Abstract
We examined individual responses to cognitive-behavior therapy for insomnia in 51 persons with chronic pain to determine the rate of clinically significant change and to identify predictors of successful treatment response. Outcome measures consisted of the Pittsburgh Sleep Quality Index (PSQI) and diary measures of sleep latency and sleep continuity. Using reliable change indices, 57% of participants were statistically improved on the PSQI after 7 weeks of treatment, but only 18% were considered fully recovered from their sleep problems. No demographic variables predicted treatment response but persons who reliably improved on the PSQI had a lower sleep self-efficacy at baseline. Improvers showed a significant increase in sleep self-efficacy ratings and a decrease in self-reported levels of distress and pain-related disability. These results suggest that patients with insomnia secondary to chronic medical conditions can be helped with cognitive-behavior therapy, although most individuals continue to have mild or subthreshold sleep problems at posttreatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Beck, A. T., Ward, C. H., Mendelson, M. M., Mock, J., and Erbaugh, J. (1961). An inventory for measuring depression. Arch. Gen. Psychiatry 4: 561–571.
Bergner, M., Bobbitt, R. A., Carter, W. B., and Gilson, B. S. (1981). The Sickness Impact Profile: Development and final revision of a health status measure. Med. Care 19: 787–805.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., and Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 28: 193–213.
Carpenter, J. S., and Andrykowski, M. A. (1996). Psychometric evaluation of the Pittsburgh Sleep Quality Index. J. Psychosom. Res. 45: 5–13. 152 Currie,Wilson, and Curran
Carskadon, M. A., Dement, W. C., Mitler, M., Guilleminault, C., Zarcone, V. P., and Spiegel, R. (1976). Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am. J. Psychiatry 133: 1382–1388.
Currie, S. R., and Wilson, K. G. (1997). Coping with chronic pain sleep problems: A selfmanagement approach. Unpublished manuscript.
Currie, S. R., Wilson, K. G., Pontefract, A. J., and deLaplante, L. (2000). Cognitive-behavioral treatment of insomnia secondary to chronic pain. J. Consult. Clin. Psychol. 68: 407–416.
Edinger, J. D., and Wohlgemuth, W. (1999). The significance and management of persistent primary insomnia: The past, present, and future of behavioral insomnia therapies. Sleep Med. Rev. 3: 101–118.
Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., and Quillian, R. E. (2001). Cognitive behavioral therapy for treatment of chronic primary insomnia: A randomized controlled trial. JAMA 285: 1856–1864.
Espie, C. A., Inglis, S. J., and Harvey, L. (2001a). Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: Analyses of outcome data at 12 months posttreatment. J. Consult. Clin. Psychol. 69:58–66.
Espie, C. A., Inglis, S. J., Tessier, S., and Harvey, L. (2001b). The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: Implementation and evaluation of a sleep clinic in general medical practice. Behav. Res. Ther. 39: 45–60.
Gagne, A., and Morin, C. M. (2001). Predicting treatment response in older adults with insomnia. J. Clin. Geropsychol. 7: 131–143.
Jacobson, N. S., and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J. Consult. Clin. Psychol. 59: 12–19.
Jacobson, N. S., Follette, W. C., Revenstorf, D., Baucom, D. H., Hahlweg, K., and Margolin, G. (1984). Variability in outcome and clinical significance of behavioral martial therapy: A reanalysis of data. J. Consult. Clin. Psychol. 52: 497–504.
Jacobson, N. S., Roberts, L. J., Berns, S. B., and McGlinchey, J. B. (1999). Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives. J. Consult. Clin. Psychol. 67: 300–307.
Kerns, R. D., Turk, D. C., and Rudy, T. E. (1985). TheWest-Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 23: 345–356.
Lacks, P. (1987). Behavioral Treatment of Persistent Insomnia, Pergamon Press, Elmsford, NY.
Lacks, P., and Morin, C. (1992). Recent advances in the assessment and treatment of insomnia. J. Consult. Clin. Psychol. 60: 586–594.
Lacks, P., and Powlishta, K. (1989). Improvement following behavioral treatment for insomnia: Clinical significance, long-term maintenance, and predictors of outcome. Behav. Ther. 20: 117–134.
Lichstein, K. L., and Riedel, T. L. (1994). Behavioral assessment and treatment of insomnia: A review with an emphasis on clinical application. Behav. Ther. 25: 659–688.
Mimeault, V., and Morin, C. M. (1999). Self-help treatment for insomnia: Bibliotherapy with and without professional guidance. J. Consult. Clin. Psychol. 67: 511–519.
Morin, C. (1993). Insomnia: Psychological Assessment and Management, Guilford Press, New York.
Morin, C. M., Culbert, J. P., and Schwartz, M. S. (1994). Nonpharmacologic interventions for insomnia: A meta-analysis of treatment efficacy. Am. J. Psychiatry 151: 1172–1180.
Morin, C. M., Colecchi, C., Ling, W. D., and Sood, R. (1995). Cognitive-behavior therapy to facilitate benzodiazepine discontinuation among hypnotic dependent patients with insomnia. Behav. Ther. 26: 733–745.
Morin, C. M., Colecchi, C., Stone, J., Sood, R., and Brink, D. (1999a). Behavioral and pharmacological therapies for late-life insomnia: A randomized controlled trial. JAMA 281: 991–999.
Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., and Bootzin, R. R. (1999b). Nonpharmacologic treatment of chronic insomnia. Sleep 22: 1134–1156.
Murtagh, D. R. R., and Greenwood, K. M. (1995). Identifying effective psychological treatments for insomnia: A meta-analysis. J. Consult. Clin. Psychol. 63: 79–89. Insomnia Treatment Response 153
National Institutes of Health Technology Assessment Panel (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA 276: 313–318.
Ogles, B. M., Lambert, M. J., and Sawyer, J. D. (1995). Clinical significance of the National Institute of Mental HealthTreatment of Depression Collaborative Research Program Data. J. Consult. Clin. Psychol. 63: 321–326.
Perlis, M., Aloia, M., Millikan, A., Boehmler, J., Smith, M., Greenblatt, D., and Giles, D. (2000). Behavioral treatment of insomnia: A clinical case series study. J. Behav. Med. 23: 149–161.
Roland, M., and Morris, R. (1983). A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low back pain. Spine 8: 141–144.
Schauenberg, H., and Strack, M. (1999). Measuring psychotherapeutic change with the Symptom Checklist SCL 90 R. Psychother. Psychosom. 68: 199–206.
Schramm, E., Hohagen, F., Grasshoff, U., Riemann, D., Hajak, G., Hans-Gunther, W., and Berger, M. (1993). Test-retest reliability and validity of the Structured Interview for Sleep Disorders according to DSM-III-R. Am. J. Psychiatry 150: 867–872.
Steedman, S. M., Middaugh, S. J., Kee, W. G., Carson, D. S., Harden, R. N., and Miller, M. C. (1992). Chronic pain medications: Equivalence levels and method of quantifying usage. Clin. J. Pain 8: 204–214.
Wilson, K. G., Watson, S. T., and Currie, S. R. (1998). Daily diary and ambulatory activitiy monitoring of sleep in patients with insomnia secondary to chronic pain. Pain 75: 75–84.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Currie, S.R., Wilson, K.G. & Curran, D. Clinical Significance and Predictors of Treatment Response to Cognitive-Behavior Therapy for Insomnia Secondary to Chronic Pain. J Behav Med 25, 135–153 (2002). https://doi.org/10.1023/A:1014832720903
Issue Date:
DOI: https://doi.org/10.1023/A:1014832720903