Who Benefits From CBT for Insomnia in Primary Care? Important Patient Selection and Trial Design Lessons from Longitudinal Results of the Lifestyles Trial
Open accessAbstract
STUDY OBJECTIVES: Evaluate long-term effects of group interventions on sleep and pain outcomes in a primary care population of older adults with osteoarthritis pain and sleep disturbance. DESIGN: Double-blind, cluster-randomized controlled trial with 18-mo follow-up. SETTING: Group Health and University of Washington, Seattle, WA, from 2009 to 2011. PARTICIPANTS: Three hundred sixty-seven adults age 60 y and older, with osteoarthritis pain and insomnia symptoms. INTERVENTIONS: Six weekly sessions of group cognitive behavioral therapy for insomnia and pain (CBT-PI), pain alone (CBT-P), and education-only control (EOC) delivered in patients' primary care clinics. MEASUREMENTS AND RESULTS: There were no significant differences between treatment groups in sleep outcomes at 18 mo. This is a change from published significant 9-mo follow-up results for insomnia severity (Insomnia Severity Index) and sleep efficiency. There were no significant treatment differences in pain at either follow-up. Post hoc analyses of participants with greater insomnia and pain severity at baseline (n = 98) showed significant (P = 0.01) 18-mo reductions in pain comparing CBT-PI versus CBT-P (adjusted mean difference [AMD] = -1.29 [95% confidence interval (CI): -2.24,-0.33]). Moderate, albeit nonsignificant, CBT-PI versus EOC treatment effects for insomnia severity (AMD = -1.43 [95% CI: -4.71, 1.86]) and sleep efficiency (AMD = 2.50 [95% CI: -5.04, 10.05]) were also observed. Possible trial design and methodological considerations that may have affected results are discussed. CONCLUSIONS: Results suggest patients with higher levels of comorbid pain and insomnia may be most likely to experience sustained benefit from cognitive behavioral therapy interventions over time, and inclusion of insomnia treatment may yield more clinically meaningful improvements than cognitive behavioral therapy for pain alone. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01142349.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
McCurry et al. (2014) found that at 18-month follow-up, benefits in pain, insomnia severity, and sleep efficiency were larger after CBT-IP than in CBT-P and education intervention groups.
“The long-term (18 months) evaluation of a subgroup of patients with severe pain and insomnia revealed that the benefits gained in pain, insomnia severity and sleep efficiency were larger after CBT-IP than in CBT-P and the education intervention groups (McCurry et al. 2014).”
From Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial (2018) · cites this paper as McCurry et al. 2014
Table 3 (Longitudinal Effects; page unavailable) shows point estimates favoring CBT-PI over CBT-P and education-only control for pain and insomnia severity in the high-pain, high-insomnia subgroup. Its sleep-efficiency estimate also slightly favors CBT-PI, but sleep efficiency declined from baseline in that arm, and group differences in sleep efficiency and insomnia severity were not statistically significant. The claim presents these uncertain comparisons as benefits gained across all three outcomes. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMcCurry et al. (2014) found that patients with high severity of insomnia and pain at baseline showed greater improvements in pain after CBT-IP (compared to CBT-P) at 18 months of follow-up.
“Similarly, McCurry et al. (2014) found that patients with a high severity of insomnia and pain at baseline showed greater improvements in pain after CBT-IP (compared to CBT-P) at 18 months of followup.”
From Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial (2018) · cites this paper as McCurry et al. (2014)
McCurry et al. (2014) found no differences among the three treatment conditions in sleep variables at 18 months of follow-up, though participants with higher baseline insomnia and pain showed greater (but not significant) improvements in insomnia severity and sleep efficiency in the CBT-IP group than in the education intervention group.
“By contrast, no differences among the three treatment conditions in sleep variables were observed at 18 months of follow-up, though participants with higher levels of insomnia and pain at baseline showed greater (but not significant) improvements in insomnia severity and sleep efficiency in the CBT-IP group than in the education intervention group (McCurry et al. 2014).”
From Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial (2018) · cites this paper as McCurry et al. 2014
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Statistical Analysis With Missing Data
Lahiff, M., Little, R. J. A., & Rubin, D. B. (1989) · Journal of the American Statistical Association · doi:10.2307/2289883 · Cited by 17,384 · see citing works
Development and validation of a geriatric depression screening scale: a preliminary report
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982) · Journal of Psychiatric Research · doi:10.1016/0022-3956(82)90033-4 · Cited by 15,025 · see citing works
Multiple imputation using chained equations: Issues and guidance for practice
White, I. R., Royston, P., & Wood, A. M. (2011) · Statistics in Medicine · doi:10.1002/sim.4067 · Cited by 9,792 · see citing works
Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010) · BMJ · doi:10.1136/bmj.c869 · Cited by 8,883 · see citing works
Statistical Analysis with Missing Data
Little, R. J. A., & Rubin, D. B. (2002) · Wiley Series in Probability and Statistics · doi:10.1002/9781119013563 · Cited by 8,473 · see citing works
Longitudinal Data Analysis for Discrete and Continuous Outcomes
Zeger, S. L., & Liang, K. (1986) · Biometrics · doi:10.2307/2531248 · Cited by 7,730 · see citing works
Grading the severity of chronic pain
Von Korff, M., Ormel, J., Keefe, F. J., & Dworkin, S. F. (1992) · Pain · doi:10.1016/0304-3959(92)90154-4 · Cited by 3,022 · see citing works
Self-citation(1987) · PubMed · Cited by 2,657 · see citing works
Wald, A. (1943) · Transactions of the American Mathematical Society · doi:10.1090/s0002-9947-1943-0012401-3 · Cited by 2,522 · see citing works
(1993) · Medical Entomology and Zoology · Cited by 2,324 · see citing works
Fundamentals of Clinical Trials
Friedman, L. M., Furberg, C. D., DeMets, D. L., Reboussin, D. M., & Granger, C. B. (2015) · doi:10.1007/978-3-319-18539-2 · Cited by 2,237 · see citing works
Statistical Analysis of Correlated Data Using Generalized Estimating Equations: An Orientation
Hanley, J. A. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwf215 · Cited by 2,185 · see citing works
Multiple Imputation of Missing Values: Update
Royston, P. (2005) · The Stata Journal Promoting communications on statistics and Stata · doi:10.1177/1536867x0500500204 · Cited by 1,683 · see citing works
Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004)
Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006) · Sleep · doi:10.1093/sleep/29.11.1398 · Cited by 1,345 · see citing works
Fully conditional specification in multivariate imputation
Van Buuren, S., Brand, J. P. L., Groothuis-Oudshoorn, C. G. M., & Rubin, D. B. (2006) · Journal of Statistical Computation and Simulation · doi:10.1080/10629360600810434 · Cited by 1,217 · see citing works
Sleep disturbances and chronic disease in older adults
Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2004.02.010 · Cited by 1,203 · see citing works
Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial
Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999) · JAMA · doi:10.1001/jama.281.11.991 · Cited by 1,095 · see citing works
Edinger, J. D., Bonnet, M. H., Bootzin, R. R., Doghramji, K., Dorsey, C. M., Espie, C. A., Jamieson, A. O., McCall, W. V., Morin, C. M., & Stepanski, E. J. (2004) · Sleep · doi:10.1093/sleep/27.8.1567 · Cited by 1,039 · see citing works
Multiple Imputation of Missing Values: Update of Ice
Royston, P. J. (2005) · The Stata Journal Promoting communications on statistics and Stata · doi:10.1177/1536867x0500500404 · Cited by 1,038 · see citing works
Smith, M. T., & Haythornthwaite, J. A. (2004) · Sleep Medicine Reviews · doi:10.1016/s1087-0792(03)00044-3 · Cited by 914 · see citing works
Meenan, R. F., Mason, J. H., Anderson, J. J., Guccione, A. A., & Kazis, L. E. (1992) · Arthritis & Rheumatism · doi:10.1002/art.1780350102 · Cited by 889 · see citing works
Warsi, A., Wang, P. S., LaValley, M. P., Avorn, J., & Solomon, D. H. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.15.1641 · Cited by 732 · see citing works
Design and analysis of group-randomized trials: a review of recent methodological developments
Murray, D. M., Varnell, S. P., & Blitstein, J. L. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.3.423 · Cited by 677 · see citing works
Dworkin, R. H., Turk, D. C., McDermott, M. P., Peirce-Sandner, S., Burke, L. B., Cowan, P., Farrar, J. T., Hertz, S., Raja, S. N., Rappaport, B. A., et al. (2009) · Pain · doi:10.1016/j.pain.2009.08.019 · Cited by 654 · see citing works
Sleep deprivation and pain perception
LAUTENBACHER, S., KUNDERMANN, B., & KRIEG, J. (2006) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2005.08.001 · Cited by 613 · see citing works
Effect Sizes in Cluster-Randomized Designs
Hedges, L. (2007) · Journal of Educational and Behavioral Statistics · doi:10.3102/1076998606298043 · Cited by 605 · see citing works
A Covariance Estimator for GEE with Improved Small‐Sample Properties
Mancl, L., & DeRouen, T. A. (2001) · Biometrics · doi:10.1111/j.0006-341x.2001.00126.x · Cited by 566 · see citing works
Fundamentals of Clinical Trials
Friedman, L. M., Furberg, C. D., & DeMets, D. L. (2010) · Springer eBooks · doi:10.1007/978-1-4419-1586-3 · Cited by 532 · see citing works
Smith, M. T., Huang, M. I., & Manber, R. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.004 · Cited by 449 · see citing works
Insurer and out‐of‐pocket costs of osteoarthritis in the US: Evidence from national survey data
Kotlarz, H., Gunnarsson, C., Fang, H., & Rizzo, J. A. (2009) · Arthritis & Rheumatism · doi:10.1002/art.24984 · Cited by 440 · see citing works
Espie, C. A. (2009) · SLEEP · doi:10.1093/sleep/32.12.1549 · Cited by 422 · see citing works
The Direct and Indirect Costs of Untreated Insomnia in Adults in the United States
Ozminkowski, R. J., Wang, S. S., & Walsh, J. K. (2007) · SLEEP · doi:10.1093/sleep/30.3.263 · Cited by 403 · see citing works
Osteoarthritis: An Overview of the Disease and Its Treatment Strategies
Sarzi‐Puttini, P., Cimmino, M. A., Scarpa, R., Caporali, R. F., Parazzini, F., Zaninelli, A., Atzeni, F., & Canesi, B. (2005) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2005.01.013 · Cited by 399 · see citing works
Rotnitzky, A. G., & Jewell, N. P. (1990) · Biometrika · doi:10.1093/biomet/77.3.485 · Cited by 388 · see citing works
Behavioral Insomnia Therapy for Fibromyalgia Patients: A Randomized Clinical Trial
Edinger, J. D., Wohlgemuth, W. K., Krystal, A. D., & Rice, J. R. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2527 · Cited by 330 · see citing works
Vitiello, M. V., Rybarczyk, B., Von Korff, M., & Stepanski, E. J. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27547 · Cited by 321 · see citing works
Self-citationCognitive–behavioral treatment of insomnia secondary to chronic pain.
Currie, S. R., Wilson, K. G., Pontefract, A. J., & deLaplante, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.3.407 · Cited by 301 · see citing works
Cognitive-behavioral treatment of insomnia secondary to chronic pain.
Currie, S. R., Wilson, K. G., Pontefract, A. J., & deLaplante, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.68.3.407 · Cited by 299 · see citing works
Arthritis self‐management education programs: A meta‐analysis of the effect on pain and disability
Warsi, A., LaValley, M. P., Wang, P. S., Avorn, J., & Solomon, D. H. (2003) · Arthritis & Rheumatism · doi:10.1002/art.11210 · Cited by 270 · see citing works
Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. D., Kirby, A. C., & Carney, C. E. (2009) · SLEEP · doi:10.1093/sleep/32.4.499 · Cited by 259 · see citing works
The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain
Jungquist, C. R., O’Brien, C., Matteson-Rusby, S., Smith, M. T., Pigeon, W. R., Xia, Y., Lu, N., & Perlis, M. L. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2009.05.018 · Cited by 256 · see citing works
Psychological Approaches to Understanding and Treating Disease-Related Pain
Keefe, F. J., Abernethy, A. P., & Campbell, L. C. (2004) · Annual Review of Psychology · doi:10.1146/annurev.psych.56.091103.070302 · Cited by 256 · see citing works
Li, K. H., Raghunathan, T. E., & Rubin, D. B. (1991) · Journal of the American Statistical Association · doi:10.1080/01621459.1991.10475152 · Cited by 246 · see citing works
Tang, N. K. Y., Goodchild, C. E., Sanborn, A. N., Howard, J., & Salkovskis, P. M. (2012) · SLEEP · doi:10.5665/sleep.1830 · Cited by 208 · see citing works
Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety
Belleville, G., Cousineau, H., Levrier, K., & St-Pierre-Delorme, M.-È. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.02.004 · Cited by 207 · see citing works
Li, K. H., Raghunathan, T. E., & Rubin, D. B. (1991) · Journal of the American Statistical Association · doi:10.2307/2290525 · Cited by 186 · see citing works
Vitiello, M. V., McCurry, S. M., Shortreed, S. M., Balderson, B. H., Baker, L. D., Keefe, F. J., Rybarczyk, B. D., & Von Korff, M. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12275 · Cited by 165 · see citing works
Self-citationHaack, M., Lee, E., Cohen, D. A., & Mullington, J. M. (2009) · Pain · doi:10.1016/j.pain.2009.05.029 · Cited by 158 · see citing works
Tiede, W., Magerl, W., Baumgärtner, U., Durrer, B., Ehlert, U., & Treede, R.-D. (2010) · Pain · doi:10.1016/j.pain.2009.08.029 · Cited by 153 · see citing works
Evidence-based psychological treatments for insomnia in older adults.
McCurry, S. M., Logsdon, R. G., Teri, L. L., & Vitiello, M. V. (2007) · Psychology and Aging · doi:10.1037/0882-7974.22.1.18 · Cited by 143 · see citing works
Self-citationSchwartz, D. R., & Carney, C. E. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.06.006 · Cited by 137 · see citing works
AN ALTERNATIVE TO THE USE OF TWO-SIDED TESTS IN CLINICAL TRIALS
Dunnett, C. W., & Gent, M. (1996) · Statistics in Medicine · doi:10.1002/(sici)1097-0258(19960830)15:16 · Cited by 110 · see citing works
New developments in cognitive behavioral therapy as the first-line treatment of insomnia
Siebern, A. T., & Manber (2011) · Psychology Research and Behavior Management · doi:10.2147/prbm.s10041 · Cited by 91 · see citing works
Sleep difficulties, pain and other correlates
Moffitt, P. F., Kalucy, E. C., Kalucy, R. S., Baum, F. E., & COOKE, R. D. (1991) · Journal of Internal Medicine · doi:10.1111/j.1365-2796.1991.tb00438.x · Cited by 83 · see citing works
McCurry, S. M., Korff, M. V., Vitiello, M. V., Saunders, K. W., Balderson, B. H. K., Moore, A. L., & Rybarczyk, B. D. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.05.012 · Cited by 59 · see citing works
Self-citationMorgan, K., Gregory, P., Tomeny, M., David, B. M., & Gascoigne, C. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04175.x · Cited by 52 · see citing works
Blay, S. L., Andreoli, S. B., & Gastal, F. L. (2007) · Annals of Clinical Psychiatry · doi:10.1080/10401230701468099 · Cited by 39 · see citing works
Korff, M. V., Vitiello, M. V., McCurry, S. M., Balderson, B. H. K., Moore, A. L., Baker, L. D., Yarbro, P., Saunders, K. W., Keefe, F. J., & Rybarczyk, B. D. (2012) · Contemporary Clinical Trials · doi:10.1016/j.cct.2012.03.010 · Cited by 37 · see citing works
Self-citationRybarczyk, B. D., Mack, L., Harris, J. H., & Stepanski, E. J. (2011) · Rehabilitation Psychology · doi:10.1037/a0025577 · Cited by 33 · see citing works
Self-citationRen, X. S., Kazis, L., & Meenan, R. F. (1999) · Arthritis & Rheumatism · doi:10.1002/1529-0131(199906)12:3
Blais (1997) · doi:10.1002/1529-0131(199707)40:7
Flagged first, then by citations
Research works printed but not linked: 1
- Guillemin F, Coste J, Pouchot J, Ghézail M, Bregeon C, Sany J. The AIMS2-SF: A short form of the Arthritis Impact Measurement Scales 2. French Quality of Life in Rheumatology Group. Arthritis Rheum 1997;40:1267-74.
Cited by
Sorted by citations
Cognitive Behavioral Therapy in Persons with Comorbid Insomnia: A Meta-Analysis
Geiger-Brown, J. M., Rogers, V. E., Liu, W., Ludeman, E. M., Downton, K. D., & Diaz-Abad, M. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.11.007 · Cited by 331 · see citing works
Selvanathan, J., Pham, C., Nagappa, M., Peng, P. W. H., Englesakis, M., Espie, C. A., Morin, C. M., & Chung, F. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101460 · Cited by 206 · see citing works
Vitiello, M. V., McCurry, S. M., Shortreed, S. M., Baker, L. D., Rybarczyk, B. D., Keefe, F. J., & Von Korff, M. (2014) · Pain · doi:10.1016/j.pain.2014.04.032 · Cited by 171 · see citing works
Self-citationDaly-Eichenhardt, A., Scott, W., Howard-Jones, M., Nicolaou, T., & McCracken, L. M. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01326 · Cited by 69 · see citing works
Lami, M. J., Martínez, M. P., Miró, E., Sánchez, A. I., Prados, G., Cáliz, R., & Vlaeyen, J. W. S. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-017-9875-4 · Cited by 63 · see citing works
Balderson, B. H., McCurry, S. M., Vitiello, M. V., Shortreed, S. M., Rybarczyk, B. D., Keefe, F. J., & Korff, M. V. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2015.1036271 · Cited by 16 · see citing works
Self-citation
- Authors
- McCurry, S. M., Shortreed, S. M., Von Korff, M., Balderson, B. H., Baker, L. D., Rybarczyk, B. D., & Vitiello, M. V.
- Affiliations
- University of Washington (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Group Health Research Institute, Seattle, WA
- Wake Forest University Health Sciences (US)
- Virginia Commonwealth University (US)
- Corresponding author
- McCurry, Susan M.
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-02-01
- Volume
- 37
- Issue
- 2
- Pages
- 299-308
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC3900626
- OpenAlex
- W1965979686
- Cited by
- 60
- References
- 61
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 9 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 5 · 2016: 4 · 2015: 4 · 2014: 5
- FWCI
- 8.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- National Institutes of Health
- National Institute on Aging (R01AG031126)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- cognitive behavioral therapy for insomnia, group intervention, insomnia, osteoarthritis pain, sleep disorders, older adults, primary care, long-term treatment outcomes, patient selection, trial design, sleep efficiency, pain outcomes
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Sleep Initiation and Maintenance Disorders, Life Style, Longitudinal Studies, Male, Middle Aged, Osteoarthritis, Pain, Primary Health Care, Research Design, Sleep, Cognitive Behavioral Therapy, Treatment Outcome, Patient Selection, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
