{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T14:04:59Z","timestamp":1792764299928,"version":"4.5.0"},"reference-count":59,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T00:00:00Z","timestamp":1714780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["23\/06859\u20105"],"award-info":[{"award-number":["23\/06859\u20105"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2018\u201019506\u20105"],"award-info":[{"award-number":["2018\u201019506\u20105"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Sleep Research"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was evaluated as a predictor or factor related to the presence\/severity of insomnia. We included 2218 individuals selected from the randomized\u2013control trial for behavioural therapy for insomnia and cross\u2010sectional studies, including 1797 individuals with insomnia and 421 controls without insomnia. All participants completed the DSM\u20105\u2010based insomnia diagnosis interview, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Acceptance Action Questionnaire\u2010II. Linear regression and multinomial logistic regression models were used. Sex, education, occupation, marital status, anxiety, depression and psychological inflexibility were possible predictors or factors associated with the severity of insomnia. Multivariate linear regression analysis demonstrated that sex (<jats:italic>\ud835\udefd<\/jats:italic>\u2009=\u20090.88; <jats:italic>t<\/jats:italic>\u2009=\u20092.80; <jats:italic>p<\/jats:italic>\u2009=\u20090.005), depression (<jats:italic>\ud835\udefd<\/jats:italic>\u2009\u2009=\u20090.41; <jats:italic>t\u2009=<\/jats:italic>\u200910.7; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), anxiety (<jats:italic>\ud835\udefd<\/jats:italic>\u2009\u2009=\u20090.58; <jats:italic>t<\/jats:italic>\u2009=\u200914.1; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and psychological inflexibility (<jats:italic>\ud835\udefd<\/jats:italic>\u2009\u2009=\u20090.09; <jats:italic>t<\/jats:italic>\u2009=\u20095.07; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were predictors of insomnia. The results of the multinomial logistic regression demonstrate that, in comparison to the absence of insomnia, insomnia at all levels (mild, moderate and severe) was associated with sex, anxiety and depression. Psychological inflexibility was only associated with severe insomnia (odds ratio\u2009=\u20091.04). These findings are important from a public health perspective because behavioural strategies designed to treat insomnia with a focus on psychological flexibility are low\u2010cost and may help improve sleep quality in adults with insomnia, which also influences mental health.<\/jats:p>","DOI":"10.1111\/jsr.14232","type":"journal-article","created":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T10:04:07Z","timestamp":1714817047000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Psychological inflexibility as a predictor associated with insomnia"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2212-4608","authenticated-orcid":false,"given":"Renatha","family":"El Rafihi\u2010Ferreira","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ila Marques Porto","family":"Linares","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3269-7941","authenticated-orcid":false,"given":"L\u00e9o","family":"Paulos\u2010Guarnieri","sequence":"additional","affiliation":[{"name":"Psy. Department of Psychiatry Universidade de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5259-6104","authenticated-orcid":false,"given":"Ali","family":"Zakiei","sequence":"additional","affiliation":[{"name":"Sleep Disorders Research Center Kermanshah University of Medical Sciences  Kermanshah Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,4]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13860"},{"key":"e_1_2_10_3_1","volume-title":"International classification of sleep disorder","author":"American Academy of Sleep Medicine","year":"2014"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-24288-2.00082-9"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/1413-82712015200107"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1389-9457(00)00065-4"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0004867412457997"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000014853"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2011.03.007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-89101995000500004"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","unstructured":"Carmo M. Morin C. Hasan R. Toscanini A. &El Rafihi\u2010Ferreira R.(2023).The network of dysfunctional beliefs about sleep: a structural re\u2010analysis of the DBAS\u201016.https:\/\/doi.org\/10.31234\/osf.io\/6vuf3","DOI":"10.31234\/osf.io\/6vuf3"},{"key":"e_1_2_10_12_1","unstructured":"Castro L. S.(2011).Adapta\u00e7\u00e3o e valida\u00e7\u00e3o do \u00cdndice de Gravidade de Ins\u00f4nia (IGI) [Adaptation and validation of the Insomnia Severity Index (IGI)]. [Master's Dissertation] Universidade Federal de S\u00e3o Paulo. UNIFESP Campus. Repository.https:\/\/repositorio.unifesp.br\/handle\/11600\/23193."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2016.01326"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41155-022-00243-x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/15402002.2022.2071272"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000881"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.53.100901.135243"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13841"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2016.05.003"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.5060"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.4258\/hir.2021.27.4.341"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0023242"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1162729"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0005-7967(01)00061-4"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2005.06.006"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.slsci.2014.08.001"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckz119"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2022.06.006"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1617"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2014.06.003"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0022-3999(00)00150-1"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1891\/jcop.19.1.29.66331"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2014.4816"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2020.11.003"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1515\/sjpain-2022-0138"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2022.10.003"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01115.x"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2023.107137"},{"key":"e_1_2_10_39_1","volume-title":"Insomnia: Psychological assessment and management","author":"Morin C. M.","year":"1993"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsmc.2022.03.003"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.11.1547"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.31887\/DCNS.2008.10.3\/dnutt"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00849"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/19.suppl_3.s7"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2012.08.001"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2021.102027"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2021.11.001"},{"key":"e_1_2_10_48_1","author":"Paulos\u2010Guarnieri L.","year":"2023","journal-title":"OSF"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2022.09.002"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1080\/09589236.2018.1491394"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0193-953X(18)30532-X"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13923"},{"key":"e_1_2_10_53_1","unstructured":"Taylor D. J. Wilkerson A. Pruiksma K. E. Dietch J. R. &Wardle\u2010Pinkston S.(2019).Structured clinical interview for sleep disorders\u2010revised (SCISD\u2010R). Retrieved from:https:\/\/insomnia.arizona.edu\/SCISD"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2018.09.005"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.paid.2016.10.011"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0025348"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2014.07.002"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcbs.2022.10.006"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/29.1.85"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"}],"container-title":["Journal of Sleep Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jsr.14232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:57:31Z","timestamp":1743555451000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jsr.14232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,4]]},"references-count":59,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1111\/jsr.14232"],"URL":"https:\/\/doi.org\/10.1111\/jsr.14232","archive":["Portico"],"relation":{},"ISSN":["0962-1105","1365-2869"],"issn-type":[{"value":"0962-1105","type":"print"},{"value":"1365-2869","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,4]]},"assertion":[{"value":"2024-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14232"}}