Daly-Eichenhardt Aisling, Scott Whitney, Howard-Jones Matthew, Nicolaou Thaleia, McCracken Lance M
INPUT Pain Management, Guys and St. Thomas NHS Foundation Trust Hospitals London, UK.
Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London London, UK.
Front Psychol. 2016 Aug 31;7:1326. doi: 10.3389/fpsyg.2016.01326. eCollection 2016.
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.
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.
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.
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.
认知行为疗法（CBT）对睡眠问题和慢性疼痛的治疗已显示出良好效果，尽管这些效果仍有提升空间。基于心理灵活性模型（接纳与承诺疗法[ACT]的基础模型）的最新进展可能会为传统CBT增添有益内容。本研究旨在探讨基于ACT的慢性疼痛治疗是否与睡眠改善相关。其次，我们研究了心理灵活性测量指标的变化与睡眠相关结果之间的关联。
本研究采用观察性队列研究方法。参与者为252名患者（73.8%为女性），他们参加了英国伦敦为期4周的跨学科疼痛管理项目。参与者完成了疼痛和功能、睡眠结果以及心理灵活性过程的标准自我报告测量。使用配对样本t检验检查治疗前至治疗后以及治疗前至随访测量的统计学显著差异。其次，进行分层多元回归分析，以检查过程测量指标的变化与治疗结果变化之间的关系。
参与者在治疗后失眠严重程度（d = 0.45）、睡眠干扰（d = 0.61）和睡眠效率（d = 0.32）测量指标上显示出统计学显著改善（所有p < 0.001）。在9个月随访时，失眠严重程度和睡眠干扰也有显著改善。在各项睡眠结果中观察到小到中等效应量。心理灵活性测量指标也有统计学显著变化，这些改善与睡眠相关结果的改善显著相关，独立贡献高达19%的独特方差。
本研究支持基于ACT的慢性疼痛治疗在解决并发睡眠困难方面的潜在有用性。需要进一步研究以确定如何改善这种治疗对共病疼痛和睡眠困难的影响，可能采用随机对照试验设计。
