Psychological Flexibility May Reduce Insomnia in Persons with Chronic Pain: A Preliminary Retrospective Study
Abstract
OBJECTIVE: Sleep disturbance is a common complaint in people with chronic pain, and is associated with a range of adverse outcomes including reports of greater pain and disability. Research into insomnia with chronic pain sufferers has not yet examined the role of psychological flexibility, a process from acceptance and commitment therapy. We examined this role. DESIGN: Participants in this study were 159 adult patients attending an assessment at a specialist pain center. They were mostly women, 63%, and the mean age was 43.8 years. RESULTS: In preliminary analyses 79% of participants met the criteria for significant insomnia based on their self-reported symptoms. As predicted, significant positive correlations were found between components of psychological flexibility, particularly acceptance of pain and values-based action, and all measures of sleep quality. In regression analyses, the components of psychological flexibility considered together accounted for between 11% and 19% of variance across a range of measures of sleep quality. CONCLUSION: These results suggest the need to further develop treatment services for people with chronic pain and insomnia.
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Psychological inflexibility was found as a predictor of higher levels of insomnia severity.
“Psychological inflexibility was found as a predictor of higher levels of insomnia severity (Daly-Eichenhardt et al., 2016;El Rafihi-Ferreira et al., 2022;McCracken et al., 2011;McCracken et al., 2021;McCracken et al., 2022;McCracken et al., 2023;Zakiei et al., 2022), whereas psychological flexibility was found as a predictor of lower levels of insomnia severity (McCracken et al., 2022;McCracken et”
From Psychological inflexibility as a predictor associated with insomnia (2024) · cites this paper as McCracken et al., 2011
Increased psychological flexibility contributes to better sleep.
“At the same time, increased psychological flexibility also contributes to better sleep.15 16”
From SoundMind Trial: a study protocol for a randomised controlled trial for online acceptance and commitment therapy and sound therapy for tinnitus (2024) · cites this paper as [15]
Cognitive flexibility has been proposed as an important process in primary insomnia and in insomnia comorbid with chronic pain.
“It has also been proposed as an important process in primary insomnia [18, 19] and even in insomnia comorbid with chronic pain [20].”
From Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management? - A randomized controlled study (2018) · cites this paper as [20]
Psychological inflexibility may be a transdiagnostic factor underlying sleep problems.
“may be a transdiagnostic factor underlying sleep problems (Kato, 2016; McCracken et al., 2011; Zakiei et al., 2022)”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as McCracken et al., 2011
Negative associations between global measures of PI and sleep quality have been observed in both clinical and non-clinical populations.
“Negative associations between global measures of PI and sleep quality have been observed in both clinical and non‐clinical populations (Kato, 2016; McCracken et al., 2011)”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as McCracken et al., 2011
That inaction did not uniquely relate to sleep quality was inconsistent with the Zakiei et al. (2022) findings and with two studies examining sleep in chronic pain patients, which showed committed action was related to sleep outcomes.
“That inaction did not uniquely relate to sleep quality was inconsistent with the Zakiei et al. (2022) findings, and similarly with two studies examining sleep in chronic pain patients, which showed committed action was related to sleep outcomes (Daly‐Eichenhardt et al., 2016; McCracken et al., 2011).”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as McCracken et al., 2011
A positive correlation has been found between psychological flexibility and improved sleep quality in people with chronic pain.
“A positive correlation has been found between psychological flexibility and improved sleep quality in people with chronic pain [57].”
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- Authors
- McCracken, L. M., Williams, J. L., & Tang, N. K. Y.
- Affiliations
- Royal National Hospital for Rheumatic Diseases (GB)
- King's College London (GB)
- Corresponding author
- McCracken, Lance M.
- Venue
- Pain Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06
- Volume
- 12
- Issue
- 6
- Pages
- 904-912
- ISSN
- 1526-2375 (ISSN-L)
- 1526-4637
- OpenAlex
- W2132533344
- Cited by
- 96
- References
- 43
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 16 · 2023: 11 · 2022: 13 · 2021: 8 · 2020: 9 · 2019: 7 · 2018: 4 · 2017: 2 · 2016: 7 · 2015: 4 · 2014: 4 · 2013: 3 · 2012: 1
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- psychological flexibility, insomnia, chronic pain, sleep quality, acceptance and commitment therapy, pain acceptance, values-based action, sleep disorders
- MeSH terms
- Adaptation, Psychological, Adult, Chronic Disease, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Pain, Pain Measurement, Surveys and Questionnaires, Retrospective Studies
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