Development of the Pain-Related Beliefs and Attitudes about Sleep (PBAS) Scale for the Assessment and Treatment of Insomnia Comorbid with Chronic Pain

Afolalu, Esther F.; Moore, Corran; Ramlee, Fatanah; Goodchild, Claire; Tang, Nicole K. Y.

doi:10.5664/jcsm.6130

Cited by 24 publications

(14 citation statements)

References 37 publications

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“…Several process measures were included as part of the assessment to inform treatment and elucidate the role of hypothesised treatment mechanisms. These were the Pain Catastrophizing Scale,57 Pain Self Perception Scale,58 Anxiety and Preoccupation about Sleep Questionnaire,59 Dysfunctional Belief and Attitude about Sleep Scale-1660 and Pain-specific Dysfunctional Belief and Attitude about Sleep Scale 61…”

Section: Methodsmentioning

confidence: 99%

Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study

et al. 2020

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ObjectivesTo test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia.DesignMixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial.SettingPrimary care.ParticipantsTwenty-five adult patients with chronic pain and insomnia.InterventionHybrid CBT or self-help control intervention.Primary and secondary outcome measuresPrimary outcomes measures were the Insomnia Severity Index and interference scale of the Brief Pain Inventory (BPI). Secondary outcomes measures were the present pain intensity rating from the BPI, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale and EQ-5D-5L.ResultsFourteen participants were randomised to receive Hybrid CBT, 11 to receive the self-help control treatment. Of the 14 in the Hybrid CBT group, 9 (64%) completed all four treatment sessions (4 discontinued due to poor health; 1 due to time constraints). Adherence to the self-help control treatment was not monitored. The total number of participants completing the 12-week and 24-week follow-ups were 12 (6 in each group; Hybrid CBT: 43%; self-help: 55%) and 10 (5 in each group; Hybrid CBT: 36%; self-help: 45%). Based on the data available, candidate outcome measures appeared to be sensitive to changes associated with interventions. Thematic analysis of pre-postintervention interview data revealed satisfaction with treatment content among those who completed the Hybrid CBT, whereas those in the self-help control treatment wanted more contact hours and therapist guidance. Other practical suggestions for improvement included shortening the duration of each treatment session, reducing the amount of assessment paperwork, and minimising the burden of sleep and pain monitoring.ConclusionImportant lessons were learnt with regard to the infrastructure required to achieve better patient adherence and retention. Based on the qualitative feedback provided by a subset of treatment completers, future trials should also consider lowering the intensity of treatment and streamlining the data collection procedure.Trial registration numberISRCTN17294365.

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Section: Methodsmentioning

confidence: 99%

Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study

et al. 2020

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“… 28 , 29 This scale is progressively being used in academic research and clinical diagnostics around the world, and it has been translated into several languages including Chinese. 28 , 30 – 32 The 16-item version of the scale has adequate test–retest reliability ( r = 0.928) and internal consistency (Cronbach’s alpha values range from 0.786 to 0.835). 33 The Chinese version of the DBAS-16 has a higher reliability and validity than other tested versions, and it is a more suitable version for assessing maladaptive cognition in the Chinese population.…”

Section: Methodsmentioning

confidence: 99%

Investigation on dysfunctional beliefs and attitudes about sleep in Chinese college students

Jin¹,

Zhou²,

Peng³

et al. 2018

NDT

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ObjectiveThe aims of this study were to evaluate a subset of sleep-related cognitions and to examine whether dysfunctional beliefs and attitudes about sleep were associated with sleep quality in college students.Patients and methodsA total of 1,333 college students were enrolled in this study by randomized cluster sampling. A brief version of Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16) was administered to college students at several colleges. Sleep quality was also assessed using the Pittsburgh Sleep Quality Index (PSQI). The DBAS-16 scores were analyzed across different demographic variables, corresponding subscales of 7-item PSQI, and relevant sleep behavior variables.ResultsA total of 343 participants were poor sleepers, while 990 were good sleepers, as defined by PSQI. The DBAS-16 scores were lower in poor sleepers than in good sleepers (46.32 ± 7.851 vs 49.87 ± 8.349, p < 0.001), and DBAS-16 scores were lower in females and nonmedical students when compared with those in males and medical students, respectively (48.20 ± 8.711 vs 49.73 ± 7.923, p = 0.001; 48.56 ± 8.406 vs 49.88 ± 8.208, p = 0.009, respectively). The total score for sleep quality, as measured by PSQI, was negatively correlated with the DBAS-16 total score (r = −0.197, p < 0.01). There were significant differences in PSQI scores between individuals with attitudes and those without attitudes about sleep with respect to good sleep habits (p < 0.001), self-relaxation (p = 0.001), physical exercise (p < 0.001), taking sleeping pills (p = 0.004), and taking no action (p < 0.001).ConclusionDysfunctional beliefs about sleep are associated with sleep quality and should be discouraged, especially for females and nonmedical college students.

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“…It is our hope that continued research in this area will help providers deliver safe and effective care for their aging patients. CBT-I disrupts the negative cycle of chronic pain and insomnia, improving both pain and sleep functioning [1,37,52] Koffel et al…”

Section: Discussionmentioning

confidence: 99%

“…In a widely accepted model of insomnia developed by Spielman and colleagues, maladaptive behaviors (napping, excessive time in bed) and cognitions (worry about sleep) perpetuate insomnia [42]. Emerging work with patients with chronic pain has identified pain specific cognitions (e.g., "I'll never get good sleep because of pain") and behaviors (e.g., napping, inactivity) that seem to enhance pain and insomnia, as well as higher levels of dysfunctional beliefs about sleep in general [1,37,48]. Figure 1, these cognitions and behaviors lead to further dysregulation of sleep processes (e.g., weakened circadian rhythm and sleep drive), which perpetuate insomnia symptoms and may lead to greater pain sensitivity and possibly increased risk of harm (e.g., use of opioid medication).…”

Section: Rationale For Use Of Behavioral Sleep Interventions In Middlmentioning

confidence: 99%

Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions

Koffel

McCurry

Smith

et al. 2018

PAIN

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Insomnia and chronic pain are common comorbid conditions in middle-aged and older adults. Up to half of older adults with chronic pain have sleeping difficulties, which greatly increases pain-related distress and disability [46,47]. Natural age-related changes in sleep architecture and circadian rhythms further contribute to insomnia, including advanced sleep phase (falling asleep early and waking early) and reduced slow-wave sleep [33]. Unfortunately, insomnia medications can have adverse cognitive and behavioral effects, especially in combination with opioids, and are specifically contraindicated in older adults due to increased fall risk [3,18,31,35,56]. Off-label use of drugs such as antidepressants, antipsychotics, and anticonvulsants are used in practice to treat insomnia for older adults, but have not been extensively studied in this population and carry considerable risk of adverse effects [39]. Behavioral sleep interventions are a promising avenue for providing better and safer sleep and pain outcomes for middle-aged and older adults, while reducing the needs and hazards of excessive reliance on sedative hypnotics and opioids. The purpose of this review is to discuss evidence that sleep disturbance causes and exacerbates pain in middle-aged and older adults and that good sleep improves pain outcomes. We examine the efficacy of cognitive behavioral therapy for insomnia (CBT-I) on pain and sleep outcomes in middleaged and older adults. Based on our review of the literature, we suggest an agenda for future research, including adaptation and additions to standard CBT-I to improve outcomes for middle-aged and older adults.

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Development of the Pain-Related Beliefs and Attitudes about Sleep (PBAS) Scale for the Assessment and Treatment of Insomnia Comorbid with Chronic Pain

Abstract: Pain-related sleep beliefs appear to be an integral part of chronic pain patients' insomnia experience. The PBAS is a valid and reliable instrument for evaluating the role of these beliefs in chronic pain patients.

Cited by 24 publications

References 37 publications

Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study

Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study

Investigation on dysfunctional beliefs and attitudes about sleep in Chinese college students

Improving pain and sleep in middle-aged and older adults: the promise of behavioral sleep interventions

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