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Mazzer, K., Boersma, K. & Linton, S. J. (2019). A longitudinal view of rumination, poor sleep and psychological distress in adolescents. Journal of Affective Disorders, 245, 686-696
Open this publication in new window or tab >>A longitudinal view of rumination, poor sleep and psychological distress in adolescents
2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 245, p. 686-696Article in journal (Refereed) Published
Abstract [en]

Background: Given the high prevalence and negative impact of psychological problems during adolescence, examining transdiagnostic factors that may have scope to positively influence a variety of psychological problems is imperative. The main purpose of this study was to investigate the longitudinal relationship between rumination and psychological distress and whether sleep mediated this relationship over a 2 year period.

Methods: Participants were 1620 high school students in the 7th and 8th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2014, 2015 and 2016. Rumination and psychological distress were self-reported, and sleep duration was calculated from reported bed-times, wake-times and sleep onset latencies.

Results: Sleep duration declined with age, whereas rumination and psychological distress increased. Rumination was predictive of future psychological distress and distress at a given time was predictive of concurrent rumination. Sleep duration did not consistently mediate the reciprocal relationships between rumination and psychological distress over time.

Limitations: Stronger longitudinal associations may have been obtained by using smaller measurement intervals or further delineation of outcome constructs.

Conclusions: Reducing rumination, rather than targeting sleep patterns, may work towards preventing the development of a number of psychological problems and is a strategy anticipated to function across disorders to improve young people's mental wellbeing.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Rumination, Adolescence, Sleep, Distress, Longitudinal
National Category
Neurology Psychiatry
Identifiers
urn:nbn:se:oru:diva-72423 (URN)10.1016/j.jad.2018.11.053 (DOI)000456697100084 ()30447567 (PubMedID)2-s2.0-85056473453 (Scopus ID)
Funder
Swedish Research Council Formas
Available from: 2019-02-14 Created: 2019-02-14 Last updated: 2019-02-14Bibliographically approved
Boersma, K., Södermark, M., Hesser, H., Flink, I., Gerdle, B. & Linton, S. J. (2019). Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial. Pain, 160(8), 1708-1718
Open this publication in new window or tab >>Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial
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2019 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed) Published
Abstract [en]

The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-75576 (URN)10.1097/j.pain.0000000000001575 (DOI)31335641 (PubMedID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Caneiro, J. P., Smith, A., Linton, S. J., Moseley, G. L. & O'Sullivan, P. (2019). How does change unfold? an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy: A replicated single-case experimental design study. Behaviour Research and Therapy, 117, 28-39
Open this publication in new window or tab >>How does change unfold? an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy: A replicated single-case experimental design study
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2019 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 117, p. 28-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To understand the process of change at an individual level, this study used a single-case experimental design to evaluate how change in potential mediators related to change in disability over time, during an exposure-based behavioural intervention in four people with chronic low back pain and high pain-related fear. A second aim was to evaluate whether the change (sequential or simultaneous) in mediators and disability occurred at the same timepoint for all individuals.

RESULTS: For all participants, visual and statistical analyses indicated that changes in disability and proposed mediators were clearly related to the commencement of Cognitive Functional Therapy. This was supported by standard outcome assessments at pre-post timepoints. Cross-lag correlation analysis determined that, for all participants, most of the proposed mediators (pain intensity, pain controllability, and fear) were most strongly associated with disability at lag zero, suggesting that mediators changed concomitantly and not before disability. Importantly, these changes occurred at different rates and patterns for different individuals, highlighting the individual temporal variability of change.

CONCLUSION: This study demonstrated the interplay of factors associated with treatment response, highlighting 'how change unfolded' uniquely for each individual. The findings that factors underpinning treatment response and the outcome changed simultaneously, challenge the traditional understanding of therapeutic change.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Behavioural change, Low back pain, Mediators, Pain-related fear, Process of change
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-74575 (URN)10.1016/j.brat.2019.02.007 (DOI)000470947600004 ()30853096 (PubMedID)2-s2.0-85062389222 (Scopus ID)
Note

Funding Agencies:

Australian Postgraduate Award (APA)  

Curtin University Postgraduate (CUPS)  

National Health & Medical Research Council of Australia  

Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2019-07-23Bibliographically approved
Nicholas, M. K., Costa, D. S., Linton, S. J., Main, C. J., Shaw, W. S., Pearce, G., . . . McGarity, A. (2019). Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care. Journal of occupational rehabilitation
Open this publication in new window or tab >>Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care
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2019 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1-3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Early intervention, Psychosocial factors, Screening, Work injury, Workers’ compensation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-75572 (URN)10.1007/s10926-019-09849-y (DOI)31346923 (PubMedID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Nicholas, M. K., Costa, D. S., Linton, S. J., Main, C. J., Shaw, W. S., Pearce, R., . . . McGarity, A. (2019). Predicting Return to Work in a Heterogeneous Sample of Recently Injured Workers Using the Brief ÖMPSQ-SF. Journal of occupational rehabilitation, 29(2), 295-302
Open this publication in new window or tab >>Predicting Return to Work in a Heterogeneous Sample of Recently Injured Workers Using the Brief ÖMPSQ-SF
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2019 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 29, no 2, p. 295-302Article in journal (Refereed) Published
Abstract [en]

Purpose: (1) to examine the ability of the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) to predict time to return to pre-injury work duties (PID) following a work-related soft tissue injury (regardless of body location); and (2) to examine the appropriateness of 50/100 as a suitable cut-off score for case identification.

Methods: Injured workers (IW) from six public hospitals in Sydney, Australia, who had taken medically-sanctioned time off work due to their injury, were recruited by insurance case managers within 5-15 days of their injury. Eligible participants (N = 213 in total) were administered the ÖMPSQ-SF over the telephone by the case manager. For objective (1) Cox proportional hazards regression analysis was used to predict days to return to PID using the ÖMPSQ-SF. For objective (2) receiver operator characteristic (ROC) analysis was used to determine the ÖMPSQ-SF total score that optimises sensitivity and specificity in detecting whether or not participants had returned to PID within 2-7 weeks.

Results: The total ÖMPSQ-SF score significantly predicted number of days to return to PID, such that for every 1-point increase in the total ÖMPSQ-SF score the predicted chance of returning to work reduced by 4% (i.e., hazard ratio = 0.96), p < 0.001. Sensitivity and specificity for the ROC analysis comparing ÖMPSQ-SF total score to return to PID within 2-7 weeks suggested 48 as the optimal cut off (sensitivity = 0.65, specificity = 0.79).

Conclusion: The results provide strong support for the use of the ÖMPSQ-SF in an applied setting for identifying those IW likely to have delayed RTW when administered within 15 days of the injury. While a score of 48/100 was the optimal cut point for sensitivity and specificity, pragmatically, 50/100 should be acceptable as a cut-off in future studies of this type.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Psychosocial factors, Screening, Work injury, Worker’s compensation
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-74590 (URN)10.1007/s10926-018-9784-8 (DOI)000468806600004 ()29796980 (PubMedID)2-s2.0-85047240649 (Scopus ID)
Note

Funding Agencies:

NSW Ministry of Health  

EML Insurance  

icare 

Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2019-06-14Bibliographically approved
Flink, I., Boersma, K., Klein-Strandberg, E. & Linton, S. J. (2019). Responding to social cues: An experimental paradigm exploring the link between context sensitivity and pain. British Journal of Health Psychology, 24(2), 443-459
Open this publication in new window or tab >>Responding to social cues: An experimental paradigm exploring the link between context sensitivity and pain
2019 (English)In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 24, no 2, p. 443-459Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The term context sensitivity refers to whether a response is in tune with the ever changing demands of the context, while insensitivity is the lack of responding to these cues. To date, we know little about how well patients with pain respond emotionally to changes in the cues provided by the social context, that is, how emotionally context (in)sensitive they are and if this is related to problem severity. The aim of this experimental study was to test a method for determining levels of context sensitivity in individuals with subacute and chronic pain and to explore the link between context (in)sensitivity and pain-related problems. We operationalized context (in)sensitivity as participants' emotional responses (observed facial expressions and self-reported affect) and pain bothersomeness in these contexts and explored the association between these context-(in)sensitive social-emotional responses and pain-related problems.

METHODS: Sixty-two participants with pain were cued to talk openly about three different topics consecutively in a counterbalanced order: (1) their pain, (2) a negative non-pain topic, and (3) a positive non-pain topic. We measured the participants' emotional responses (observed facial expressions and self-reported affect) and pain bothersomeness across these contexts and explored the effect of social-emotional responding on pain-related problems.

RESULTS: The results showed that, irrespective of individuals' baseline levels of pain bothersomeness, positive affect, and negative affect, those who reacted with more negative affect and pain bothersomeness when prompted to discuss a positive topic had higher levels of pain-related problems. Moreover, those who showed more negative facial expressions and pain bothersomeness when prompted to discuss a negative non-pain topic also had higher levels of pain-related problems.

CONCLUSIONS: These findings highlight a link between sensitivity to the social context and the severity of a pain problem. We showed that individuals with greater problem severity were less sensitive to social cues in their emotional responses, as compared to individuals with less pain-related problems. As predicted, context-insensitive responding appears to be most strongly associated with pain-related problems when dealing with negative emotions. Although the cross-sectional nature of the study prohibits causal conclusions, our findings demonstrate a link and future research is clearly needed to unravel the role of context sensitivity in the development of pain over time.

Statement of contributionWhat is already known on this subject?

  • Responding to social cues seems to be important for adaptation to pain. The term context sensitivity refers to whether a response is in tune with the provided social cue. To date, we know little about how well patients with persistent pain respond emotionally to changes in the social context, that is, how context (in)sensitive they are and if this is linked to problem severity.

What does this study add?

  • A test of a method for determining levels of context sensitivity in individuals with persistent pain.
  • Information about to what extent individuals with chronic pain respond context sensitively.
  • Knowledge on the link between social context sensitivity and level of pain problems.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Chronic pain, context sensitivity, flexibility, social context
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-74213 (URN)10.1111/bjhp.12362 (DOI)000466379000012 ()30907044 (PubMedID)2-s2.0-85063340334 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P14-0799:1
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2019-06-19Bibliographically approved
Engman, L., Flink, I., Ekdahl, J., Boersma, K. & Linton, S. J. (2018). Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain. European Journal of Pain, 22(8), 1388-1398
Open this publication in new window or tab >>Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain
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2018 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 8, p. 1388-1398Article in journal (Refereed) Published
Abstract [en]

Background: Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.

Methods: One hundred and seventeen women, 18-35years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

Results: Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.

Conclusions: Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.

Significance: In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Psychology Anesthesiology and Intensive Care Neurology
Identifiers
urn:nbn:se:oru:diva-66612 (URN)10.1002/ejp.1227 (DOI)000441435800002 ()29635880 (PubMedID)2-s2.0-85045933115 (Scopus ID)
Available from: 2018-04-17 Created: 2018-04-17 Last updated: 2018-08-27Bibliographically approved
Engman, L., Flink, I., Ter Kuile, M. & Linton, S. J. (2018). CBT group treatment for vulvovaginal pain with partner involvement: a single case experimental design pilot. In: : . Paper presented at IASR (International Academy of Sex Research) 44th annual meeting, Madrid, Spain, 2018.
Open this publication in new window or tab >>CBT group treatment for vulvovaginal pain with partner involvement: a single case experimental design pilot
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Recurring pain in the vulvovaginal regional induced by touch or pressure is thought to be the most frequent cause of superficial dyspareunia in premenopausal women. Its prevalence is 7-15% in community samples and has a serious impact on couples sexual function, sexual satisfaction, general psychological well-being and overall quality of life.

The last decade of research suggests that psychological factors, such as fear of pain, catastrophizing, and avoidance behavior may contribute to the maintenance and exacerbation of dyspareunia. Conventional cognitive behavioral therapy (CBT) interventions aim at reducing pain, restoring sexual function and improving the romantic relationship by targeting the thoughts, emotions, behaviors and couple interactions associated with the experience of dyspareunia. Furthermore, given the interpersonal sexual context in which dyspareunia is most often triggered, relationship factors is an important area to address.

Research Questions: The primary purpose is to evaluate whether a CBT group program with partner involvement improves pain during penetration in women with superficial dyspareunia. Secondary objectives are to evaluate women’s (and their partner’s) sexuality (sexual function & satisfaction), psychological adjustment (negative and positive penetration beliefs, pain coping behaviour) and relationship factors (relationship satisfaction). 

Methods: The current study consists of a CBT group treatment program of 10 group sessions and 3 individual couple sessions distributed over a period of 6 months. The study will employ a single case experimental design with multiple baselines (N=6) where each individual represents a case and is randomized to a specific length of baseline. The primary and secondary outcomes will be measured weekly through both baseline and treatment phase to enable investigation of changes in outcome between the two phases. Additionally, secondary outcomes for both women and their partners are measured pre- and post-treatment. Single case experimental designs are recommended as a first step to investigate individual responses to psychological interventions as well as testing interventions as a pilot before implementing treatments in extensive RCT studies (Morley, 2017).

Results: Data collection is in progress and will be completed early June 2018. The results of the study will be presented at the conference.

Keywords
Vulvovaginal pain, CBT group treatment, Partner participation, Single case experimental design
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-70480 (URN)
Conference
IASR (International Academy of Sex Research) 44th annual meeting, Madrid, Spain, 2018
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2018-12-04Bibliographically approved
Edebol-Carlman, H., Schrooten, M. G. S., Ljóttson, B., Boersma, K., Linton, S. J. & Brummer, R. J. (2018). Cognitive behavioral therapy for irritable bowel syndrome: the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial. Scandinavian Journal of Pain, 18, 81-91
Open this publication in new window or tab >>Cognitive behavioral therapy for irritable bowel syndrome: the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial
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2018 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, p. 81-91Article in journal (Refereed) Published
Abstract [en]

Background and aims: Irritable bowel syndrome (IBS), is a common multifactorial gastrointestinal disorder linked to disturbances in the microbe gut-brain axis. Cognitive behavioral therapy (CBT), in face-to-face format has showed promising results on IBS and its associated psychological symptoms. The present study explored for the first time if CBT for IBS affects the autonomic nervous system (ANS) during experimentally induced visceral pain and cognitive stress, respectively. The levels of state and trait anxiety, current and perceived stress were also evaluated.

Methods: In this uncontrolled trial, individual CBT was performed in face-to-face format for 12 weeks in 18 subjects with IBS. Heart rate variability and skin conductance were measured during experimentally induced visceral pain and during a cognitive task (Stroop color-word test), before and after intervention. The levels of state and trait anxiety as well as self-rated current and perceived stress were also measured before and after the intervention.

Results: CBT did not affect ANS activity during experimentally induced visceral pain and cognitive stress. The sympathetic activity was high, typical for IBS and triggered during both visceral pain and cognitive stress. The levels of state and trait anxiety significantly decreased after the intervention. No significant changes in self-rated current or perceived stress were found.

Conclusions: Results suggest that face-to-face CBT for IBS improved anxiety- a key psychological mechanism for the IBS pathophysiology, rather than the autonomic stress response to experimentally induced visceral pain and cognitive stress, respectively.

Place, publisher, year, edition, pages
Walter de Gruyter, 2018
Keywords
irritable bowel syndrome; cognitive behavioral therapy; state anxiety; trait anxiety; stress; autonomic nervous system; visceral hypersensitivity
National Category
Neurology
Identifiers
urn:nbn:se:oru:diva-64294 (URN)10.1515/sjpain-2017-0153 (DOI)000426817200009 ()2-s2.0-85043578532 (Scopus ID)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-03-27Bibliographically approved
Wiklund, T., Linton, S. J., Alföldi, P. & Gerdle, B. (2018). Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management?: A randomized controlled study. BMC Musculoskeletal Disorders, 19(1), Article ID 111.
Open this publication in new window or tab >>Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management?: A randomized controlled study
2018 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, no 1, article id 111Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Most people suffering chronic pain are plagued by sleeping difficulties. Cognitive behaviour therapy has produced promising results for insomnia comorbid with chronic pain, but the access to such treatment is often limited. Over the last ten years, interventions aiming to increase cognitive flexibility and physical activity have been assumed to be effective treatments for a variety of conditions, including insomnia and chronic pain. If proven effective, these treatments could constitute the first steps in a stepped care model for chronic pain and insomnia.

METHODS: Two hundred ninety-nine chronic pain subjects were randomized to Exercise, ACT-based stress management (ACT-bsm), or an active control group. Two hundred thirty-two participants (78%) received their allocated intervention at least to some extent. These participants were evaluated using mixed model analyses for changes in sleep (Insomnia Severity Index, ISI), pain intensity, depression, and anxiety immediately after treatment, six months and twelve months after treatment.

RESULTS: The mixed model analyses revealed that Exercise had a positive effect on insomnia compared with the control group and the effect remained after 12 months. No clear effect (i.e., both for completers and for completers together with treatment non-completers) upon ISI was found for the ACT-bsm. Pain intensity decreased significantly both in the exercise group and in the control group. For the two psychological variables (i.e., symptoms of anxiety and depression) were found significant improvements over time but no group differences. The treatment effects for ISI and pain intensity did not reach clinical significance per definitions presented in other relevant studies.

CONCLUSIONS: Beneficial significant effects on insomnia was confirmed in the exercise condition. However, these changes were probably not clinically important. For pain intensity a general decrease was found in the Exercise condition and in the control condition, while no change occurred in ACT-bsm. No group differences were found for the two psychological variables.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Sleep, Insomnia, Rehabilitation, Chronic pain, Exercise, Acceptance and commitment therapy, Randomized controlled trial
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-66613 (URN)10.1186/s12891-018-2020-z (DOI)000429815900002 ()29631567 (PubMedID)2-s2.0-85045212758 (Scopus ID)
Note

Funding Agencies:

Vårdal Foundation (Rehsam)

County Council of Östergötland

Available from: 2018-04-17 Created: 2018-04-17 Last updated: 2018-09-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5359-0452

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