| RPT |
.| .| Dysfunctional Beliefs and Attitudes About Sleep (DBAS-16)| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN:
5. After a poor night's sleep, I know that it will interfere with my daily activities on the next day.| <*Answer_6593*>|
6. In order to be alert and function well during the day, I am better off taking a sleeping pill rather than having a poor night's sleep.| <*Answer_6594*>|
7. When I feel irritable, depressed, or anxious during the day, it is mostly because I did not sleep well the night before.| <*Answer_6595*>|
8. When I sleep poorly on one night, I know that it will disturb my sleep schedule for the whole week.| <*Answer_6596*>|
9. Without an adequate night's sleep, I can hardly function the next day.| <*Answer_6597*>|
10. I can't ever predict whether I will have a good or poor night's sleep.| <*Answer_6598*>|
11. I have little ability to manage the negative consequences of disturbed sleep.| <*Answer_6599*>|
12. When I feel tired, have no energy, or just seem not to function well during the day, it is generally because I did not sleep well the night before.| <*Answer_6600*>|
13. I believe that insomnia is essentially the result of a chemical imbalance.| <*Answer_6601*>|
14. I feel that insomnia is ruining my ability to enjoy life and prevents me from doing what I want.| <*Answer_6602*>|
<.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | |
15. Medication is probably the only solution to sleeplessness.| <*Answer_6603*>|
16. I avoid or cancel obligations (social, family, occupational) after a poor night's sleep.| <*Answer_6604*>|
| | Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with
other diagnostic activities.| $~
DBAS-16 Total Score = <-TOTAL SCORE->|
| Higher scores reflect greater dysfunctional beliefs about sleep. Target beliefs expressed in items with scores greater than 5.| |
Questions and Answers| |
1. I need 8 hours of sleep to feel refreshed and function well during the day.| <*Answer_6589*>|
2. When I do not get the proper amount of sleep on a given night, I need to catch up on the next day by napping or on the next night by sleeping longer.| <*Answer_6590*>|
3. I am concerned that chronic insomnia may have serious consequences for my physical health.| <*Answer_6591*>|
4. I am worried that I may lose control over my abilities to sleep.| <*Answer_6592*>|
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