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Cited by 63Fibromyalgia and Chronic Fatigue Syndrome ResearchSleep and related disordersMusculoskeletal pain and rehabilitation

Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial

Open access
Lami, María J., Martínez, M. Pilar, Miró, Elena, Sánchez, Ana I., Prados, Germán, Cáliz, Rafael, Vlaeyen, Johan W. S.·2018·Cognitive Therapy and Research
DOI 10.1007/s10608-017-9875-4
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Abstract

This controlled trial aims to analyze the efficacy of cognitive-behavioral therapy for insomnia and pain (CBT-IP) compared to cognitive-behavioral therapy for pain (CBT-P) and usual medical care (UMC) at improving sleep and other clinical manifestations (pain, fatigue, impaired functioning, and emotional distress) in women with fibromyalgia (FM). One hundred and twenty-six patients with FM were randomly assigned to different treatment groups and 113 completed the treatments (38 in the CBT-IP group, 34 in the CBT-P group and 41 in the UMC group) and a number of self-reports at pre-treatment, post-treatment, and 3 months of follow-up. The CBT-IP group showed significant improvements at post-treatment in several sleep variables (i.e., subjective sleep quality, sleep latency, sleep efficiency, and use of sleeping medication) that were not observed in the CBT-P and UMC groups. The CBT-IP and CBT-P groups reported significant improvements at post-treatment in FM impact and self-efficacy for coping with pain; the CBT-IP group reported improvements at follow-up in pain intensity, and the CBT-P reported improvements at post-treatment in pain catastrophizing and pain acceptance. Clinical improvements are also described. The findings revealed differential responses between groups regarding sleep and other adjustment parameters and the CBT-IP group exhibited the best clinical response pattern overall. More research in the area of FM treatment is needed to enhance the efficacy of the CBT and identify which patients are likely to benefit from each modality of CBT. © 2017, Springer Science+Business Media, LLC.

Verified 2026-10-05 · 1 reference not checked yet

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Crossref · 10.1007/s10608-017-9875-4

Cites

70 of 71 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

16 of 51 cited sources checked · 11 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    McCurry et al. (2014) found that at 18-month follow-up, benefits in pain, insomnia severity, and sleep efficiency were larger after CBT-IP than in CBT-P and education intervention groups.

    “The long-term (18 months) evaluation of a subgroup of patients with severe pain and insomnia revealed that the benefits gained in pain, insomnia severity and sleep efficiency were larger after CBT-IP than in CBT-P and the education intervention groups (McCurry et al. 2014).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites McCurry et al. 2014 source

      Table 3 (Longitudinal Effects; page unavailable) shows point estimates favoring CBT-PI over CBT-P and education-only control for pain and insomnia severity in the high-pain, high-insomnia subgroup. Its sleep-efficiency estimate also slightly favors CBT-PI, but sleep efficiency declined from baseline in that arm, and group differences in sleep efficiency and insomnia severity were not statistically significant. The claim presents these uncertain comparisons as benefits gained across all three outcomes. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    McCurry et al. (2014) found that patients with high severity of insomnia and pain at baseline showed greater improvements in pain after CBT-IP (compared to CBT-P) at 18 months of follow-up.

    “Similarly, McCurry et al. (2014) found that patients with a high severity of insomnia and pain at baseline showed greater improvements in pain after CBT-IP (compared to CBT-P) at 18 months of followup.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites McCurry et al. (2014) source
  • Findingcitation

    Neither the previous studies (Pigeon et al. 2012; Tang et al. 2012; Vitiello et al. 2013) nor the present study displayed significant improvements in pain intensity after CBT-IP or CBT-P at post-treatment.

    “Regarding pain-related variables, neither of the studies (Pigeon et al. 2012;Tang et al. 2012;Vitiello et al. 2013) nor the present displayed significant improvements in pain intensity after CBT-IP or CBT-P at post-treatment.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Pigeon et al. 2012 source
    • cites Tang et al. 2012 source
    • cites Vitiello et al. 2013 source
  • Premisecitation

    A review of studies with FM patients (Bernardy et al. 2010) showed that the CBT approach provides a greater sense of control over symptoms.

    “Similar results are mentioned in review of studies with FM patients (Bernardy et al. 2010), showing clearly that the CBT approach provides a greater sense of control over the symptoms (Clauw 2014).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Bernardy et al. 2010 source

      The Abstract reports that CBT significantly improved pain self-efficacy after treatment and at follow-up, supporting a greater sense of control over pain. The claim extends that finding to FM symptoms generally; the Abstract reports no significant effect on pain, fatigue, or sleep symptoms themselves. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites Clauw 2014 source
  • Premisecitation

    Vitiello et al. (2013) in a large sample of older adults showed a greater reduction in insomnia severity in a CBT-IP group than in a CBT-P group and an education intervention group.

    “The clinical trial performed by Vitiello et al. (2013) in a large sample of older adults showed a greater reduction in insomnia severity in a CBT-IP group than in a CBT-P group and an education intervention group.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Vitiello et al. (2013) source
  • May combine two claims. 50
  • Classified as probably not a substantial claim. 27
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Poor sleep is linked to disrupted central pain processing, described as a diffuse hyperalgesia state in fibromyalgia, possibly from loss of descending analgesic activity and central sensitization.

    “Poor sleep is related to a disturbance of central painprocessing mechanisms, identified as a”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Lee et al. 2011 source

      The Rheumatoid arthritis section (page unavailable) links sleep disturbance to pain thresholds at joint and nonjoint sites, indicating a central mechanism. The Fibromyalgia section (page unavailable) describes diffuse hyperalgesia that may partly reflect loss of descending analgesia and central sensitization. The paper does not specifically establish that poor sleep is linked to that diffuse hyperalgesic state in fibromyalgia. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients with fibromyalgia experience substantial impairments in functional status and mental and physical health.

    “Patients with FM experience substantial impairments in functional status and mental and physical health (Wolfe et al. 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Wolfe et al. 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent studies found that 88.75% of people diagnosed with fibromyalgia report sleep difficulties.

    “Recent studies have found that 88.75% of people diagnosed with FM report sleep difficulties (Wagner et al. 2012)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Wagner et al. 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Spanish version of the CPAQ has shown adequate test-retest reliability, internal consistency, and construct validity.

    “The Spanish version of the CPAQ has shown adequate test-retest reliability, internal consistency, and construct validity (Rodero et al. 2010).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Rodero et al. 2010 source

  • May combine two claims.

    Premisecitation

    Vitiello et al. (2013) found greater improvements in insomnia after CBT-IP than after an education intervention, and both CBT-IP and CBT-P were associated with significantly greater improvements in sleep efficiency than education, but the three groups did not differ in pain intensity.

    “Results revealed greater improvements in insomnia after CBT-IP than after the mentioned intervention.Both, CBT-IP and CBT-P were associated with significantly greater improvements in sleep efficiency than in education intervention but the three groups did not exhibit any differences in pain intensity (Vitiello et al. 2013).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Vitiello et al. 2013 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    People with fibromyalgia also report chronic fatigue, cognitive problems, unrefreshing sleep, and somatic issues like irritable bowel syndrome, morning stiffness, or temporomandibular disorder.

    “Patients with FM also report other symptoms as chronic fatigue, cognitive dysfunctions, sleep disturbances with unrefreshing sleep, and somatic symptoms such as irritable bowel syndrome, morning stiffness, or temporomandibular disorder (Fitzcharles and Yunus 2012).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Fitzcharles and Yunus 2012 source

      Sections 2.1 and 2.2 describe fatigue, cognitive changes, poor or disturbed sleep, irritable bowel syndrome, stiffness, and temporomandibular disorder in patients with fibromyalgia. Section 2.2 also discusses nonrestorative sleep. The copy lists stiffness and morning fatigue separately, but does not specifically identify morning stiffness. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Finan et al. (2014) concluded that the pain severity index may be a poor primary outcome because it fails to consider the complex variance between sleep and pain.

    “In the latest review of CBT-IP in chronic pain patients (Finan et al. 2014), the authors reached the conclusion that the pain severity index may be a poor primary outcome because it fails to consider the complex variance between sleep and pain.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Finan et al. 2014 source

      In “Integrated Analysis and Future Directions,” the review says pain severity may be a poor primary endpoint, at least when measured within six months. It offers insufficiently broad pain assessments as a possible explanation for why trials may miss the complexities of the sleep–pain relationship, rather than establishing that explanation as the reason. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    McCurry et al. (2014) found no differences among the three treatment conditions in sleep variables at 18 months of follow-up, though participants with higher baseline insomnia and pain showed greater (but not significant) improvements in insomnia severity and sleep efficiency in the CBT-IP group than in the education intervention group.

    “By contrast, no differences among the three treatment conditions in sleep variables were observed at 18 months of follow-up, though participants with higher levels of insomnia and pain at baseline showed greater (but not significant) improvements in insomnia severity and sleep efficiency in the CBT-IP group than in the education intervention group (McCurry et al. 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites McCurry et al. 2014 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to the fear-avoidance model, pain catastrophizing is a crucial cognitive variable involved in emotional distress and impairment associated with pain experience.

    “According to the influential fear-avoidance model of chronic pain (Leeuw et al. 2007;Vlaeyen and Linton 2012), pain catastrophizing is a crucial cognitive variable involved in emotional distress and impairment associated to pain experience.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Leeuw et al. 2007 source
    • cites Vlaeyen and Linton 2012 source

  • May combine two claims.

    Findingown data

    In women with fibromyalgia, both CBT-IP and CBT-P groups reported significant post-treatment improvements in fibromyalgia impact and self-efficacy for coping with pain.

    “The CBT-IP and CBT-P groups reported significant improvements at post-treatment in FM impact and self-efficacy for coping with pain;”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The CBT-IP group improved significantly on sleep quality-total from pre- to post-treatment, whereas the CBT-P and UMC groups did not.

    “Whereas the CBT-IP group showed significant improvements in Sleep quality-total at post-treatment, the CBT-P and UMC groups did not.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    ANCOVA for sleep quality-total showed significant medium effects of time, group, and their interaction.

    “The ANCOVA for sleep quality-total revealed a significant and medium effect of time, group and time × group”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Sleep efficiency improved significantly after CBT-IP from pre- to post-treatment, but not after CBT-P or UMC.

    “Sleep efficiency improved significantly after CBT-IP, shown by significant differences between pre-and post-treatment, but not after CBT-P or UMC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The UMC group showed a significant reduction in fatigue at post-treatment, but this reduction tended to increase significantly at follow-up.

    “A significant reduction of fatigue after UMC was observed at post-treatment; however, this reduction tended to increase significantly at follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The differences in daytime functioning between CBT-IP and UMC and between CBT-P and UMC increased at follow-up.

    “These differences between CBT-IP and UMC and between CBT-P and UMC increased at follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sleep disturbances showed significant medium effects of time, group, and time × group.

    “Sleep disturbances showed significant and medium effects of time, group, and time × group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants showed significant improvements in pain catastrophizing after CBT-P but not after CBT-IP, despite both treatments addressing dysfunctional beliefs about pain.

    “Likewise, participants showed significant improvements in pain catastrophizing after CBT-P but not after CBT-IP, despite the fact that both treatments address dysfunctional beliefs about pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Significant improvements in pain catastrophizing and pain acceptance after CBT-P were observed at post-treatment, but this trend was inverted at follow-up.

    “Significant improvements in both pain variables (catastrophizing and acceptance) after CBT-P were observed at post-treatment, but this trend was inverted at follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Depression showed differences at post-treatment (UMC vs CBT-P) and at follow-up (UMC vs CBT-P and UMC vs CBT-IP), in favor of UMC.

    “Depression showed differences at post-treatment (UMC vs. CBT-P) and at follow-up (UMC vs. CBT-P and UMC vs. CBT-IP), in favor of UMC.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In our study, changes in pain catastrophizing delivered by CBT-IP or CBT-P were followed by improvements in impairment and self-efficacy, but positive changes in depression or anxiety were not observed after these treatments.

    “In our study, changes in pain catastrophizing, delivered by CBT-IP or CBT-P, were followed by improvements in impairment and self-efficacy, but positive changes in depression or anxiety were not observed after these treatments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At baseline, the UMC group had better subjective sleep quality than the CBT-IP group.

    “The UMC group reported better subjective sleep quality at baseline than CBT-IP.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Fatigue did not improve after CBT-IP or CBT-P, but positive changes were observed after UMC, although these improvements were transitory and fatigue tended to return to pre-treatment levels at UMC follow-up.

    “However, fatigue was improved neither after CBT-IP nor CBT-P but positive changes were observed after UMC, although such improvements were transitory and fatigue tended to return to pre-treatment levels at UMC´s follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Daytime functioning showed a significant medium effect of time and a significant pre-treatment difference between CBT-IP and UMC.

    “Regarding daytime functioning, a significant and medium effect of time was observed, as well as a significant pre-treatment difference between the CBT-IP and UMC groups mentioned earlier.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For sleep latency, there was a close-to-significant small effect of time, and the CBT-IP group showed significant improvement at post-treatment.

    “In sleep latency, a close to significance and small effect of time was found and significant improvements were observed at post-treatment in the CBT-IP group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients reported a significant reduction in use of sleeping medication after CBT-IP, but not after CBT-P or UMC.

    “Patients reported a significant reduction of Use of sleeping medication after CBT-IP, but not after CBT-P or UMC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    According to the RCI, 46.4% of CBT-P patients, 62.9% of CBT-IP patients, and 11.1% of UMC patients showed significant clinical changes in sleep quality-total.

    “According to the RCI, 46.4% of patients in the CBT-P group, 62.9% in the CBT-IP group and 11.1% in the UMC group exhibited significant clinical changes in Sleep quality-Total.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The CBT-IP group improved significantly on subjective sleep quality from pre- to post-treatment, but the CBT-P and UMC groups did not.

    “The CBT-IP group showed a significant improvement between pre-and post-treatment in this parameter but neither CBT-P nor the UMC did.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No significant effects of group, time, or time × group were observed for anxiety and pain catastrophizing.

    “Regarding anxiety and pain catastrophizing, no significant effects of group, time or time × group were observed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    General fatigue showed significant large effects of time, group, and time × group.

    “Significant and large effects of time, group and time × group were identified in general fatigue.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At post-treatment, there were significant differences in depression between CBT-P and UMC, and these differences remained at follow-up.

    “At post-treatment, significant differences between CBT-P and UMC were observed; at follow-up, these differences remained.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    FM impact showed a significant medium effect of time and significant improvement after CBT-P and CBT-IP at post-treatment.

    “In FM impact, participants exhibited a significant and medium time effect and a significant improvement after CBT-P and CBT-IP at post-treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Pain catastrophizing, measured by the PCS, showed no statistically significant time, group, or time-by-group effects.

    “| Pain cata- | CBT-P | 24.91 (12.07) | 20.00 (10.59) | 22.84 (14.14) | 0.51 | 1.13 | 1.37 | 3.75***(.72) | -2.44*(-.55) |”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Anxiety, measured by the SCL-90-R, showed no statistically significant time, group, or time-by-group effects.

    “| Anxiety (SCL- | CBT-P | 1.63 (0.81) | 1.71 (0.94) | 1.60 (1.05) | 1.47 | 2.04 | 1.60 | -1.31 | 1.17 |”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PSQI is considered a reliable and valid instrument for measuring sleep quality in patients with fibromyalgia.

    “The PSQI is considered a reliable and valid instrument to measure sleep quality in patients with FM (Osorio et al. 2006)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Osorio et al. 2006

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Spanish version of the PCS has shown adequate internal consistency, test-retest reliability, and sensitivity to change.

    “The Spanish version of the PCS has shown adequate internal consistency, test-retest reliability, and sensitivity to change (García-Campayo et al. 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites García-Campayo et al. 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The prevalence of fibromyalgia is about 2.9-4.7% in the general European population and is more frequent in women than in men.

    “The prevalence is about 2.9-4.7% in the general European population and more frequent in women than in men (Branco et al. 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Branco et al. 2010 source

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    One hundred and twenty-six women with fibromyalgia were randomly assigned to CBT-P, CBT-IP, or UMC, with 42 patients per condition.

    “One hundred and twenty-six patients with FM were randomly assigned to one of the three conditions: CBT-P (n = 42), CBT-IP (n = 42), or UMC (n = 42).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Spanish interdisciplinary consensus document for fibromyalgia treatment recommends CBT as the best approach for patients with high levels of catastrophizing and depression.

    “The Spanish interdisciplinary consensus document for FM treatment (Alegre de Miquel et al. 2010) also recommends CBT as the best approach for patients with high levels of catastrophizing and depression.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Alegre de Miquel et al. 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Sleep in fibromyalgia is marked by shorter total sleep time, a large drop in slow-wave sleep percentage from alpha wave intrusion, and heightened arousal.

    “Previous reviews (Díaz-Piedra et al. 2015;Moldofsky 2009;Prados and Miró 2012) have described a reduction of total sleep time, a considerable decrease in the percentage of slow-wave sleep due to the intrusion of alpha waves, and increased arousal as common characteristics of sleep in FM.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Díaz-Piedra et al. 2015 source
    • cites Moldofsky 2009 source
    • cites Prados and Miró 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Spanish version of the MPQ has shown adequate reliability and validity in several studies.

    “The Spanish version of the MPQ has shown adequate reliability and validity in several studies (e.g., Lázaro et al. 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lázaro et al. 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Spanish adaptation of the PSQI has shown adequate psychometric characteristics.

    “The Spanish adaptation of the PSQI has shown adequate psychometric characteristics (Royuela and Macías 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Royuela and Macías 1997

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The American Pain Society recommends a multidisciplinary approach to chronic pain treatment and particularly CBT over other psychotherapies.

    “The American Pain Society (APS) recommends a multidisciplinary approach to the treatment of chronic pain and particularly to the cognitive-behavioral therapy (CBT) over other psychotherapies (Häuser et al. 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Häuser et al. 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A psychologist blinded to group assignment assessed the outcome measures.

    “A psychologist who was blinded to group assignment assessed the following measures:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The treatment groups did not differ on any baseline measures (all p > .10), except that the CBT-IP group had a higher percentage of antidepressant and anxiolytic intake (p < .05).

    “Groups did not differ in any baseline measures (all p > .10),except in percentage of antidepressant and anxiolytic intake, which was higher in the CBT-IP group (p < .05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A previous pilot study by the authors' research group found that CBT-IP achieved greater improvements in several polysomnography parameters than CBT-P in women with fibromyalgia, and these improvements were concordant with a positive change in self-reported sleep quality only in CBT-IP.

    “In a previous pilot study our research group (Prados et al. in review) compared CBT-P (n = 15) versus CBT-IP (n = 17) in FM women observing that CBT-IP achieves greater improvements in several polysomnography parameters than CBT-P, and these improvements were concordant with a positive change in self-reported sleep quality only in CBT-IP.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Prados et al. in review

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Pigeon et al. (2012) found that CBT-IP and CBT-I were superior to CBT-P in improving sleep parameters, depression, and fatigue in a small sample of chronic pain patients.

    “Pigeon et al. (2012) evaluated clinical changes in a small sample of patients with chronic pain (n = 21) in CBT-P, CBT-IP, CBT-I and waiting list (WL) groups.Results showed the advantage of CBT-IP and CBT-I over CBT-P in improving sleep parameters, depression, and fatigue.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pigeon et al. 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Spanish adaptation of the CPSS has shown good construct validity and internal consistency.

    “The Spanish adaptation of the CPSS has shown good construct validity and internal consistency (Martín-Aragón et al. 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Martín-Aragón et al. 1999

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The Spanish adaptation of the FIQ has shown adequate test-retest reliability, internal consistency, external validity, and sensitivity.

    “The Spanish adaptation of the FIQ has shown adequate test-retest reliability, internal consistency, external validity, and sensitivity (Rivera and González 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rivera and González 2004

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    CBT-I has proven helpful for many patients with chronic pain syndromes, including fibromyalgia, but has shown limitations in improving patients' ability to mitigate pain severity.

    “Although CBT-I has proven to be helpful for many patients with chronic pain syndromes, including FM, it has also shown limitations in improving patients' ability to mitigate the severity of pain (Martínez et al. 2014b).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Martínez et al. 2014b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Fibromyalgia is a rheumatic condition marked by widespread muscle and soft-tissue pain lasting over three months and tenderness at specific body sites.

    “Fibromyalgia (FM) is a rheumatic disease characterized by widespread pain in muscles and soft tissues for more than 3 months and tenderness in specific points of the body (Wolfe et al. 1990).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wolfe et al. 1990 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    A number generator was used by a researcher blinded to the trial implementation to randomly allocate patients to treatments.

    “In order to allocate patients randomly to the treatments (42 patients in each condition), a number generator was used by a researcher blinded to the implementation of the trial.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Patients with fibromyalgia show more insomnia and less restorative sleep than rheumatic patients and the general population.

    “showing more insomnia and less restorative sleep than rheumatic patients and the general population (Belt et al. 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Belt et al. 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The relationship between sleep and the origin and maintenance of chronic pain is well-established.

    “Even though the relationship between sleep and the origin and maintenance of chronic pain is well-established (Prados and Miró 2012)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Prados and Miró 2012 source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The present trial used a per-protocol analysis because of its explanatory approach.

    “Given the explanatory approach of the trial, a per-protocol analysis was used.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Tang et al. (2012) compared a waiting list group and a CBT-IP group and showed significant improvements between pre- and post-CBT-IP in sleep diary data (e.g., latency, efficiency, and sleep time).

    “The study performed by Tang et al. (2012) compared a waiting list group and a CBT-IP group and showed significant improvements between pre-and post-CBT-IP in sleep diary data (e.g., latency, efficiency, and sleep time).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tang et al. (2012) source

  • May combine two claims.

    Study design and conductreasoning

    The per-protocol analysis left out the analysis of dropouts, so the comparison could not be fully guaranteed.

    “This inevitably left out the analysis of dropouts, so the comparison could not be fully guaranteed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Pigeon et al. (2012) found that CBT-IP was associated with better results in insomnia severity, total wake time, and sleepiness than CBT-P and a control condition, though its small sample size prevents firm conclusions.

    “Though the small sample size of the study conducted by Pigeon et al. (2012) does not make it possible to reach firm conclusions, it revealed that CBT-IP was associated with better results in insomnia severity, total wake time, and sleepiness than CBT-P and a control condition.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pigeon et al. (2012) source

  • May combine two claims.

    Interpretationown data

    CBT-IP and CBT-P were better than UMC, and the combined CBT addressing pain and insomnia improved more clinical parameters than CBT focused on pain alone.

    “Taking these findings all together, it can be stated that CBT-IP and CBT-P were better than UMC, and the combined version of CBT addressing pain and insomnia was able to improve more clinical parameters than CBT that focused on pain alone.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Tang et al. (2012) showed a greater reduction of pain catastrophizing in the CBT-IP group compared to the control group, though there were no comparisons with any other CBT approach.

    “The study by Tang et al. (2012) showed a greater reduction of pain catastrophizing in the CBT-IP group compared to the control group, though there were no comparisons with any other CBT approach.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tang et al. (2012) source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Differences in the dropout amount between treatment groups could have affected the results, but the magnitude of this possible influence could not be measured.

    “The differences in the dropout amount in the treatments group could have affected the results; regrettably, the magnitude of this possible influence could not be measured.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Glombiewski et al. (2010) concluded that CBT is efficient in reducing pain catastrophizing in the short term.

    “These results are in line with those obtained in a review by Glombiewski et al. (2010), which concluded that CBT is efficient in reducing pain catastrophizing in short term.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Glombiewski et al. (2010) source

  • May combine two claims.

    Premisecitation

    Tang et al. (2012) found significant improvements after CBT-IP in pain interference rather than in symptoms monitoring condition.

    “Tang et al. (2012) found significant improvements after CBT-IP in pain interference rather than in symptoms monitoring condition”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tang et al. (2012) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pigeon et al. (2012) observed that CBT-P showed a larger effect on pain interference than CBT-I and CBT-IP.

    “Pigeon et al. (2012) observed that CBT-P showed a larger effect on pain interference than CBT-I and CBT-IP.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pigeon et al. (2012) source

  • May combine two claims.

    Interpretationnone given

    Reversing the negative interaction between sleep and pain in therapeutic contexts is difficult, and CBT focused on insomnia and pain does not achieve complete recovery of sleep in all patients.

    “In conclusion, reversing the negative interaction between sleep and pain in therapeutic contexts is difficult, and CBT focused on insomnia and pain does not achieve complete recovery of sleep in all patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Martínez et al. (2015) found that in patients with FM, poorer sleep quality was associated with higher pain catastrophizing.

    “In patients with FM, Martínez et al. (2015) found that poorer sleep quality was associated with higher pain catastrophizing.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Martínez et al. (2015) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All study procedures involving human participants complied with the ethical standards of the University of Granada Ethics Committee and the 1964 Helsinki Declaration and its later amendments.

    “All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Granada Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Informed consent was obtained from every participant included in the study.

    “Informed consent was obtained from all individual participants included in the study.”
    Quote in the paperNot a substantial claim
67 of 67

  • The authors state this as an assumption.

    Treatment aimed at regulating sleep disturbances and improving restorative sleep is likely to have an impact on the main symptoms of fibromyalgia.

    “From this perspective, given the two-way relationship between sleep and pain, it can be assumed that treatment aimed at regulating sleep disturbances and improving the restorative value of sleep is likely to have an impact on the main symptoms of FM (Thomas 2011).”

  • The paper relies on this without support.

    The Spanish adaptation of the SCL-90-R has adequate internal consistency and a factor structure similar to the original version.

    “The Spanish adaptation of the SCL-90-R has shown adequate internal consistency and a factor structure similar to that of the original version.”

  • The paper relies on this without support.

    The present study is the first to explore the efficacy of CBT-IP in comorbid FM and insomnia compared with CBT-P and UMC at post-treatment and follow-up, with sleep quality as primary outcome and a wide variety of self-reported wellbeing measures as secondary outcomes.

    “The present study is the first to explore the efficacy of CBT-IP in comorbid FM and insomnia compared with CBT-P and UMC at post-treatment and follow-up considering as a primary outcome sleep quality and as a secondary outcome a wide variety of self-reported measures of wellbeing.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Baseline-difference summary conflicts with reported FM-impact result

    Minor

    The results text says the groups differed at baseline only in two medication measures, but it also reports a significant baseline difference in FM impact between CBT-P and UMC.

  • Overall sleep latency exceeds every group mean

    Minor

    The reported overall mean is 50 minutes, although the three group means are 46, 48, and 38 minutes. An overall mean calculated from those groups cannot be higher than all three.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 8

  1. Cohen, J. (1988). Statistical power analysis for the behavior sciences (2nd edn.). Hillsdale: Lawrence Erlbaum.
  2. Derogatis, L. R. (2002). SCL-90-R. Cuestionario de 90 síntomas. [SCL-90-R. Symptom checklist 90 revised]. Madrid: TEA Ediciones.
  3. Martín-Aragón, M., Pastor, M. A., Rodríguez-Marín, J., March, M. J., Lledó, A., López-Roig, S., & Terol, M. C. (1999). Percepción de autoeficacia en dolor crónico: Adaptación y validación de la chronic pain self-efficacy scale [Perceived self-efficacy in chronic pain: Adaptation and validation of the chronic pain self-efficacy scale]. Revista de Psicología de la Salud, 11, 53–75.
  4. Martínez, M. P., Miró, E., & Sánchez, A. I. (2014b). Tratamiento psicológico del insomnio en la fibromialgia y otros síndromes de dolor crónico [Psychological treatment of insomnia in fibromyalgia and other chronic pain syndromes]. CM de Psicobioquímica, 3, 39–54.
  5. Morin, C. M. (1998). Insomnio. Asistencia y tratamiento psicológico [Insomnia. Assistance and psychological treatment]. Barcelona: Ariel.
  6. Prados, G., Miró, E., Martínez, M. P., Sánchez, A. I., Lami, M. J., & Cáliz, R. (in review). Effects of combined cognitive-behavioral therapy on polysomnographic parameters and perceived sleep quality in fibromyalgia women.
  7. Royuela, A., & Macías, J. A. (1997). Propiedades clinimétricas de la versión castellana del cuestionario de Pittsburgh [Clinimetrical properties of the Spanish version of the Pittsburgh questionnaire]. Vigilia-Sueño, 9, 81–94.
  8. Salaberría, K., Páez, D., & Echeburúa, E. (1996). Evaluación de la validez del cambio inducido por los tratamientos psicológicos [Assessment of the validity of change induced by psychological treatments]. Boletín de Psicología, 52, 71–96.

Cited by

Sorted by citations

Related

Authors
Lami, M. J., Martínez, M. P., Miró, E., Sánchez, A. I., Prados, G., Cáliz, R., & Vlaeyen, J. W. S.
Affiliations
  • Universidad de Granada (ES)
  • Hospital Universitario Virgen de las Nieves (ES)
  • Maastricht University (NL)
Corresponding author
Lami, María J.
ORCID
Venue
Cognitive Therapy and Research
Publisher
Springer Science and Business Media LLC
Published
2017-10-19
Volume
42
Issue
1
Pages
63-79
ISSN
  • 0147-5916 (ISSN-L)
  • 1573-2819
DOI
10.1007/s10608-017-9875-4
OpenAlex
W2765335034
Cited by
63
References
71
Citations by year
2026: 4 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 12 · 2021: 14 · 2020: 10 · 2019: 4 · 2018: 3
FWCI
2.83
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • Cognitive Therapy and Research (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • Lirias (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
  • Ministerio de Ciencia e Innovación (PSI2009-13765PSIC)
  • Ministerio de Economía y Competitividad (PSI2014-58379-P)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
fibromyalgia, insomnia, sleep quality, pain intensity, pain catastrophizing, pain acceptance, coping self-efficacy, fatigue

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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