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Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial

Cognitive Therapy and Research volume 42, pages 63–79 (2018)Cite this article

Abstract

This controlled trial aims to analyze the efficacy of cognitive-behavioral therapy for insomnia and pain (CBT-IP) compared to cognitive-behavioral therapy for pain (CBT-P) and usual medical care (UMC) at improving sleep and other clinical manifestations (pain, fatigue, impaired functioning, and emotional distress) in women with fibromyalgia (FM). One hundred and twenty-six patients with FM were randomly assigned to different treatment groups and 113 completed the treatments (38 in the CBT-IP group, 34 in the CBT-P group and 41 in the UMC group) and a number of self-reports at pre-treatment, post-treatment, and 3 months of follow-up. The CBT-IP group showed significant improvements at post-treatment in several sleep variables (i.e., subjective sleep quality, sleep latency, sleep efficiency, and use of sleeping medication) that were not observed in the CBT-P and UMC groups. The CBT-IP and CBT-P groups reported significant improvements at post-treatment in FM impact and self-efficacy for coping with pain; the CBT-IP group reported improvements at follow-up in pain intensity, and the CBT-P reported improvements at post-treatment in pain catastrophizing and pain acceptance. Clinical improvements are also described. The findings revealed differential responses between groups regarding sleep and other adjustment parameters and the CBT-IP group exhibited the best clinical response pattern overall. More research in the area of FM treatment is needed to enhance the efficacy of the CBT and identify which patients are likely to benefit from each modality of CBT.

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Funding

This research was financially supported by the Spanish Ministry of Science and Innovation (ref. PSI2009-13765PSIC) and Spanish Ministry of Economy and Competitiveness (ref. PSI2014-58379-P).

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Authors and Affiliations

  1. Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain

    María J. Lami, M. Pilar Martínez, Elena Miró & Ana I. Sánchez

  2. Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain

    M. Pilar Martínez, Elena Miró & Ana I. Sánchez

  3. Department of Nursing, University of Granada, Granada, Spain

    Germán Prados

  4. Rheumatology Service, Virgen de las Nieves University Hospital, Granada, Spain

    Rafael Cáliz

  5. Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium

    Johan W. S. Vlaeyen

  6. Faculty of Psychology and Neuroscience, Research Group Behavioral Medicine, Maastricht University, Maastricht, Netherlands

    Johan W. S. Vlaeyen

  7. Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Granada, Campus Universitario de Cartuja, s/n, 18071, Granada, Spain

    María J. Lami

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María J. Lami, M. Pilar Martínez, Elena Miró, Ana I. Sánchez, Germán Prados, Rafael Cáliz and Johan W. S. Vlaeyen declares that they have no conflict of interest.

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Lami, M.J., Martínez, M.P., Miró, E. et al. Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial. Cogn Ther Res 42, 63–79 (2018). https://doi.org/10.1007/s10608-017-9875-4

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Keywords

  • Fibromyalgia
  • Cognitive-behavioral therapy
  • Insomnia
  • Randomized controlled trial