Predictors of Adherence to Psychological Treatment for Insomnia and Pain: Analysis from a Randomized Trial
Open accessAbstract
OBJECTIVES: Poor adherence to psychological treatment for insomnia is common and limits treatment gains. Very little is known about predictors of adherence among patients with chronic pain, although adherence is theorized to be more critical and more challenging for these patients. This secondary data analysis examines predictors of drop-out and therapy nonattendance in an osteoarthritis population receiving psychological treatment for insomnia and pain. METHODS: Data were analyzed from the "Lifestyles" trial, a randomized controlled trial of a 6-week group cognitive behavioral pain coping skills intervention (CBT-P), group cognitive-behavioral therapy for pain and insomnia (CBT-PI), and an education only attention control group (EOC). The current analysis focuses on 122 participants randomized to CBT-PI from 6 primary care clinics. Measures of treatment acceptability, demographics, and symptoms were collected at baseline. Factor analysis was used to clarify the boundaries of these domains, and hierarchical regression was used to examine the incremental predictive power of these patient characteristics on therapy attendance. RESULTS: Ratings of treatment acceptability were distinct from demographic and medical variables and baseline symptoms. Treatment acceptability was significantly related to session attendance and drop-out (rs ranging from 0.24 to 0.32) and was also one of the strongest predictors of session attendance (β=0.20; P<0.05). DISCUSSION: Perceptions of treatment acceptability early in treatment represent a potentially modifiable target to enhance adherence to psychological treatment for insomnia and pain among patients with chronic pain. This work represents an important step towards understanding how to best maximize sleep treatments for this patient population.
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Attitudes toward a treatment can fundamentally improve adherence to, and outcomes of, an intervention.
“It is important to overcome these challenges regarding adherence and engagement, as attitudes toward a treatment can fundamentally improve adherence to, and outcomes of, an intervention (Koffel et al., 2018).”
From Acceptability and Co-Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study (2020) · cites this paper as Koffel et al., 2018
In the Discussion section, treatment acceptability predicts session attendance and is significantly related to dropout. The paper presents improved treatment outcomes as a possibility, but says further work is needed to determine how attendance contributes to symptom reduction. It therefore does not establish that changing attitudes improves outcomes. (LLM, conf=0.87)
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- Authors
- Koffel, E., Vitiello, M. V., McCurry, S. M., Rybarczyk, B., & Von Korff, M.
- Affiliations
- University of Minnesota (US)
- University of Washington (US)
- Virginia Commonwealth University (US)
- Group Health Research Institute, Seattle, WA
- Corresponding author
- Koffel, Erin
- Venue
- The Clinical Journal of Pain
- Published
- 2018-04
- Volume
- 34
- Issue
- 4
- Pages
- 375-382
- ISSN
- 0749-8047 (ISSN-L)
- PMC
- PMC5837899
- OpenAlex
- W2754198690
- Cited by
- 26
- References
- 48
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 1 · 2020: 4 · 2018: 2
- FWCI
- 2.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG031126)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- medication adherence, insomnia, chronic pain, osteoarthritis, treatment acceptability, therapy attendance, cognitive behavioral therapy for insomnia, group therapy, primary care
- MeSH terms
- Treatment Adherence and Compliance, Adaptation, Psychological, Aged, Aged, 80 and over, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Pain, Patient Acceptance of Health Care, Regression Analysis, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Pain Management
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