Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management? – A randomized controlled study

Abstract

BackgroundMost 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.MethodsTwo 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.ResultsThe 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.ConclusionsBeneficial 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.Trial registrationThe study was registered in Clinical Trials (Trial registration: ClinicalTrials.gov Id: NCT02399644, 21 January 2015, retrospectively registered).

Acceptance and Commitment Therapy with Ecological Systems Theory: Addressing Muslim Mental Health Issues and Wellbeing

“…These flexibility processes gradually interacting with one another produce greater psychological flexibility or inflexibility processes interact with one another and cause psychopathology. In other words, ACT is about providing room for pain and helping clients to move forward toward chosen values to create a meaningful life and enhancing the quality of life and/or addressing issues, which is the main duty of mental health providers (Tanhan, 2018 (Kyllönen, Muotka, Puolakanaho, Astikainen, Keinonen, & Lappalainen, 2018;Pleger, Treppner, Diefenbacher, Schade, Dambacher, & Fydrich, 2018;Proctor, Moghaddam, Evangelou, & Das Nair, 2018;Puolakanaho et al, 2019), obsessive compulsive disorder (Rohani, Rasouli-Azad, Twohig, Ghoreishi, Lee, & Akbari, 2018;Twohig et al, 2018), cancer related psychological issues (González-Fernández, Fernández-Rodríguez, Paz-Caballero, & Pérez-Álvarez, 2018;McClure, Bricker, Mull, & Heffner, 2019;Wells-Di Gregorio et al, 2019), chronic pain (Razavi, Aboalghasimi, Akbari, & Nadirinabi, 2019), migraine (Grazzi, Bernstein, Raggi, Sansone, Grignani, Searl, & Rizzoli, 2019), sleep issues (Päivi, Sitwat, Harri, Joona, & Raimo, 2019;Wiklund, Linton, Alföldi, & Gerdle, 2018), suicide prevention (Bazley & Pakenham, 2019;Ducasse et al, 2018), psychosis (Spidel, Daigneault, Kealy, & Lecomte, 2019). In addition, online versions of ACT RCTs were conducted to address various issues including pain (Lin et al, 2017;Simister, Tkachuk, Shay, Vincent, Pear, & Skrabek, 2018), depression (Molander et al, 2018), stress (Hofer et al, 2018), and smoking (Bricker, Mull, McClure, Watson, & Heffner, 2018).…”

The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review

“…In other words, most studies have examined the effect of ACT on comorbid insomnia. Considering Tables 2, 5 studies have assessed the effect of ACT on people with chronic pain [30,33,37,41,43]. One research work also studied the Fibromyalgia condition which has symptoms such as widespread pain and fatigue [27].…”

“…In 4 studies, the protocol therapy was performed in person, and individually on the study sample [21,29,41,44]. In 2 other studies, all sessions were performed in groups [31,43]. In one of these research works, acceptance and commitment therapy based stress management (ACT-bsm) was utilised [43].…”

“…In 2 other studies, all sessions were performed in groups [31,43]. In one of these research works, acceptance and commitment therapy based stress management (ACT-bsm) was utilised [43]. Some other studies used both group and individual methods to hold meetings [32,34,37,38].…”

“…Four other studies scheduled 7 sessions as part of the project. In the research project conducted by Zetterqvist et al (2018), the last session was performed when people were called in for a follow up [27,37,38,43]. Some other studies used 6 sessions of therapy to present their findings in accordance with the ACT principles [31,35,39,42].…”