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Comparing the Effects of CBT on Insomnia and Fibromyalgia Pain

January 10, 2019
Insomnia patients may reap the best benefits from cognitive behavioral therapy

A PPM Brief

A study1 examined the effects of cognitive behavioral therapy (CBT) for insomnia and pain (CBT-I and CBT-P, respectively) in patients with comorbid fibromyalgia and insomnia. A total of 113 patients (median age = 53, SD = 10.9) were randomized to eight sessions in an insomnia group (CBT-I; n = 39), a pain group (CBT-P; n = 37), or a waitlist control (WLC, n = 37).

Primary outcomes included self-reported sleep onset latency, wake after sleep onset, sleep efficiency, sleep quality, and pain ratings, while secondary outcomes included dysfunctional beliefs and attitudes about sleep; actigraphy and polysomnography sleep onset latency, wake after sleep onset, and sleep efficiency. These outcomes were examined post-treatment and after a 6-month follow up through the McGill Pain Questionnaire and Pain Disability Index.

Insomnia patients may reap the best benefits from cognitive behavioral therapy. (Source: 123RF)

Results showed that:

  • Both treatments improved self-reported wake after sleep onset, sleep efficiency, and sleep quality relative to control at post-treatment and follow-up in a mixed effects analyses, with generally larger effect sizes for CBT-I.
  • Dysfunctional beliefs and attitudes about sleep improved only in the CBT-I group.
  • The proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I post-treatment and for both treatments at 6 months relative to control in a clinical significance analyses.
  • Few participants achieved greater than 50% pain reductions.
  • Proportion achieving pain reductions of greater than 30% (~1/3) was higher for both treatments post-treatment and for CBT-I at 6 months relative to control.
  • Pain and mood improvements did not differ by group.

“Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and [the] mechanisms driving intervention effects is needed,” study authors concluded.

Last updated on: January 17, 2019
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