Development of the Adaptive Cognition and Behaviors about Sleep-6 (ACBS-6) for sleep-related conditions or behaviors diminishing insomnia severity.

Background: This study aimed to develop a scale to assess adaptive sleep-related beliefs and behaviors, measuring how well individuals accept sleep disturbances, in the Korean general population.

Methods: We conducted an anonymous online survey among the Korean general population. The scale development involved the following process: 1) defining the purpose of developing the scale, 2) generating appropriate items, 3) reducing redundant items, 4) conducting psychometric tests and further reducing items, and 5) developing the final version of the scale. Furthermore, the reliability and validity of the scale were evaluated, and convergent validity was examined using the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep-6 items (DBAS-6), and Metacognition Questionnaire-Insomnia-6 items (MCQI-6).

Results: The final six items extracted through exploratory factor analysis were clustered into two factors: adaptive sleep-related cognitions and behaviors. Model fit indices (comparative fit index = 0.96, Tucker-Lewis index = 0.93, root mean square error of approximation = 0.06, and standardized root mean square residual = 0.04) supported the two-factor structure of the scale in confirmatory factor analysis. The Adaptive Cognition and Behaviors about Sleep-6 (ACBS-6) demonstrated good internal consistency reliability (McDonald's omega = 0.734). Linear regression analysis revealed that the DBAS-6 (β = 0.50, p < 0.001) and MCQI-6 (β = 0.22, p < 0.001) positively contributed to the ISI score, whereas ACBS-6 (β = -0.07, p = 0.041) inversely contributed to the ISI score.

Conclusions: The ACBS-6 exhibits acceptable reliability and strong structural validity, supporting its two-factor model of adaptive sleep-related cognitions and behaviors.