleepers would not be expected to completely disagree with these beliefs; instead, their degree of agreement would be moderately low and reflect some flexibility in the beliefs. In contrast, strong endorsement of these beliefs may connote less flexibility and, consequently, more distress when faced with situations that appear to confirm such beliefs. Since its advent, the DBAS has been employed in several types of studies designed to document the role of maladaptive beliefs in the protraction of primary insomnia. Given the presumed mechanistic importance of such beliefs to primary insomnia, those with this condition should show more rigidly held or selfdefeating sleep-related beliefs than should those without sleep complaints. Studies7,8 testing this assumption have employed the DBAS to compare the sleep-related beliefs of insomnia sufferers and noncomplaining normal sleepers. However, it is difficult to discern the specific beliefs that are important in primary insomnia from these studies because the former study7 compared a mixed group of primary and secondary insomnia sufferers with normal sleepers, whereas the latter study8 subdivided groups of Identifying Critical Beliefs About Sleep in Primary Insomnia