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The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Open accessAbstract
Study objectives To assess the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in patients with non-malignant chronic pain.Methods Twenty-eight subjects with chronic neck and back pain were stratified according to gender, age, and ethnicity, then assigned to one of the two treatment groups: CBT-I or a contact control condition.Intervention Eight weeks of CBT-I including sleep restriction, stimulus control, sleep hygiene, and one session of cognitive therapy devoted to catastrophic thoughts about the consequences of insomnia.Measurements and results Outcomes included sleep diary assessments of sleep continuity, pre-post measures of insomnia severity (ISI), pain (Multidimensional Pain Inventory), and mood (BDI and POMS). Subjects receiving CBT-I (n=19), as compared to control subjects (n=9), exhibited significant decreases in sleep latency, wake after sleep onset, number of awakenings, and significant increase in sleep efficiency. The diary findings were paralleled by significant changes in the ISI (p=0.05). Significant improvement (p=0.03) was found on the Interference Scale of the Multidimensional Pain Inventory. The groups did not significantly differ on mood measures or measures of pain severity.Conclusions CBT-I was successfully applied to patients experiencing chronic pain. Significant improvements were found in sleep as well as in the extent to which pain interfered with daily functioning. The observed effect sizes for the sleep outcomes appear comparable to or better than meta-analytic norms for subjects with Primary Insomnia.
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“RCTs of CBT-I only, with no medication comparator condition, generally find that treatment is as efficacious in those with comorbid disorders compared to those with primary insomnia (for example see [38]).”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [38]
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Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares
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Self-citationCognitive–behavioral factors in tinnitus-related insomnia
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“Cognitive–behavioral therapy for insomnia has been shown to work with insomnia co-occurring with other physical health problems, such as chronic pain (Jungquist et al., 2010; Tang et al., 2012), and evidence has indicated it is also effective in tinnitus-related insomnia (Marks et al.”
BackgroundComorbid insomnia and cognitive behavior therapy
Chand, S. P. (2015) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217415612737 · Cited by 6
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“found significant improvements in sleep and chronic pain using Masters-level CBT-I practitioners who received similar training and ongoing supervision [14].”
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“Furthermore, there is growing evidence that improved sleep following CBT-I positively influences the clinical course of the comorbid condition [22, 23].”
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“There is research to suggest that sleep continues to improve after treatment (e.g., Jungquist et al., 2010); thus, a stronger design would be to randomly allocate participants into conditions with different “doses” of CBT-I with a longitudinal follow-up.”
BackgroundAlmeida, L. A., Bilterys, T., Looveren, E. V., Maîresse, O., Cagnie, B. J., Meeus, M., Moens, M., Goubert, D., Munneke, W., Danneels, L. A., et al. (2023) · Healthcare · doi:10.3390/healthcare11243152 · Cited by 2
“…sample size calculation was performed with G*Power 3 (Düsseldorf, Germany) and it was calculated for a comparison analysis based on a medium effect size of 0.565, which was estimated based on a pilot study by Jungquist et al. that used the Insomnia Severity Index to assess insomnia severity [29].”
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“There is growing evidence for the efficacy of CBT-I in specific populations as well, such as cancer (Johnson et al., 2016), pain (Jungquist et al., 2010), psychiatric disorders (Taylor & Pruiksma, 2014), and traumatic brain injury (Nguyen, McKay, et al., 2017; Ouellet & Morin, 2007; Theadom et al.,…”
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Metadata
- Authors
- Jungquist, C. R., O’Brien, C., Matteson-Rusby, S., Smith, M. T., Pigeon, W. R., Xia, Y., Lu, N., & Perlis, M. L.
- Affiliations
- University of Rochester Medicine (US)
- Johns Hopkins University (US)
- University of Rochester (US)
- University of Pennsylvania (US)
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2010-03
- Volume
- 11
- Issue
- 3
- Pages
- 302-309
- ISSN
- 1389-9457 (ISSN-L)
- PMC
- PMC2830371
- OpenAlex
- W2101759370
- Cited by
- 256
- References
- 27
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 12 · 2023: 9 · 2022: 20 · 2021: 22 · 2020: 13 · 2019: 22 · 2018: 13 · 2017: 17 · 2016: 16 · 2015: 25 · 2014: 23 · 2013: 11 · 2012: 21
- FWCI
- 20.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (L30 MH087269)
- National Institute of Nursing Research (NR5R21NR009080-02., R21NR009080)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy for insomnia, chronic pain, insomnia, neck pain, back pain, sleep restriction, stimulus control, sleep hygiene, catastrophic thinking, pain interference, sleep efficiency, mood
- MeSH terms
- Adult, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Medical Records, Middle Aged, Pain, Pain Measurement, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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