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Clinical Significance and Predictors of Treatment Response to Cognitive-Behavior Therapy for Insomnia Secondary to Chronic Pain
Abstract
We examined individual responses to cognitive-behavior therapy for insomnia in 51 persons with chronic pain to determine the rate of clinically significant change and to identify predictors of successful treatment response. Outcome measures consisted of the Pittsburgh Sleep Quality Index (PSQI) and diary measures of sleep latency and sleep continuity. Using reliable change indices, 57% of participants were statistically improved on the PSQI after 7 weeks of treatment, but only 18% were considered fully recovered from their sleep problems. No demographic variables predicted treatment response but persons who reliably improved on the PSQI had a lower sleep self-efficacy at baseline. Improvers showed a significant increase in sleep self-efficacy ratings and a decrease in self-reported levels of distress and pain-related disability. These results suggest that patients with insomnia secondary to chronic medical conditions can be helped with cognitive-behavior therapy, although most individuals continue to have mild or subthreshold sleep problems at posttreatment.
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“The effect size for the improvements in sleep duration and subjective sleep quality in this study were similar or even greater than that reported for cognitive behavioral intervention and other physical activity studies [18, 30, 36-38].”
From Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia (2010) · cites this paper as [36]
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Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia
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MethodLifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?
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“To date, only a few studies have tested the efficacy of cognitive-behavioral therapy for insomnia in chronic pain populations, and they have demonstrated promising results [16,35,76].”
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“An early study of CBT for insomnia in people with chronic pain showed 57% of participants achieved a reliable improvement, although only 18% fully recovered from sleep problems (Currie et al., 2002).”
BackgroundDoes Effective Management of Sleep Disorders Improve Pain Symptoms?
Roehrs, T. (2009) · Drugs · doi:10.2165/11531260-000000000-00000 · Cited by 68
“[6] Currie et al. (2002) Subsequent Reliable Change Index[16] analyses of 51 patients from the same dataset confirmed these results.”
BackgroundResultExperiences of living with chronic back pain: The physical disabilities
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“Sleep is also seen to be an important outcome measure in pain research [21,22].”
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Effect of different types of exercise on sleep quality of elderly subjects
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Significância clínica e mudança confiável na avaliação de intervenções psicológicas
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“Many research studies define pain as chronic once it has persisted for 6 months (eg, Currie, Wilson, & Curran, 2002 ).”
Cognitive–behavior group intervention for relatives of cancer patients: a controlled study
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“The results are similar to those of other studies that measured the effect of CB group interventions [57].”
ResultA step towards stepped care: delivery of CBT-I with reduced clinician time
Manber, R., Simpson, N. S., & Bootzin, R. R. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.09.003 · Cited by 32
Improved Sleep May Reduce Arthritis Pain
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Sleep is a modifiable determinant of health: Implications and opportunities for health psychology
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Flaxer, J. M., Heyer, A., & Francois, D. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.10.011 · Cited by 22
Level of Distress Among Workers Undergoing Work Rehabilitation for Musculoskeletal Disorders
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“Similarly, in the Canadian population, the prevalence of mood disorders in those experiencing persistent pain due to low back pain was found to be 19.8% [ 17 ].”
BackgroundInfluentialFighting Insomnia and Battling Lethargy: The Yin and Yang of Palliative Care
Davis, M. P., & Goforth, H. W. (2014) · Current Oncology Reports · doi:10.1007/s11912-014-0377-1 · Cited by 18
Nijs, J., Maîresse, O., & Tang, N. K. Y. (2024) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2024.100594 · Cited by 17
Brief Behavioral Therapy for Insomnia in Patients with Irritable Bowel Syndrome: A Pilot Study
Ballou, S., Katon, J. M., Rangan, V., Cheng, V., Nee, J. W., Iturrino, J., & Lembo, A. J. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06182-w · Cited by 19
Sleep duration, life satisfaction and disability
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Does exercise impact on sleep for people who have rheumatoid arthritis? A systematic review
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“The ISI a seven-item questionnaire, which asks the person to rate the nature and symptoms of their sleep problems using a five-point Likert scale (0 = no problem, 4 = very severe problem) [35, 36] and can be completed in 5 min or less.”
Nielson, S. A., Perez, E., Soto, P. F., Boyle, J. T., & Dzierzewski, J. M. (2023) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2023.101856 · Cited by 17
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“Although no clear pattern of predictors of response to CBTi has emerged, some studies have found that higher baseline insomnia severity (Currie, Wilson, & Curran, 2002; Espie, Inglis, & Harvey, 2001; Van Houdenhove, Buyse, Gabriëls, & Van den Bergh, 2011) and higher baseline total sleep time…”
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“Similarly, in the Canadian population, the prevalence of mood disorders in those experiencing persistent low back pain was 19.8% (Currie et al. 2002 ) .”
BackgroundInfluentialZarean, E., Azadeh, A., Pirali, H., Doroushi, B., Edrisi, A., Ahmadi, A., Baharizadeh, A., & Torkian, S. (2021) · Middle East Current Psychiatry · doi:10.1186/s43045-021-00083-y · Cited by 15
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BackgroundLocatelli, G., Rebora, P., Occhino, G., Ausili, D., Riegel, B. J., Cammarano, A., Uchmanowicz, I., Alvaro, R., Vellone, E., & Zeffiro, V. (2023) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000998 · Cited by 14
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Insomnia: Sleep Restriction Therapy
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“Indeed, cognitive behavioral models targeting dysfunctional sleep habits and beliefs have found that improved sleep quality was associated with decreased depressive symptoms and reduced pain-related disability ( 95 ).”
BackgroundCurrent Views on Chronic Pain and Its Relationship to the State of Sleep
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“trado que es efectiva en los pacientes con dolor para tratar la dificultad en el sueño [13-15], pero los resultados en cuanto al descenso secundario del dolor son inconsistentes, y hay varios estudios que no hallaron beneficios [2].”
BackgroundSleep Disturbance in Neck Pain Patients: Implications to Pain Intensity and Disability
Aldabbas, M. M., Tanwar, T., Iram, I., Spence, D. W., Pandi-Perumal, S. R., & Veqar, Z. (2022) · Sleep and Vigilance · doi:10.1007/s41782-022-00216-1 · Cited by 6
“Previous research [29] has shown that a possible relationship exists between sleep disruption and physical disability, thus supporting the hypothesis that sleep may play an important role in the mechanism by which disability develops.”
BackgroundInitial Sleep Time Predicts Success in Manual-Guided Cognitive Behavioral Therapy for Insomnia
Bothelius, K., Kyhle, K., Broman, J., Gordh, T., & Fredrikson, M. (2015) · Behavioral Sleep Medicine · doi:10.1080/15402002.2015.1007995 · Cited by 6
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Predictors of Depressive and Anxiety Symptoms among African American HIV-positive Women
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“Our results that higher baseline SSES predicts both short-term and longer-term CBT-I outcomes contrasts with the one prior study (Currie et al., 2002) that examined sleep self-efficacy as a predictor of CBT-I treatment response.”
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“In addition, a sleep diary, a subjective tool utilized in a number of studies on sleep disorders and in general practices [32], was also recorded.”
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Sunnhed, R., Hesser, H., Carlbring, P., Harvey, A. G., & Jansson‐Fröjmark, M. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106611 · Cited by 2
An Online Mindfulness Intervention for Pain and Wellbeing
Leov, J. (2016) · Otago University Research Archive (University of Otago) · Cited by 2
Cognitive Behavior Therapy for Insomnia
Harris, S. F., & McGlinchey, E. L. (2017) · Wiley eBooks · doi:10.1002/9781118877142.ch17 · Cited by 1
Naamanka, E., & Suutari, V. (2014) · Jyväskylä University Digital Archive (University of Jyväskylä)
TRATAMIENTO PSICOLÓGICO DEL INSOMNIO EN LA FIBROMIALGIA Y OTROS SÍNDROMES DE DOLOR CRÓNICO
de Vaca, P. M. N.-C., Miró, E., & Sánchez, A. I. (2014)
Sleep and pain management in the elderly
Rains, J. C., & Penzien, D. B. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511770661.019
Impact of chronic pain upon anxiety, sleep, and mood dimensions
Jarvis, S. E., & Toth, C. C. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139152211.028
Prados, G. (2014) · Institutional Repository of the University of Granada (University of Granada)
Berg, L. M. (2020) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.7118
“Patients reporting an improved PSQI global score according to the RCI are assumed to also have clinically improved sleep quality from baseline to followup.(33) This means that 38.”
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The Prognosis of Neuropathic Pain
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Metadata
- Authors
- Currie, S. R., Wilson, K. G., & Curran, D.
- Affiliations
- University of Ottawa (CA)
- University of Calgary (CA)
- Corresponding author
- Currie, Shawn R.
- Venue
- Journal of Behavioral Medicine
- Published
- 2002-04
- Volume
- 25
- Issue
- 2
- Pages
- 135-153
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- OpenAlex
- W1521059902
- Cited by
- 100
- References
- 37
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 6 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 6 · 2016: 7 · 2015: 5 · 2014: 9 · 2013: 10 · 2012: 3
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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, predictors of treatment response, Pittsburgh Sleep Quality Index, sleep latency, sleep continuity, pain-related disability, distress, reliable change index
- MeSH terms
- Adult, Analysis of Variance, Chronic Disease, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Pain, Psychotherapy, Brief, Surveys and Questionnaires, Sampling Studies, Sleep, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome
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