Abstract
Aims: Cognitive and behavioral treatments (CBT) for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT) may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related outcomes.Methods: The study used an observational cohort methodology. Participants were 252 patients (73.8% female) attending a 4-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibility. Pre- to post-treatment, and pre-treatment to follow-up measures were examined for statistically significant differences using paired samples t-tests. Secondarily, hierarchical multiple regression analyses were conducted to examine change in process measures in relation to change in treatment outcome.Results: Participants showed statistically significant improvements (all p < 0.001) at post-treatment on measures of insomnia severity (d = 0.45), sleep interference (d = 0.61), and sleep efficiency (d = 0.32). Significant improvements in insomnia severity and sleep interference were also observed at 9-month follow up. Small to medium effect sizes were observed across the sleep outcomes. Statistically significant changes were also observed on measures of psychological flexibility, and these improvements were significantly associated with improvements on sleep-related outcomes, independently contributing up to 19% of unique variance.Conclusion: This study supports the potential usefulness of ACT-based treatments for chronic pain for addressing co-occurring sleep difficulties. Further research is needed to determine how to improve the impact of this treatment for co-morbid pain and sleep difficulties, possibly using a randomized-controlled trial design.
Highlights
Sleep is clearly an important factor in the experience of chronic pain
Improvements in pain intensity, pain interference, and depression were significantly correlated with improvements in insomnia severity and sleep interference
Improvements on all of the psychological flexibility processes were significantly correlated with improvements in insomnia severity and sleep interference
Summary
When people with chronic pain are asked to identify the most important areas of their life impacted by pain, sleep is rated among their top five (Turk et al, 2008). There is likely a bi-directional relationship between chronic pain and insomnia (Koffel et al, 2016). Given that both chronic pain and sleep difficulties are independently linked to reduced quality of life, a greater focus on addressing insomnia in the context of chronic pain is needed (Currie et al, 2002; Smith and Haythornthwaite, 2004; Tang et al, 2007; Fishbain et al, 2010; McCracken et al, 2011)
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