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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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“This point of view is further buttressed by the Spielman Model [3,4] which clearly suggests that chronic insomnia is maintained, irrespective of the original precipitants, by a common set of perpetuating factors which are largely cognitive and behavioral in nature.”
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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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