Toward a Synergistic Cognitive-Behavioral Model for Concomitant Insomnia and Pain -- Jeff Bryson
Cognitive-behavioral models and interventions exist for insomnia and pain independently. A large number of individuals exhibit concomitant pain and insomnia and a synergistic model for understanding these conditions among those experiencing both conditions is needed. This study examined cognitive-behavioral aspects of pain and insomnia among those with concomitant insomnia and chronic pain. One-hundred eleven individuals between the ages of 21 and 65 meeting the general criteria for chronic pain and insomnia were included in this study. Participants completed a demographics form and a packet including the Dysfunctional Beliefs and Attitudes about Sleep – 16-item version, Insomnia Severity Index, Sleep Hygiene Index, Sleep Associated Monitoring Index, Pain Catastrophizing Scale, Pain Disability Questionnaire, Modified Somatic Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support. Pain catastrophizing (PC) and dysfunctional beliefs and attitudes about sleep (DBAS), as well as somatic awareness and sleep-associated monitoring were significantly correlated. Two backward stepwise regression models were utilized to determine a model for predicting insomnia severity and pain disability respectively using a combination of sleep and pain-associated measures. Both insomnia severity and pain disability were predicted by PC and DBAS. Insomnia severity was also predicted by somatic awareness and pain disability by depression and social support. A third backward stepwise regression was used to examine sleep hygiene variables that predicted insomnia severity. Napping, exercise near bedtime, engaging in cognitively arousing activities near bedtime, general stimulus control, as well as stress, emotionality, worry, thinking, and planning at bedtime were the best predictors. Maladaptive thought patterns related to pain and insomnia and associated features appear to have a synergistic effect on both insomnia and pain disability and support a combined cognitive-behavioral model.