A CBT Self-Management Approach for Insomnia Among People with Chronic Pain: A Randomized Controlled Trial
Fotini Zachariades, Ph.D., Alumna, School of Psychology (2012)
Although primary insomnia has received much research attention, much less has been directed toward comorbid insomnia in the context of medical or psychiatric conditions such as chronic pain. Given the overlap between insomnia and other conditions including chronic pain, and that improvement of sleep difficulties may also have a beneficial effect on the management of chronic pain, the treatment of insomnia appears to be of much salience in terms of public health benefits. Cognitive-behaviour therapy (CBT) for insomnia has been applied to some samples with medical conditions such as cancer. Self-management approaches may be a more cost-effective and easily accessible format for the treatment of insomnia. Within the context of chronic pain, a previous study investigated a group-based CBT treatment approach. The present thesis involves a randomized controlled trial testing the efficacy of a CBT-oriented, self-management approach toward insomnia among a chronic pain population. Primary outcome measures included sleep-related variables, while mood, fatigue, and pain severity served as the secondary outcomes. Additionally, the potential mediating role of pre-sleep arousal and pain-related disability in the context of insomnia and chronic pain were investigated. Participants were adult outpatients with chronic pain recruited from a hospital rehabilitation centre and pain clinic. Findings indicated improvements amongst intervention group participants in terms of insomnia severity, time to fall asleep, and fatigue severity, relative to control group participants at post-treatment. Furthermore, findings supported the mediating role of pain-related disability and pre-sleep arousal. Theoretical, methodological, and clinical implications are discussed.