Validation of the Adaptive Cognition and Behaviors-6 (ACBS-6) Scale in Individuals with Insomnia and its Association with Sleep- Related Safety Behaviors

Background Insomnia is a chronic disorder in which dysfunctional beliefs and maladaptive safety behaviors contribute to its persistence. This study aimed to validate the Adaptive Cognition and Behaviors about Sleep-6 (ACBS-6) and examine its psychometric properties and associations with dysfunctional beliefs, safety behaviors, and insomnia severity. Methods A total of 600 participants with insomnia were recruited through an online survey. Participants completed the ACBS-6, Dysfunctional Beliefs and Attitudes about Sleep-6 (DBAS-6), Insomnia Severity Index (ISI), and Sleep-Related Behavior Questionnaire-10 (SRBQ-10). For psychometric analysis, the Rasch model and graded response model within Confirmatory Factor Analysis (CFA) and Item Response Theory (IRT) were used. Reliability was assessed using McDonald's Omega, and associations with related constructs were examined using correlation, regression, and mediation analyses. Results As a result of the CFA, a two-factor structure (adaptive cognition and adaptive behavior) of the ACBS-6 was identified, and all items showed significant factor loadings. In the IRT analysis, item fit was good, with high reliability and discrimination; however, questions 3 and 4 provided limited information across the latent characteristics. The scale showed a significant negative correlation with the ISI (r = -0.15, p < 0.01), whereas the DBAS-6 (r = 0.47) and the SRBQ-10 (r = 0.49) showed positive correlations. In the regression analysis, ACBS-6 (β = -0.15), DBAS-6 (β = 0.29), and SRBQ-10 (β = 0.32 significantly predicted the severity of insomnia, and the model explained 32% of the variance. Mediation analysis showed that adaptive cognition and behavior partially buffered the effect of insomnia severity on dysfunctional beliefs and safe behavior. Conclusions The ACBS-6 demonstrated robust validity and reliability as a measure of adaptive sleep-related cognition and behavior in individuals with insomnia. Adaptive cognitions and behaviors were associated with lower insomnia severity and served as protective factors, attenuating the impact of dysfunctional beliefs and maladaptive safety behaviors.