![]() Both of them can lead to persistent worry, leaving the individual vulnerable to the full spectrum of anxiety symptoms ( Borkovec et al., 1983 Koerner et al., 2020).Ĭombined with the cognitive-behavioral theory, IU is a dispositional characteristic that results from a set of acutely sensitive deep-seated beliefs that become activated in response to ambiguous situations ( Koerner et al., 2020). Meanwhile, cognitive avoidance (CA) indicates a person's tendency to use avoidance strategies when confronted with intrusive thoughts ( Dugas et al., 1998 Dugas, Savard, et al., 2007). Negative problem orientation (NPO) describes a dysfunctional cognitive set of minds about a person's cognitive approach when faced with solving problems ( Maydeu-Olivares & D'Zurilla, 1996). It is typically the cornerstone of this model, which not only directly increases the risk of excessive worrying but also functions as a higher-order vulnerability factor for worry by predisposing individuals toward cognitive avoidance and negative problem orientation ( Dugas et al., 1998). In this model, intolerance of uncertainty (IU) refers to a cognitive bias whereby individuals perceive uncertainty as distressing and aversive that significant efforts are adopted to avoid it ( Dugas et al., 1998 Dugas, 2000). The cognitive model of generalized anxiety disorderĭugas et al. (1998) proposed a cognitive model of generalized anxiety disorder (GAD) that identifies four frequent cognitive components: intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and worry. Since the cognitive model of GAD is usually the most persuasive model to explain the occurrence, maintenance, and development of GAD ( Dugas et al., 1998), this study aims to investigate whether this model can be applied to adolescents’ sleep quality from both cross-sectional and longitudinal perspectives. In particular, generalized anxiety disorder (GAD) is one of the most common anxiety disorders that is found in individuals with poor sleep quality ( Hertenstein et al., 2019 Nguyen et al., 2022), suggesting that poor sleep quality and GAD may share the same pathological processes. Numerous studies have documented that anxiety often co-occurs with poor sleep quality ( Baglioni et al., 2016 Blake et al., 2018 Cox & Olatunji, 2020). Although researchers have noted the impact of mental disorders on sleep quality, there has been limited research on the underlying factors influencing poor sleep quality in adolescents, particularly with regard to comorbidity factors. By now, there is a vast amount of literature exploring factors that affect adolescents’ poor sleep quality, mainly focusing on individual traits, social environmental factors, and mental disorders ( Brown et al., 2018 Lin et al., 2019 Zou et al., 2023). Prior research indicates that the occurrence of insomnia symptoms in Chinese adolescents ranges from 3.4% to 12.2% ( Zhang et al., 2016), leading to several unfavorable consequences ( Chiang et al., 2017 Roach et al., 2021). Poor sleep quality is a common health problem among adolescents. The present study constructs a new model to explain adolescents’ sleep quality, providing a foundation for future interventions. ![]() Study 2 partially confirmed the above model again from the longitudinal perspective. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. Study 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents’ sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1. In Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. ![]() Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents’ sleep quality. Poor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents’ sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. ![]()
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