Validation of the adaptive cognition and behaviors about sleep-6 (ACBS-6) scale in individuals reporting insomnia symptoms 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 reporting insomnia symptoms 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). Psychometric properties were evaluated using confirmatory factor analysis (CFA) and item response theory (IRT), including the Rasch model and graded response model (GRM). 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, items 3 and 4 provided limited information across the latent characteristics. The scale showed a significant negative correlation with the ISI ( r = -0.13, 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 a significant indirect association between insomnia symptom severity and dysfunctional beliefs and maladaptive sleep-related behaviors through adaptive cognition and behavior. Conclusions The ACBS-6 showed evidence of validity and reliability as a measure of adaptive sleep-related cognition and behavior in individuals reporting insomnia symptoms. Adaptive cognitions and behaviors were associated with lower insomnia symptom severity and showed significant associations with dysfunctional beliefs and maladaptive safety behaviors.