Acceptance-based behavioural treatment for insomnia in chronic pain: A clinical pilot study

Authors:
Vendela Zetterqvist, Rebecca Grudin, Jenny Rickardsson, Rikard K. Wicksell, & Linda Holmström

Abstract:
Background
For patients with chronic pain the prevalence of insomnia is 5–8 times higher as compared to the general population. Acceptance and Commitment Therapy (ACT) has gained strong empirical support in the treatment of chronic pain and is today increasingly used in pain clinics. However, no ACT-consistent treatment for insomnia in chronic pain has yet been empirically evaluated, although preliminary data show a relation between acceptance and aspects of insomnia. The aim of this clinical pilot study was to develop and evaluate the feasibility and preliminary outcome of an acceptance-based behavioural group treatment protocol for insomnia in patients with chronic pain.

Methods
Patients with chronic pain who had completed an ACT program to improve behavioural flexibility and functioning, and continued to have poor sleep to an extent that met the diagnostic criteria for insomnia, were considered eligible for participation in an acceptance-based behavioural group treatment for insomnia. Sixteen patients were enrolled in the study. Feasibility and treatment effects (primary outcome measure: Insomnia Severity Index, ISI) were assessed pre- and post treatment, as well as three months post- treatment.

Results
There was a satisfying degree of retention and treatment compliance. On average patients participated in 5.31 (SD=0.70) out of six group sessions and completed 4.63 (SD = 0.62) of the five homework assignments. Overall, the completion rate of planned assessments was acceptable. However, assessment of sleep diary data at follow-up had 37.5% missing data and the recruitment rate averaged one patient per month. Significant improvements were seen in most outcomes, and results were maintained at follow-up, with large effects on primary outcome (ISI) at post-treatment g′= 2.02, 95% CI [0.90–3.14], and at follow-up g′= 1.69, 95% CI [.59, 2.78]. At follow-up twelve (75.0%) of the patients were classified as responders, of which five (31.2%) were remitters.

Conclusion
Results overall showed a satisfying degree of feasibility with regards to retention, treatment compliance and completion of planned assessments. Changes in procedure are required in order to optimise recruitment rate. The treatment is potentially promising in terms of improved sleep for patients with longstanding pain. Larger, randomised controlled studies are needed to evaluate the treatment.

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