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Lenneis A, Das-Friebel A, Tang NKY, Sanborn AN, Lemola S, Singmann H, Wolke D, von Mühlenen A, Realo A. The influence of sleep on subjective well-being: An experience sampling study. Emotion 2024; 24:451-464. [PMID: 37535565 DOI: 10.1037/emo0001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Previous research has associated sleep with subjective well-being (SWB), but less is known about the underlying within-person processes. In the current study, we investigated how self-reported and actigraphy-measured sleep parameters (sleep onset latency, sleep duration, sleep satisfaction, social jetlag, and sleep efficiency) influence SWB (positive affect [PA], negative affect [NA], and life satisfaction [LS]) at the within- and between-person levels. Multilevel analyses of data from 109 university students who completed a 2-week experience sampling study revealed that higher within-person sleep satisfaction was a significant predictor of all three components of next day's SWB (ps < .005). Higher between-person sleep satisfaction was also related to higher levels of PA and LS (ps < .005), whereas shorter self-reported between-person sleep onset latency was associated with higher PA and LS, and lower NA (ps < .05). However, longer actigraphy-measured within-person sleep onset latency was associated with higher next day's LS (p = .028). When including within- and between-person sleep parameters into the same models predicting SWB, only within- and between-person sleep satisfaction remained a significant predictor of all components of SWB. Additionally, we found an effect of higher self-reported within-person sleep onset latency on PA and of shorter self-reported within-person sleep duration on LS (ps < .05). Our results indicate that the evaluative component of sleep-sleep satisfaction-is most consistently linked with SWB. Thus, sleep interventions that are successful in not only altering sleep patterns but also enhancing sleep satisfaction may stand a better chance at improving students' SWB. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anu Realo
- Department of Psychology, University of Warwick
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2
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Nijs J, Mairesse O, Tang NKY. The importance of sleep in the paradigm shift from a tissue- and disease-based pain management approach towards multimodal lifestyle interventions for chronic pain. Braz J Phys Ther 2024; 28:100594. [PMID: 38359541 PMCID: PMC10877106 DOI: 10.1016/j.bjpt.2024.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Jo Nijs
- Faculty of Physical Education & Physical Therapy, Vrije Universiteit Brussel, Belgium; Chronic pain rehabilitation, Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physical Therapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Olivier Mairesse
- Brain Body and Cognition (BBCO), Department of Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Belgium
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Tang NKY, Saconi B, Jansson‐Fröjmark M, Ong JC, Carney CE. Cognitive factors and processes in models of insomnia: A systematic review. J Sleep Res 2023; 32:e13923. [PMID: 37364869 PMCID: PMC10909484 DOI: 10.1111/jsr.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy for insomnia, cognitive constructs are termed and conceptualised differently in different theories of insomnia proposed over the past decades. In search of consensus in thinking, the current systematic review identified cognitive factors and processes featured in theoretical models of insomnia and mapped any commonality between models. We systematically searched PsycINFO and PubMed for published theoretical articles on the development, maintenance and remission of insomnia, from inception of databases to February, 2023. A total of 2458 records were identified for title and abstract screening. Of these, 34 were selected for full-text assessment and 12 included for analysis and data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified nine distinguishable models of insomnia published between 1982 and 2023 and extracted 20 cognitive factors and processes featured in these models; 39 if sub-factors were counted. After assigning similarity ratings, we observed a high degree of overlap between constructs despite apparent differences in terminologies and measurement methods. As a result, we highlight shifts in thinking around cognitions associated with insomnia and discuss future directions.
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Affiliation(s)
| | - Bruno Saconi
- Department of Population Health Sciences, GeisingerDanvillePennsylvaniaUSA
| | - Markus Jansson‐Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region StockholmStockholmSweden
| | | | - Colleen E. Carney
- Department of PsychologyToronto Metropolitan UniversityTorontoOntarioCanada
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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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Cheatle MD, Giordano NA, Themelis K, Tang NKY. Suicidal thoughts and behaviors in patients with chronic pain, with and without co-occurring opioid use disorder. Pain Med 2023; 24:941-948. [PMID: 37014415 PMCID: PMC10391589 DOI: 10.1093/pm/pnad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/07/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Individuals with chronic pain and a co-occurring substance use disorder present higher risk of suicide, but the individual and joint impacts of chronic pain and substance use disorders on suicide risk are not well defined. The objective of this study was to exam the factors associated with suicidal thoughts and behaviors in a cohort of patients with chronic non-cancer pain (CNCP), with or without concomitant opioid use disorder (OUD). DESIGN Cross sectional cohort design. SETTING Primary care clinics, pain clinics, and substance abuse treatment facilities in Pennsylvania, Washington, and Utah. SUBJECTS In total, 609 adults with CNCP treated with long-term opioid therapy (>/= 6 months) who either developed an OUD (cases, n = 175) or displayed no evidence of OUD (controls, n = 434). METHODS The predicted outcome was elevated suicidal behavior in patients with CNCP as indicated by a Suicide Behavior Questionnaire-Revised (SBQ-R) score of 8 or above. The presence of CNCP and OUD were key predictors. Covariates included demographics, pain severity, psychiatric history, pain coping, social support, depression, pain catastrophizing and mental defeat. RESULTS Participants with CNCP and co-occurring OUD had an increased odds ratio of 3.44 in reporting elevated suicide scores as compared to participants with chronic pain only. Multivariable modeling revealed that mental defeat, pain catastrophizing, depression, and having chronic pain, and co-occurring OUD significantly increased the odds of elevated suicide scores. CONCLUSIONS Patients with CNCP and co-morbid OUD are associated with a 3-fold increase in risk of suicide.
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Affiliation(s)
- Martin D Cheatle
- Department of Psychiatry and Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19106, United States
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States
| | - Kristy Themelis
- Department of Psychology, University of Warwick, CV4 7AL Coventry, United Kingdom
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, CV4 7AL Coventry, United Kingdom
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Tang NKY, Banks PDW, Sanborn AN. Judgement of sleep quality of the previous night changes as the day unfolds: A prospective experience sampling study. J Sleep Res 2023; 32:e13764. [PMID: 36436945 PMCID: PMC10909469 DOI: 10.1111/jsr.13764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
How we form judgements of sleep quality is poorly understood. Emerging literature suggests that people infer their sleep quality based on multiple sources of accessible information, raising the possibility that sleep quality judgement may evolve as new relevant information becomes available. This study investigated whether people's rating of sleep quality of the night before changes throughout the following day, and what post-sleep factors are associated with the changes. A prospective experience sampling study of 119 healthy young adults, who completed eight short online surveys interspaced 2 hr apart from 08:00 hours to 22:00 hours. Each survey asked the participants to report total sleep time and sleep quality of the night before, and to provide ratings of current mood, physical and social activity, and pain/discomfort. A memory test was added to the final survey of the day to measure the participants' recall of their first survey responses to sleep quality, as well as total sleep time and mood. The absolute majority (91.1%) of the participants had one or more change in their sleep quality rating across the eight surveys. A similar percentage of change was found for mood rating (100%) but not total sleep time report (20.5%). Memory test in the final survey revealed that the within-person variations in sleep quality rating were not simply memory errors. Instead, positive physical activity post-sleep predicted increases in sleep quality rating. Therefore, judgement of sleep quality of the night before changes as the day unfolds, and post-sleep information can be used by people to infer their sleep quality.
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Sandhu HK, Booth K, Furlan AD, Shaw J, Carnes D, Taylor SJC, Abraham C, Alleyne S, Balasubramanian S, Betteley L, Haywood KL, Iglesias-Urrutia CP, Krishnan S, Lall R, Manca A, Mistry D, Newton S, Noyes J, Nichols V, Padfield E, Rahman A, Seers K, Tang NKY, Tysall C, Eldabe S, Underwood M. Reducing Opioid Use for Chronic Pain With a Group-Based Intervention: A Randomized Clinical Trial. JAMA 2023; 329:1745-1756. [PMID: 37219554 PMCID: PMC10208139 DOI: 10.1001/jama.2023.6454] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023]
Abstract
Importance Opioid use for chronic nonmalignant pain can be harmful. Objective To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care. Design, Setting, and Participants Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020. Intervention Participants were randomized 1:1 to either usual care or 3-day-long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months. Main Outcomes and Measures The 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report. Results Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (-4.1 in the intervention and -3.17 in the usual care groups; between-group difference: mean difference, -0.52 [95% CI, -1.94 to 0.89]; P = .15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P < .001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt). Conclusions and Relevance In people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities. Trial Registration isrctn.org Identifier: ISRCTN49470934.
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Affiliation(s)
- Harbinder K. Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Katie Booth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrea D. Furlan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Jane Shaw
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom
- now with Boston Scientific, Hemel Hempstead, United Kingdom
| | - Dawn Carnes
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephanie J. C. Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charles Abraham
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Sharisse Alleyne
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Shyam Balasubramanian
- Department of Anaesthesia and Pain Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Lauren Betteley
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kirstie L. Haywood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Cynthia P. Iglesias-Urrutia
- Department of Health Sciences, University of York, York, United Kingdom
- Danish Centre for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Sheeja Krishnan
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrea Manca
- Centre for Health Economics, University of York, York, United Kingdom
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- now with Statistics and Decision Sciences, Janssen Pharmaceuticals Research & Development, High Wycombe, United Kingdom
| | - Sian Newton
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jennifer Noyes
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Emma Padfield
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- now with IQVIA, Reading, Berkshire, United Kingdom
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, United Kingdom
| | - Kate Seers
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Colin Tysall
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, United Kingdom
- Service User and Carer Engagement, Coventry University, Coventry, United Kingdom
| | - Sam Eldabe
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom
- Hôpital de Morges, Morges, Switzerland
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Gillett JL, Karadag P, Themelis K, Li YM, Lemola S, Balasubramanian S, Singh SP, Tang NKY. Investigating mental defeat in individuals with chronic pain: Protocol for a longitudinal experience sampling study. BMJ Open 2023; 13:e066577. [PMID: 36746544 PMCID: PMC9906405 DOI: 10.1136/bmjopen-2022-066577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Previous qualitative and cross-sectional research has identified a strong sense of mental defeat in people with chronic pain who also experience the greatest levels of distress and disability. This study will adopt a longitudinal experience sampling design to examine the within-person link between the sense of mental defeat and distress and disability associated with chronic pain. METHODS AND ANALYSIS We aim to recruit 198 participants (aged 18-65 years) with chronic pain, to complete two waves of experience sampling over 1 week, 6 months apart (time 1 and time 2). During each wave of experience sampling, the participants are asked to complete three short online surveys per day, to provide in-the-moment ratings of mental defeat, pain, medication usage, physical and social activity, stress, mood, self-compassion, and attention using visual analogue scales. Sleep and physical activity will be measured using a daily diary as well as with wrist actigraphy worn continuously by participants throughout each wave. Linear mixed models and Gaussian graphical models will be fit to the data to: (1) examine the within-person, day-to-day association of mental defeat with outcomes (ie, pain, physical/social activity, medication use and sleep), (2) examine the dynamic temporal and contemporaneous networks of mental defeat with all outcomes and the hypothesised mechanisms of outcomes (ie, perceived stress, mood, attention and self-compassion). ETHICS AND DISSEMINATION The current protocol has been approved by the Health Research Authority and West Midlands-Solihull Research Ethics Committee (Reference Number: 17/WM0053). The study is being conducted in adherence with the Declaration of Helsinki, Warwick Standard Operating Procedures and applicable UK legislation.
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Affiliation(s)
- Jenna L Gillett
- Department of Psychology, University of Warwick, Coventry, UK
| | - Paige Karadag
- Department of Psychology, University of Warwick, Coventry, UK
| | - Kristy Themelis
- Department of Psychology, University of Warwick, Coventry, UK
| | - Yu-Mei Li
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Sakari Lemola
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | | | - Swaran Preet Singh
- Mental Health and Wellbeing, University of Warwick, Warwick Medical School, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
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Halpin SJ, Casson AJ, Tang NKY, Jones AKP, O'Connor RJ, Sivan M. A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance. Front Pain Res (Lausanne) 2023; 4:1096084. [PMID: 36910250 PMCID: PMC9996154 DOI: 10.3389/fpain.2023.1096084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. Materials and methods In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. Results 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Discussion Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.
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Affiliation(s)
- Stephen J Halpin
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Alexander J Casson
- Department of Electrical and Electronic Engineering, University of Manchester, Manchester, United Kingdom
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Warwick, United Kingdom
| | - Anthony K P Jones
- Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.,Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
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Patel K, Moukhtarian TR, Russell S, Daly G, Walasek L, Tang NKY, Toro C, Meyer C. Digital cognitive behavioural therapy intervention in the workplace: study protocol for a feasibility randomised waitlist-controlled trial to improve employee mental well-being, engagement and productivity. BMJ Open 2022; 12:e060545. [PMID: 36600345 PMCID: PMC9743318 DOI: 10.1136/bmjopen-2021-060545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION One in six workers experience some form of mental health problems at work costing the UK economy an estimated £70 billion/year. Digital interventions provide low cost and easily scalable delivery methods to implement psychological interventions in the workplace. This trial tests the feasibility of implementing a self-guided 8-week digital cognitive behavioural therapy intervention for subthreshold to clinical depression and/or anxiety versus waitlist control (ie, life as usual) in the workplace. METHODS AND ANALYSIS Feasibility of implementation will be tested using a mixed-methods evaluation of the two-arm randomised waitlist-control trial. Evaluation will include examination of organisational buy-in, and the engagement of employees through the trial indicated by the completion of outcome measures. In addition, we also explore how participants use the platform, the appropriateness of the analysis both with reference to the outcome measures and linear modelling. Finally, we examine the acceptability of the intervention based on participants experiences using qualitative interviews. Assessments take place at baseline (T0), at 8 weeks post-treatment (T1), at short-term follow-up 4 weeks post-treatment (T2) and long-term follow-ups (6 and 12 months after-end of treatment). We will recruit from 1 July 2021 to 31 December 2021 for employees and self-employed workers with depression and anxiety symptoms (subclinical and clinical levels) who are not seeking or engaged in treatment at the time of the trial. ETHICS AND DISSEMINATION Full approval was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20-21). The current protocol version is 2.8 (August 2021). Publication of results in peer-reviewed journals will inform the scientific, clinical and business communities. We will disseminate results through webinars, conferences, newsletter as well as a lay summary of results on the study website (mhpp.me). TRIAL REGISTRATION NUMBER ISRCTN31161020.
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Affiliation(s)
| | - Talar Rita Moukhtarian
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sean Russell
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Guy Daly
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | | | - Carla Toro
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Caroline Meyer
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
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11
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Chandler L, Patel C, Lovecka L, Gardani M, Walasek L, Ellis J, Meyer C, Johnson S, Tang NKY. Improving university students' mental health using multi-component and single-component sleep interventions: A systematic review and meta-analysis. Sleep Med 2022; 100:354-363. [PMID: 36198252 DOI: 10.1016/j.sleep.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023]
Abstract
University is a time of significant transitions during a young adult's life, with delayed and shortened sleep and poor mental health a common occurrence. This systematic review and meta-analysis examined the effect of both multi-component and single-component sleep interventions on improving university students' sleep and mental health. Five databases (MEDLINE, PsycINFO, Embase, CINAHL and Cochrane Library) were searched for relevant literature published until April 2022. Treatment studies including university students aged 18-24 years, participating in a sleep intervention (multi-component, e.g., CBT-I, or single-component, e.g., sleep hygiene) were eligible. Comparator groups were either active, i.e., alternative intervention, or passive, i.e., waitlist control or treatment-as-usual, with study outcomes to include measures of sleep and mental health. Of 3435 references screened, 11 studies involving 5267 participants, with and without insomnia symptoms, were included for a narrative synthesis on intervention designs and methodology. Six studies eligible for meta-analyses showed a moderate effect of sleep interventions in reducing sleep disturbance (SMD = -0.548 [CI: -0.837, -0.258]) at post-treatment, alongside a small effect in improving anxiety (SMD = -0.226 [CI: -0.421, -0.031]) and depression (SMD = -0.295 [CI: -0.513, -0.077]). Meta-regression examining study and intervention characteristics identified subpopulation (experiencing insomnia or not) as a significant moderator for effects on sleep (p = 0.0003) and depression (p = 0.0063), with larger effects in studies with participants experiencing insomnia. Comparison group type (active or passive) was also a significant moderator (p = 0.0474), with larger effects on sleep in studies using passive comparison groups. Study type, delivery format, and intervention duration were not identified as significant moderators. At follow-ups, small but significant effects were sustained for anxiety and depression. Protecting and promoting sleep amongst university students may help safeguard and advance mental health.
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Affiliation(s)
| | - Chloe Patel
- Warwick Manufacturing Group, University of Warwick, UK
| | - Lia Lovecka
- Department of Psychology, University of Warwick, UK
| | - Maria Gardani
- School of Health in Social Science, University of Edinburgh, UK
| | | | - Jason Ellis
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, UK
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Tang NKY, McEnery KAM, Chandler L, Toro C, Walasek L, Friend H, Gu S, Singh SP, Meyer C. Pandemic and student mental health: mental health symptoms among university students and young adults after the first cycle of lockdown in the UK. BJPsych Open 2022; 8:e138. [PMID: 35880308 PMCID: PMC9345288 DOI: 10.1192/bjo.2022.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early COVID-19 research suggests a detrimental impact of the initial lockdown on young people's mental health. AIMS We investigated mental health among university students and young adults after the first UK lockdown and changes in symptoms over 6 months. METHOD In total, 895 university students and 547 young adults not in higher education completed an online survey at T1 (July-September 2020). A subset of 201 university students also completed a 6 month follow-up survey at T2 (January-March 2021). Anxiety, depression, insomnia, substance misuse and suicide risk were assessed. RESULTS At T1, approximately 40%, 25% and 33% of the participants reported moderate to severe anxiety and depression and substance misuse risk, clinically significant insomnia and suicidal risk. In participants reassessed at T2, reductions were observed in anxiety and depression but not in insomnia, substance misuse or suicidality. Student and non-student participants reported similar levels of mental health symptoms. Student status was not a significant marker of mental health symptoms, except for lower substance misuse risk.Cross-sectionally, greater symptoms across measures were consistently associated with younger age, pre-existing mental health conditions, being a carer, worse financial status, increased sleep irregularity and difficulty since lockdown. Longitudinally, T2 symptoms were consistently associated with worse financial status and increased difficulty sleeping at T1. However, these associations were attenuated when baseline mental health symptoms were adjusted for in the models. CONCLUSIONS Mental health symptoms were prevalent in a large proportion of young people after the first UK lockdown. Risk factors identified may help characterise high-risk groups for enhanced support and inform interventions.
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Affiliation(s)
| | | | | | - Carla Toro
- Warwick Manufacturing Group, University of Warwick, UK
| | | | - Hannah Friend
- Wellbeing and Safeguarding Group, Professional Services, University of Warwick, UK
| | - Sai Gu
- Executive Office and School of Engineering, University of Warwick, UK
| | - Swaran P Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, UK
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Moukhtarian TR, Patel K, Toro C, Russel S, Daly G, Walasek L, Tang NKY, Meyer C. Effects of a hybrid digital cognitive-behavioural therapy for insomnia and emotion regulation in the workplace (SLEEP): study protocol for a randomised waitlist control trial. BMJ Open 2022; 12:e058062. [PMID: 35840305 PMCID: PMC9295651 DOI: 10.1136/bmjopen-2021-058062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This trial tests the efficacy of implementing a hybrid digital cognitive-behavioural therapy for insomnia (dCBT-I) and emotion regulation (ER) in the workplace. The study protocol follows the SPIRIT (Standard Protocol Items: Recommendations for Intervention Trials) 2013 recommendations. METHODS AND ANALYSIS This is a mixed methods evaluation with a two-arm randomised waitlist control design of a 6-week dCBT-I+ER intervention through self-guided online platform and four videoconferencing therapy sessions. A process evaluation will examine the fidelity of delivery and experiences of the intervention. The primary outcomes are the Insomnia Severity Index, the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder-7. The secondary outcomes are job productivity, job satisfaction, well-being, quality of life, self-reported (sleep diary data) and objective (actigraphy) sleep parameters, and usage of online intervention platform. Assessments take place at baseline (T0), week 8 post-treatment (T1) and week 12 postrandomisation (T2). We will recruit 156 workers with sleep and ER problems ranging from subclinical to clinical levels not engaged in treatment at the time of the trial. ETHICS AND DISSEMINATION Full approval was given by the University of Warwick Biomedical and Research Ethics Committee (BSREC 45/20-21). The current protocol version is 2.9_Dec21. Publication of results will inform the scientific, clinical and business communities through peer-reviewed articles, webinars, conferences and newsletters. TRIAL REGISTRATION NUMBER ISRCTN13596153.
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Affiliation(s)
| | - Krishane Patel
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
| | - Carla Toro
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
| | - Sean Russel
- Health and Life Science Centre, Coventry University, Coventry, UK
| | - Guy Daly
- The British University, Cairo, Egypt
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Caroline Meyer
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
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14
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Rakhimov A, Realo A, Tang NKY. The Self-Compassion Scale: Validation and Psychometric Properties within the Exploratory Structural Equation Modeling Framework. J Pers Assess 2022; 105:422-435. [PMID: 35822872 DOI: 10.1080/00223891.2022.2093731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Self-Compassion Scale (SCS) is one of the several tools for measuring compassionate self-attitude. Despite its popularity, there is an ongoing controversy regarding its factor structure. Previous studies employing exploratory structural equation modeling (ESEM) found support for the single-bifactor (one general and six group factors) model over the competing two-bifactor (two general factors representing compassionate and uncompassionate self-responding and six group factors) model. Here, we replicated and extended previous ESEM studies through examining the validity and dimensionality of different bifactor models in a sample of UK adults. Model fit was examined across two estimators: maximum likelihood and weighted least square mean and variance adjusted. Finally, we investigated whether one or two observed scores of the SCS can better identify cases of depression, anxiety, and mental wellbeing. Both bifactor models showed good fit to the data irrespective of the estimators used, but only the single-bifactor model demonstrated satisfactory convergent and criterion validity and unidimensionality. The total observed SCS score detected depression, anxiety and high mental wellbeing with higher accuracy than any of the two scores. Overall, we propose to use the total score of the SCS in further research and practice.
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Affiliation(s)
| | - Anu Realo
- Department of Psychology, University of Warwick.,Institute of Psychology, University of Tartu
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15
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Selvanathan J, Tang NKY, Peng PWH, Chung F. Sleep and pain: relationship, mechanisms, and managing sleep disturbance in the chronic pain population. Int Anesthesiol Clin 2022; 60:27-34. [PMID: 35261343 DOI: 10.1097/aia.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Janannii Selvanathan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Philip W H Peng
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Sandhu HK, Shaw J, Carnes D, Furlan AD, Tysall C, Adjei H, Muthiah C, Noyes J, Tang NKY, Taylor SJ, Underwood M, Willis A, Eldabe S. Development and testing of an opioid tapering self-management intervention for chronic pain: I-WOTCH. BMJ Open 2022; 12:e053725. [PMID: 35296478 PMCID: PMC8928279 DOI: 10.1136/bmjopen-2021-053725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe the design, development and pilot of a multicomponent intervention aimed at supporting withdrawal of opioids for people with chronic non-malignant pain for future evaluation in the Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial. DESIGN The I-WOTCH intervention draws on previous literature and collaboration with stakeholders (patient and public involvement). Intervention mapping and development activities of Behaviour Change Taxonomy are described. SETTING The intervention development was conducted by a multidisciplinary team with clinical, academic and service user perspectives. The team had expertise in the development and testing of complex health behaviour interventions, opioid tapering and pain management in primary and secondary care, I.T programming, and software development-to develop an opioid tapering App. PARTICIPANTS The I-WOTCH trial participants are adults (18 years and over) with chronic non-malignant pain using strong opioids for at least 3 months and on most days in the preceding month. OUTCOMES A multicomponent self-management support package to help people using opioids for chronic non-malignant pain reduce opioid use. INTERVENTIONS AND RESULTS Receiving information on the impact of long-term opioid use, and potential adverse effects were highlighted as important facilitators in making the decision to reduce opioids. Case studies of those who have successfully stopped taking opioids were also favoured as a facilitator to reduce opioid use. Barriers included the need for a 'trade-off to fill the deficit of the effect of the drug'. The final I-WOTCH intervention consists of an 8-10 week programme incorporating: education; problem-solving; motivation; group and one to one tailored planning; reflection and monitoring. A detailed facilitator manual was developed to promote consistent delivery of the intervention across the UK. CONCLUSIONS We describe the development of an opioid reduction intervention package suitable for testing in the I-WOTCH randomised controlled trial. TRIAL REGISTRATION NUMBER ISRCTN49470934.
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Affiliation(s)
- Harbinder Kaur Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Shaw
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK
| | - Dawn Carnes
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea D Furlan
- Toronto Rehabilitation Institute, University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Institute for Work & Health, Toronto, Ontario, Canada
| | - Colin Tysall
- UNTRAP, University of Warwick, Coventry, West Midlands, UK
- SUCE, Coventry University, Coventry, West Midlands, UK
| | - Henry Adjei
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chockalingam Muthiah
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jennifer Noyes
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, West Midlands, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Adrian Willis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sam Eldabe
- Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK
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17
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Rakhimov A, Ong J, Realo A, Tang NKY. Being kind to self is being kind to sleep? A structural equation modelling approach evaluating the direct and indirect associations of self-compassion with sleep quality, emotional distress and mental well-being. Curr Psychol 2022. [DOI: 10.1007/s12144-021-02661-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Rakhimov A, Whibley D, Tang NKY. Cognitive-behavioural pathways from pain to poor sleep quality and emotional distress in the general population: The indirect effect of sleep-related anxiety and sleep hygiene. PLoS One 2022; 17:e0260614. [PMID: 35061683 PMCID: PMC8782309 DOI: 10.1371/journal.pone.0260614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Pain can have a negative impact on sleep and emotional well-being. This study investigated whether this may be partly explained by maladaptive sleep-related cognitive and behavioural responses to pain, including heightened anxiety about sleep and suboptimal sleep hygiene. METHODS This cross-sectional study used data from an online survey that collected information about pain (Brief Pain Inventory), sleep (Pittsburgh Sleep Quality Index; Sleep Hygiene Index; Anxiety and Preoccupation about Sleep Questionnaire) and emotional distress (PROMIS measures; Perceived Stress Scale). Structural equation modelling examined the tenability of a framework linking these factors. RESULTS Of 468 survey respondents (mean age 39 years, 60% female), 29% reported pain (mean severity 1.12), most commonly in the spine or low back (28%). Pain severity correlated with poor sleep quality, poor sleep hygiene, anxiety about sleep and emotional distress. In the first structural equation model, indirect effects were identified between pain severity and sleep quality through anxiety about sleep (β = .08, p < .001) and sleep hygiene (β = .12, p < .001). In the second model, an indirect effect was identified between pain severity and emotional distress through sleep quality (β = .19, p < .01). Combining these models, indirect effects were identified between pain severity and emotional distress through anxiety about sleep, sleep hygiene and sleep quality. CONCLUSIONS This study provides data to support the tenability of a theoretically guided framework linking pain, sleep and emotional distress. If upheld by experimental and/or longitudinal study, this framework holds the potential to inform public health initiatives and more comprehensive pain assessment.
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Affiliation(s)
- Arman Rakhimov
- Department of Psychology, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, United States of America
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry, West Midlands, United Kingdom
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19
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Collard VEJ, Moore C, Nichols V, Ellard DR, Patel S, Sandhu H, Parsons H, Sharma U, Underwood M, Madan J, Tang NKY. Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers. BMC Fam Pract 2021; 22:210. [PMID: 34666682 PMCID: PMC8527665 DOI: 10.1186/s12875-021-01552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 08/30/2023]
Abstract
Background Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01552-3.
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Affiliation(s)
- V E J Collard
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - C Moore
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - V Nichols
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - S Patel
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Parsons
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - U Sharma
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, CV4 7AL, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - J Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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20
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Tang NKY. Is cognitive-behaviour therapy for insomnia (CBT-I) the new best pain killer? Sleep Med Rev 2021; 60:101536. [PMID: 34416427 DOI: 10.1016/j.smrv.2021.101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK.
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21
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Lemola S, Gkiouleka A, Read B, Realo A, Walasek L, Tang NKY, Elliott MT. Can a 'rewards-for-exercise app' increase physical activity, subjective well-being and sleep quality? An open-label single-arm trial among university staff with low to moderate physical activity levels. BMC Public Health 2021; 21:782. [PMID: 33892665 PMCID: PMC8063391 DOI: 10.1186/s12889-021-10794-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study examined the impact of a 'rewards-for-exercise' mobile application on physical activity, subjective well-being and sleep quality among 148 employees in a UK university with low to moderate physical activity levels. METHODS A three-month open-label single-arm trial with a one-year follow-up after the end of the trial. Participants used the Sweatcoin application which converted their outdoor steps into a virtual currency used for the purchase of products available at the university campus' outlets, using an in-app marketplace. The primary outcome measure was self-reported physical activity. Secondary measures included device-measured physical activity, subjective well-being (i.e., life satisfaction, positive affect, negative affect), and self-reported sleep quality. RESULTS The findings show an increase in self-reported physical activity (d = 0.34), life satisfaction (d = 0.31), positive affect (d = 0.29), and sleep quality (d = 0.22) during the three-month trial period. CONCLUSION The study suggests that mobile incentives-for-exercise applications might increase physical activity levels, positive affect, and sleep quality, at least in the short term. The observed changes were not sustained 12 months after the end of the trial.
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Affiliation(s)
- Sakari Lemola
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK.
- Department of Psychology, Bielefeld University, Bielefeld, Germany.
| | - Anna Gkiouleka
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Brieze Read
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Anu Realo
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK
| | - Mark T Elliott
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
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Lenneis A, Das-Friebel A, Singmann H, Teder-Laving M, Lemola S, Wolke D, Tang NKY, von Mühlenen A, Allik J, Realo A. Intraindividual Variability and Temporal Stability of Mid-Sleep on Free and Workdays. J Biol Rhythms 2021; 36:169-184. [PMID: 33353473 PMCID: PMC8056704 DOI: 10.1177/0748730420974842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
People differ in their sleep timings that are often referred to as a chronotype and can be operationalized as mid-sleep (midpoint between sleep onset and wake-up). The aims of the present studies were to examine intraindividual variability and longer-term temporal stability of mid-sleep on free and workdays, while also considering the effect of age. We used data from a 2-week experience sampling study of British university students (Study 1) and from a panel study of Estonian adults who filled in the Munich Chronotype Questionnaire twice up to 5 years apart (Study 2). Results of Study 1 showed that roughly 50% of the variance in daily mid-sleep scores across the 14-day period was attributed to intraindividual variability as indicated by the intraclass correlation coefficient. However, when the effect of free versus workdays was considered, the intraindividual variability in daily mid-sleep across 2 weeks was 0.71 the size of the interindividual variability. In Study 2, mid-sleep on free and workdays showed good levels of temporal stability-the retest correlations of mid-sleep on free and workdays were 0.66 and 0.58 when measured twice over a period of 0-1 to 5 years. The retest stability of mid-sleep scores on both free and workdays sharply increased from young adulthood and reached their peak when participants were in late 40 to early 50 years of age, indicating that age influences the stability of mid-sleep. Future long-term longitudinal studies are necessary to explore how age-related life circumstances and other possible factors may influence the intraindividual variability and temporal stability of mid-sleep.
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Affiliation(s)
- Anita Lenneis
- Department of Psychology, University of Warwick, Coventry, UK
| | | | - Henrik Singmann
- Faculty of Brain Sciences, University College London, London, UK
| | | | - Sakari Lemola
- Department of Psychology, University of Warwick, Coventry, UK
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jüri Allik
- Institute of Psychology, University of Tartu, Tartu, Estonia
- The Estonian Academy of Sciences, Tallinn, Estonia
| | - Anu Realo
- Department of Psychology, University of Warwick, Coventry, UK
- Institute of Psychology, University of Tartu, Tartu, Estonia
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Clarke L, Chisholm K, Cappuccio FP, Tang NKY, Miller MA, Elahi F, Thompson AD. Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis. Schizophr Res 2021; 227:81-91. [PMID: 32646803 DOI: 10.1016/j.schres.2020.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and investigate how sleep disturbances relate to psychotic symptoms, functioning and Quality of Life (QoL) in At Risk Mental State (ARMS) youth. METHOD A comprehensive search of six databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and CENTRAL) was conducted. Eligible studies provided data on sleep disturbances or disorders in ARMS patients. RESULTS Sixteen studies met the inclusion criteria (n = 1962 ARMS patients) including 7 cross-sectional studies, 2 RCT's and 7 cohort studies. Narrative synthesis revealed that self-reported sleep (e.g., general disturbances, fragmented night time sleep and nightmares) was poorer among ARMS patients compared to healthy controls. In the limited studies (n = 4) including objective measurements of sleep disturbances, ARMS patients experienced higher levels of movement during sleep, more daytime naps and increased sleep latency compared to controls. Furthermore, sleep disturbances were associated with attenuated psychotic symptoms and functional outcomes cross-sectionally and longitudinally. Only one study investigated the relationship between sleep and QoL. The exploratory meta-analysis revealed a significant difference in self-reported sleep disturbances measured by the PSQI (mean difference in score: 3.30 (95% CI 1.87, 4.74), p < 0.00001) and SIPS (mean difference in score: 1.58 (95% CI 0.80, 2.35), p < 0.00001) of ARMS patients compared to control groups. CONCLUSIONS ARMS individuals report impaired sleep quality and reduced sleep quantity compared to healthy controls. However, further research is needed to explore the longitudinal relationship between sleep disruptions and QoL in early psychosis. Significant variations in how sleep is measured across studies highlight a need to assess disturbances to sleep using robust and consistent approaches in this patient group.
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Affiliation(s)
- Latoya Clarke
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Francesco P Cappuccio
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Michelle A Miller
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Farah Elahi
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew D Thompson
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
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24
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Baglioni C, Tang NKY, Johann AF, Altena E, Bramante A, Riemann D, Palagini L. Insomnia and poor sleep quality during peripartum: a family issue with potential long term consequences on mental health. J Matern Fetal Neonatal Med 2020; 35:4534-4542. [PMID: 33267621 DOI: 10.1080/14767058.2020.1854718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Improving maternal's health is a worldwide priority. Sleep is a fundamental operating state of the central nervous system and it may be one of the most important psychophysiological processes for brain function and mental health. The study of maternal sleep problem including insomnia, however, implies deepening our understanding of family context. Family systems are dynamic and involve reciprocal interactions among members during day and night. So far, however, maternal and children's sleep has been rarely studied in a family perspective, and paternal sleep has often been neglected. METHODS The present work summarizes in a narrative review the state of the art of our current knowledge on the role of insomnia and poor quality of sleep for mental health in all family members in the peripartum period. The mother, the father, the child and the family interactive perspectives are considered. RESULTS Insomnia and poor sleep problems are frequent in all family members during peripartum. Poor sleep and insomnia symptoms are recognized as important risk factors for mental health in adults and children. Despite this alarming evidence, sleep is rarely assessed in clinical contexts. CONCLUSIONS Clinical implications include the utmost relevance of assessing sleep problems during pregnancy and early post-partum. Insomnia and poor sleep quality should be evaluated and treated in the clinical practice by using a "family perspective."
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Affiliation(s)
- Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Warwick, UK
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ellemarije Altena
- UMR 5287, Institut de Neurosciences Intégratives et Cognitives d'Aquitaine, Neuroimagerie et Cognition Humaine, CNRS, Université de Bordeaux, Bordeaux, France
| | - Alessandra Bramante
- Italian Section of Marcè Society for Perinatal Mental Health, Busto Arsizio, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laura Palagini
- Psychiatric Clinic, Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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25
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Das-Friebel A, Lenneis A, Realo A, Sanborn A, Tang NKY, Wolke D, von Mühlenen A, Lemola S. Bedtime social media use, sleep, and affective wellbeing in young adults: an experience sampling study. J Child Psychol Psychiatry 2020; 61:1138-1149. [PMID: 32924153 DOI: 10.1111/jcpp.13326] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Findings from primarily cross-sectional studies have linked more extensive social media use to poorer sleep and affective wellbeing among adolescents and young adults. This study examined bedtime social media use, sleep, and affective wellbeing, using an experience sampling methodology with the aim of establishing a day-to-day temporal link between the variables. The study hypothesized a positive association between increased bedtime social media use and lower affective wellbeing the following day, mediated by poorer sleep. METHODS Using a smartphone application, 101 undergraduate students (Mage = 19.70 years, SD = 1.09 years), completed daily questionnaires assessing the previous night's bedtime social media use and sleep duration and satisfaction (one measurement per day, questionnaire sent at 08:00), and momentary affective wellbeing (five measurements per day, at randomly varying times between 08:00 and 22:00 on weekdays and 10:00 and 22:00 on weekends), for 14 consecutive days. Objective assessments of total sleep time and sleep efficiency were obtained via wrist-worn actigraphs. By means of separate multilevel models, it was tested whether increased bedtime social media use predicted poorer sleep the same night, whether poorer sleep was predictive of positive and negative affect the following day, and whether sleep mediated the relationship between social media use and affective wellbeing. RESULTS Increased bedtime social media use was not associated with poorer sleep the same night. Apart from subjective sleep satisfaction, no other sleep variable (i.e., subjective sleep duration, objective total sleep time and objective sleep efficiency) predicted positive or negative affect the following day. CONCLUSIONS This study found that bedtime social media use is not detrimental to the sleep and affective wellbeing of healthy young adults. However, it is possible that bedtime social media use may be harmful to the sleep of vulnerable individuals.
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Affiliation(s)
| | - Anita Lenneis
- Department of Psychology, University of Warwick, Coventry, UK
| | - Anu Realo
- Department of Psychology, University of Warwick, Coventry, UK.,Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Adam Sanborn
- Department of Psychology, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | | | - Sakari Lemola
- Department of Psychology, University of Warwick, Coventry, UK.,Department of Psychology, Bielefeld University, Bielefeld, Germany
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Abstract
Supplemental Digital Content is available in the text. Objectives: A relationship between sleep and pain is well established. A better understanding of the mechanisms that link sleep and pain intensity is urgently needed to optimize pain management interventions. The objective of this systematic review was to identify, synthesize, and critically appraise studies that have investigated putative mediators on the path between sleep and pain intensity. Methods: A systematic search of 5 electronic bibliographic databases (EMBASE, MEDLINE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials) was conducted. Eligible studies had to apply a formal test of mediation to variables on the path between a sleep variable and pain intensity or vice versa. All searches, data extraction and quality assessment were conducted by at least 2 independent reviewers. Results: The search yielded 2839 unique articles, 9 of which were eligible. Of 13 mediation analyses, 11 investigated pathways from a sleep variable to pain intensity. Putative mediators included affect/mood, depression and/or anxiety, attention to pain, pain helplessness, stress, fatigue, and physical activity. Two analyses investigated pathways from pain intensity to a sleep variable, examining the potentially mediating role of depressive symptoms and mood. Although evidence supported a mediating role for psychological and physiological aspects of emotional experiences and attentional processes, methodological limitations were common, including use of cross-sectional data and minimal adjustment for potential confounders. Discussion: A growing body of research is applying mediation analysis to elucidate mechanistic pathways between sleep and pain intensity. Currently sparse evidence would be illuminated by more intensively collected longitudinal data and improvements in analysis.
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Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Aberdeen Centre for Arthritis and Musculoskeletal Health.,Department of Physical Medicine and Rehabilitation, Kratz Lab.,Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Nourah AlKandari
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
| | - Kaja Kristensen
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Max Barnish
- Evidence Synthesis and Modelling for Health Improvement (ESMI), Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter
| | | | - Katie L Druce
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Richter D, Krämer MD, Tang NKY, Montgomery-Downs HE, Lemola S. Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers. Sleep 2020; 42:5289255. [PMID: 30649536 DOI: 10.1093/sleep/zsz015] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/06/2018] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES To examine the changes in mothers' and fathers' sleep satisfaction and sleep duration across prepregnancy, pregnancy, and the postpartum period of up to 6 years after birth; it also sought to determine potential protective and risk factors for sleep during that time. METHODS Participants in a large population-representative panel study from Germany reported sleep satisfaction and sleep duration in yearly interviews. During the observation period (2008-2015), 2541 women and 2118 men reported the birth of their first, second, or third child and provided longitudinal data for analysis. Fixed-effects regression models were used to analyze changes in sleep associated with childbirth. RESULTS Sleep satisfaction and duration sharply declined with childbirth and reached a nadir during the first 3 months postpartum, with women more strongly affected (sleep satisfaction reduction compared with prepregnancy: women, 1.81 points on a 0 to 10 scale, d = 0.79 vs. men, 0.37 points, d = 0.16; sleep duration reduction compared with prepregnancy: women, 62 min, d = 0.90 vs. men, 13 min, d = 0.19). In both women and men, sleep satisfaction and duration did not fully recover for up to 6 years after the birth of their first child. Breastfeeding was associated with a slight decrease in maternal sleep satisfaction (0.72 points, d = 0.32) and duration (14 min, d = 0.21). Parental age, household income, and dual vs. single parenting were unrelated, or only very weakly related, to improved sleep. CONCLUSIONS Following the sharp decline in sleep satisfaction and duration in the first months postpartum, neither mothers' nor fathers' sleep fully recovers to prepregnancy levels up to 6 years after the birth of their first child.
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Affiliation(s)
- David Richter
- German Institute for Economic Research (DIW Berlin, Deutsches Institut für Wirtschaftsforschung e.V.), Berlin, Germany
| | - Michael D Krämer
- German Institute for Economic Research (DIW Berlin, Deutsches Institut für Wirtschaftsforschung e.V.), Berlin, Germany
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | | | - Sakari Lemola
- Department of Psychology, University of Warwick, Coventry, United Kingdom
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28
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Tang NKY, Moore C, Parsons H, Sandhu HK, Patel S, Ellard DR, Nichols VP, Madan J, Collard VEJ, Sharma U, Underwood M. Implementing a hybrid cognitive-behavioural therapy for pain-related insomnia in primary care: lessons learnt from a mixed-methods feasibility study. BMJ Open 2020; 10:e034764. [PMID: 32193269 PMCID: PMC7150590 DOI: 10.1136/bmjopen-2019-034764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To test the feasibility of implementing a brief but intensive hybrid cognitive behavioural therapy (Hybrid CBT) for pain-related insomnia. DESIGN Mixed-methods, with qualitative process evaluation on a two-arm randomised controlled feasibility trial. SETTING Primary care. PARTICIPANTS Twenty-five adult patients with chronic pain and insomnia. INTERVENTION Hybrid CBT or self-help control intervention. PRIMARY AND SECONDARY OUTCOME MEASURES Primary 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. RESULTS Fourteen 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. CONCLUSION Important 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 NUMBER ISRCTN17294365.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, West Midlands, UK
| | - Corran Moore
- Department of Psychology, University of Leicester, Leicester, Leicestershire, UK
| | - Helen Parsons
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Harbinder Kaur Sandhu
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Shilpa Patel
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - David R Ellard
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Vivien P Nichols
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | - Jason Madan
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
| | | | - Uma Sharma
- Patient Representative, Coventry, West Mindlands, UK
| | - Martin Underwood
- Clinical Trials Unit, University of Warwick, Warwick Medical School, Coventry, West Midlands, UK
- University Hospitals of Coventry and Warwickshire, Coventry, West Midlands, UK
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29
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Sandhu HK, Abraham C, Alleyne S, Balasubramanian S, Betteley L, Booth K, Carnes D, Furlan AD, Haywood K, Iglesias Urrutia CP, Lall R, Manca A, Mistry D, Nichols VP, Noyes J, Rahman A, Seers K, Shaw J, Tang NKY, Taylor S, Tysall C, Underwood M, Withers EJ, Eldabe S. Testing a support programme for opioid reduction for people with chronic non-malignant pain: the I-WOTCH randomised controlled trial protocol. BMJ Open 2019; 9:e028937. [PMID: 31399456 PMCID: PMC6701652 DOI: 10.1136/bmjopen-2019-028937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic non-malignant pain has a major impact on the well-being, mood and productivity of those affected. Opioids are increasingly prescribed to manage this type of pain, but with a risk of other disabling symptoms, when their effectiveness has been questioned. This trial is designed to implement and evaluate a patient-centred intervention targeting withdrawal of strong opioids in people with chronic pain. METHODS AND ANALYSIS A pragmatic, multicentre, randomised controlled trial will assess the clinical and cost-effectiveness of a group-based multicomponent intervention combined with individualised clinical facilitator led support for the management of chronic non-malignant pain against the control intervention (self-help booklet and relaxation compact disc). An embedded process evaluation will examine fidelity of delivery and investigate experiences of the intervention. The two primary outcomes are activities of daily living (measured by Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (8A)) and opioid use. The secondary outcomes are pain severity, quality of life, sleep quality, self-efficacy, adverse events and National Health Service (NHS) healthcare resource use. Participants are followed up at 4, 8 and 12 months, with a primary endpoint of 12 months. Between-group differences will indicate effectiveness; we are looking for a difference of 3.5 points on our pain interference outcome (scale 40 to 77). We will undertake an NHS perspective cost-effectiveness analysis using quality adjusted life years. ETHICS AND DISSEMINATION Full approval was given by Yorkshire & The Humber - South Yorkshire Research Ethics Committee on 13 September, 2016 (16/YH/0325). Appropriate local approvals were sought for each area in which recruitment was undertaken. The current protocol version is 1.6 date 19 December 2018. Publication of results in peer- reviewed journals will inform the scientific and clinical community. We will disseminate results to patient participants and study facilitators in a study newsletter as well as a lay summary of results on the study website. TRIAL REGISTRATION NUMBER ISRCTN49470934; Pre-results.
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Affiliation(s)
- Harbinder K Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Charles Abraham
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sharisse Alleyne
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shyam Balasubramanian
- Department of Anaesthesia and Pain Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Lauren Betteley
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea D Furlan
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Kirstie Haywood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Vivien P Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jennifer Noyes
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, University College London, London, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jane Shaw
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Colin Tysall
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
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30
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Tang NKY. Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:281-289. [PMID: 28284902 DOI: 10.1016/j.pnpbp.2017.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is a form of evidence-based talking therapy that emphasises the importance of behaviour and conscious thoughts in shaping our emotional experiences. As pain becomes increasingly accepted as not only a sensory but also an emotional experience, success in using CBT to treat emotional disorders has resulted in the incorporation of cognitive-behavioural principles into the management of chronic pain. Outcomes of CBT-informed interdisciplinary pain management programmes are modest at best, despite rapid methodological improvements in trial design and implementation. Whilst the field searches for new treatment directions, a hybrid CBT approach that seeks to simultaneously tackle pain and its comorbidities shows promise in optimising treatment effectiveness and flexibility. This article provides a brief description of the core characteristics of CBT and the transformation this therapeutic model has brought to our understanding and management of chronic pain. Current evidence on efficacy of CBT for chronic pain is then reviewed, followed by a critical consideration of the advantages and disadvantages of the new hybrid treatment approach that conceptualises and treats chronic pain in connection with its comorbidities. Recent progress made in the area of pain and insomnia is highlighted as an example to project therapeutic innovations in the near future.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
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31
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Afolalu EF, Ramlee F, Tang NKY. Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Sleep Med Rev 2018; 39:82-97. [PMID: 29056414 PMCID: PMC5894811 DOI: 10.1016/j.smrv.2017.08.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/04/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
Abstract
Emerging longitudinal research has highlighted poor sleep as a risk factor of a range of adverse health outcomes, including disabling pain conditions. In establishing the causal role of sleep in pain, it remains to be clarified whether sleep deterioration over time is a driver of pain and whether sleep improvement can mitigate pain-related outcomes. A systematic literature search was performed using PubMed MEDLINE, Ovid EMBASE, and Proquest PsycINFO, to identify 16 longitudinal studies involving 61,000 participants. The studies evaluated the effect of sleep changes (simulating sleep deterioration, sleep stability, and sleep improvement) on subsequent pain-related outcomes in the general population. A decline in sleep quality and sleep quantity was associated with a two- to three-fold increase in risk of developing a pain condition, small elevations in levels of inflammatory markers, and a decline in self-reported physical health status. An exploratory meta-analysis further revealed that deterioration in sleep was associated with worse self-reported physical functioning (medium effect size), whilst improvement in sleep was associated with better physical functioning (small effect size). The review consolidates evidence that changes in sleep are prospectively associated with pain-related outcomes and highlights the need for further longitudinal investigations on the long-term impact of sleep improvements.
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Affiliation(s)
- Esther F Afolalu
- Department of Psychology, University of Warwick, United Kingdom.
| | - Fatanah Ramlee
- Department of Psychology, University of Warwick, United Kingdom; Department of Psychology and Counselling, Sultan Idris Education University, Malaysia
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, United Kingdom.
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32
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Abstract
People with chronic pain often report sleep of "poor quality." However, it is unclear what defines sleep quality and whether their sleep quality judgment is influenced by factors other than sleep. We purposively interviewed 17 participants with and without chronic pain and thematically analyzed their interview transcripts. Four salient criteria for judging sleep quality were (a) memories of night-time sleep disruptions, (b) feelings on waking and cognitive functioning during the day, (c) ability to engage in daytime physical and social activity, and (d) changes in physical symptoms (and pain intensity among participants with chronic pain). Sleep quality judgment is complex and involves retrospective decision making influenced by not only memories of the night but also how we feel and what we do during the day.
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Affiliation(s)
- Fatanah Ramlee
- a Department of Psychology , University of Warwick , Coventry , England
| | - Esther F Afolalu
- a Department of Psychology , University of Warwick , Coventry , England
| | - Nicole K Y Tang
- a Department of Psychology , University of Warwick , Coventry , England
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33
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Abstract
Study objectives: We conceptualized sleep quality judgment as a decision-making process and examined the relative importance of 17 parameters of sleep quality using a choice-based conjoint analysis. Methods: One hundred participants (50 good sleepers; 50 poor sleepers) were asked to choose between 2 written scenarios to answer 1 of 2 questions: “Which describes a better (or worse) night of sleep?”. Each scenario described a self-reported experience of sleep, stringing together 17 possible determinants of sleep quality that occur at different times of the day (day before, pre-sleep, during sleep, upon waking, day after). Each participant answered 48 questions. Logistic regression models were fit to their choice data. Results: Eleven of the 17 sleep quality parameters had a significant impact on the participants’ choices. The top 3 determinants of sleep quality were: Total sleep time, feeling refreshed (upon waking), and mood (day after). Sleep quality judgments were most influenced by factors that occur during sleep, followed by feelings and activities upon waking and the day after. There was a significant interaction between wake after sleep onset and feeling refreshed (upon waking) and between feeling refreshed (upon waking) and question type (better or worse night of sleep). Type of sleeper (good vs poor sleepers) did not significantly influence the judgments. Conclusions: Sleep quality judgments appear to be determined by not only what happened during sleep, but also what happened after the sleep period. Interventions that improve mood and functioning during the day may inadvertently also improve people’s self-reported evaluation of sleep quality.
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Affiliation(s)
- Fatanah Ramlee
- Department of Psychology, University of Warwick, Coventry, UK.,Department of Psychology and Counselling, Sultan Idris Education University, Perak, Malaysia
| | - Adam N Sanborn
- Department of Psychology, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
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34
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Tang NKY, Fiecas M, Afolalu EF, Wolke D. Changes in Sleep Duration, Quality, and Medication Use Are Prospectively Associated With Health and Well-being: Analysis of the UK Household Longitudinal Study. Sleep 2017; 40:2845958. [PMID: 28364423 DOI: 10.1093/sleep/zsw079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Introduction Sleep is a plausible target for public health promotion. We examined the association of changes in sleep with subsequent health and well-being in the general population. Aims and Methods We analyzed data from the UK Household Longitudinal Survey, involving 30594 people (aged > 16) who provided data on sleep and health and well-being at both Wave 1 (2009-2011) and Wave 4 (2012-2014) assessments. Predicting variables were changes in sleep quantity, sleep quality, and sleep medication use over the 4-year period. Outcome variables were the General Health Questionnaire (GHQ-12) and the 12-Item Short-Form Health Survey (SF-12) mental (MCS) and physical (PCS) component scores at Wave 4. Linear regression on each outcome was fully adjusted for potential confounders and baseline values of the relevant predicting and outcome variables. Results Better outcomes were associated with an increase in sleep duration (GHQ: β = 1.031 [95% confidence interval {CI}: -1.328, -0.734]; MCS: 1.531 [1.006, 2.055]; PCS: -0.071 [-0.419, 0.56]), sleep quality (GHQ: β = -2.031 [95% CI: -2.218, -1.844]; MCS: 3.027 [2.692, 3.361]; PCS: 0.924 [0.604, 1.245]), and a reduction in sleep medication use (GHQ: β = -1.929 [95% CI: -2.400, -1.459]; MCS: 3.106 [2.279, 3.933]; PCS: 2.633 [1.860, 3.406]). Poorer outcomes were on the other hand associated with a reduction in sleep duration, a decrease in sleep quality, and an increase in sleep medication use. Changes in sleep quality yielded the largest effects on the health and well-being outcomes. Conclusions Changes in sleep were temporally associated with subsequent health and well-being. Initiatives that aim to protect a critical amount of sleep, promote sleep quality, and reduce sleep medication use may have public health values.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Mark Fiecas
- Department of Statistics, University of Warwick, Coventry, UK
| | | | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
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Blågestad T, Pallesen S, Grønli J, Tang NKY, Nordhus IH. How Perceived Pain Influence Sleep and Mood More Than The Reverse: A Novel, Exploratory Study with Patients Awaiting Total Hip Arthroplasty. Front Psychol 2016; 7:1689. [PMID: 27840617 PMCID: PMC5083715 DOI: 10.3389/fpsyg.2016.01689] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/13/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: Attributions about how comorbid symptoms worsen or improve each other are central cognitive components of chronic pain that are shown to facilitate or impede the recovery process. Still, these attributions have been poorly illuminated in chronic pain patients. The present study explored perceptions of how sleep, pain, and mood influence each other in patients awaiting total hip arthroplasty (THA). Design and Methods: In this cross-sectional study, 291 patients (mean age 67.8, 65.3% female) rated 12 statements about how much a given symptom (pain, sleep, mood) changed when another symptom (pain, sleep, mood) worsened or improved on a response scale ranging from much worse (-2) via no change (0) to much better (2). Sleep (Bergen Insomnia Scale), pain (McGill Pain Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale) were assessed as background variables. Results: Of the patients in the study, 56% reported symptoms indicating insomnia. Anxiety and depression were indicated in 16 and 10%, respectively. Over 80% rated their pain as horrible/unbearable and reported that pain occurred always/daily. When experiencing increased pain, a majority perceived that sleep (90%) and mood (70%) worsened, whilst experiencing reduced pain improved sleep and mood in 50%. Poor sleep increased pain and worsened mood in 45 and 60% of the patients, respectively. Better sleep was perceived to reduce pain and improve mood in 50%. Worsened mood increased pain (46%) and worsened sleep (52%). Improved mood decreased pain and improved sleep in 25 and 35%, respectively. Discussion: In this study, a novel approach was used to investigate perceptions of reciprocal relationships between symptoms. We found that THA patients perceived interrelationships between pain, sleep and mood. These perceived interrelations were stronger when symptoms worsened than when symptoms improved. They also held stronger beliefs about the effect of pain on sleep and mood, than the effect of sleep and mood on pain. Attributions are central in illness perception and ultimately affect illness behavior. For patients who perceive symptoms to interrelate, the door has already been opened to utilize these attributions in treatments aiming to disrupt vicious cycles, hence supporting the use of multimodal treatments.
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Affiliation(s)
- Tone Blågestad
- Department of Clinical Psychology, University of Bergen Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of BergenBergen, Norway; The Norwegian Competence Center for Sleep Disorders, Haukeland University HospitalBergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick Coventry, UK
| | - Inger H Nordhus
- Department of Clinical Psychology, University of BergenBergen, Norway; Department of Behavioural Sciences in Medicine, University of OsloOslo, Norway
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Afolalu EF, Moore C, Ramlee F, Goodchild CE, Tang NKY. Development of the Pain-Related Beliefs and Attitudes about Sleep (PBAS) Scale for the Assessment and Treatment of Insomnia Comorbid with Chronic Pain. J Clin Sleep Med 2016; 12:1269-77. [PMID: 27448428 DOI: 10.5664/jcsm.6130] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/16/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Dysfunctional beliefs and attitudes about sleep is a cognitive-behavioral factor central to the development and perpetuation of insomnia. Previous works to unravel the complex interrelationship between pain and insomnia have not explored the role of inflexible beliefs about the sleep-pain interaction, possibly due to a lack of a valid instrument for doing so. The current study evaluated the psychometric and functional properties of a 10-item Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale. METHODS The PBAS scale was administered to four clinical samples of chronic pain patients with comorbid insomnia: to examine the scale's psychometric properties (n = 137), test-retest reliability (n = 26), sensitivity to treatment (n = 20), and generalizability (n = 62). All participants completed the PBAS together with validated measures of pain interference, insomnia severity, and cognitive-behavioral processes hypothesized to underpin insomnia. RESULTS The PBAS scale was found to be reliable, with adequate internal consistency and temporal stability. Factor analysis suggested a 2-factor solution representing beliefs about "pain as the primary cause of insomnia" and the "inevitable consequences of insomnia on pain and coping." The PBAS total score was positively correlated with scores from the Insomnia Severity Index (ISI) scale, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale, and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ). It was a significant predictor of insomnia severity and pain interference. A significant reduction in PBAS was also observed in patients after receiving a hybrid cognitive-behavioral intervention for both pain and insomnia. CONCLUSIONS 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.
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Affiliation(s)
| | - Corran Moore
- Department of Psychology, University of Warwick, Coventry, UK
| | - Fatanah Ramlee
- Department of Psychology, University of Warwick, Coventry, UK
| | | | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
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Sandhu H, Bernstein CJ, Davies G, Tang NKY, Belhag M, Tingle A, Field M, Foss J, Lindahl A, Underwood M, Ellard DR. Combined cognitive-behavioural and mindfulness programme for people living with dystonia: a proof-of-concept study. BMJ Open 2016; 6:e011495. [PMID: 27496234 PMCID: PMC4985914 DOI: 10.1136/bmjopen-2016-011495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To design and test the delivery of an intervention targeting the non-motor symptoms of dystonia and pilot key health and well-being questionnaires in this population. DESIGN A proof-of-concept study to test the delivery, acceptability, relevance, structure and content for a 3-day group residential programme for the management of dystonia. SETTING Participants were recruited from a single botulinum toxin clinic. The intervention was delivered in the community. PARTICIPANTS 14 participants consented to take part (2 withdrew prior to the starting of intervention). The average age was 60 years (range 44-77), 8 of whom were female. After drop-out, 9 participants completed the 3-day programme. INTERVENTION A 3-day group residential programme. PRIMARY AND SECONDARY OUTCOME MEASURES Process evaluation and interviews were carried out before and after the intervention to explore participant's views and expectations, as well as experiences of the intervention. Select questionnaires were completed at baseline, 1-month and 3-month follow-up. RESULTS Although participants were not sure what to expect from the programme, they found it informative and for many this together with being in a group with other people with dystonia legitimised their condition. Mindfulness was accepted and adopted as a coping strategy. This was reflected in the 1-month follow-up. CONCLUSIONS We successfully delivered a 3-day residential programme to help those living with dystonia manage their condition. Further improvements are suggested. The quantitative outcome measures were acceptable to this group of patients with dystonia.
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Affiliation(s)
- H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - C J Bernstein
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - G Davies
- University of Southampton, Southampton, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - M Belhag
- Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Tingle
- The Dystonia Society (West Midlands Group), West Midlands, UK
| | - M Field
- The Dystonia Society (West Midlands Group), West Midlands, UK
| | - J Foss
- Department of Computer Science, University of Warwick, Coventry, UK
| | - A Lindahl
- Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Bernstein CJ, Ellard DR, Davies G, Hertenstein E, Tang NKY, Underwood M, Sandhu H. Behavioural interventions for people living with adult-onset primary dystonia: a systematic review. BMC Neurol 2016; 16:40. [PMID: 27000094 PMCID: PMC4802601 DOI: 10.1186/s12883-016-0562-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Primary dystonia is a chronic neurological movement disorder that causes abnormal muscle movements. Pain and emotional distress may accompany these physical symptoms. Behavioural interventions are used to help people with long term conditions improve their quality of life. Little is known about behavioural interventions applied to Dystonia. We report a systematic review of studies reporting current evidence of behavioural interventions for people with primary dystonia. Methods We did systematic searches of Medline, PsycINFO, AHMED and CINAHL. We assessed the methodological quality of included studies using a risk of bias tool. Any disagreements were resolved by liaising with an independent rater. Physiological outcomes such as dystonia severity and psychological outcomes such as sleep and depression were selected on the basis that primary dystonia causes motor and non-motor symptoms. No time limit was placed on the searches. A narrative synthesis of the results is presented. Results Of 1798 titles and abstracts screened, 14 full articles were retrieved and inclusion and exclusion criteria applied. Of these a final nine were eligible for the review (N = 73). Only two were Randomised Controlled Trials (RCTs). Using the Movement Disorders Society (MDS) dystonia classification, that was published after this work started, all of the included studies were of idiopathic adult onset focal dystonia without associated features. These included: blepharospasm (eye dystonia) (N = 1), cervical dystonia (neck dystonia) (N = 2), writer’s cramp (hand dystonia) (N = 3) and the yips (N = 3). No studies reported on dystonia that affects two or more body regions. Studies reported good adherence and response rates to treatment. Physiological and psychological improvements were noted in all studies at weekly, monthly and yearly follow-ups. Caution should be taken when interpreting the results because of the scarcity of RCTs identified, use of small sample sizes, and inappropriate statistical methods. Conclusion We identified few studies; mainly of poor methodological quality that all studied a focal dystonia. It is not possible to draw firm conclusions. Nevertheless, the data suggests that a combined behavioural therapy approach including relaxation practice for people with idiopathic adult onset focal dystonia merits further investigation.
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Affiliation(s)
- C J Bernstein
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - D R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| | - G Davies
- University of Southampton, Southampton, UK
| | - E Hertenstein
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | - N K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - M Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - H Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Tang NKY, Lereya ST, Boulton H, Miller MA, Wolke D, Cappuccio FP. Nonpharmacological Treatments of Insomnia for Long-Term Painful Conditions: A Systematic Review and Meta-analysis of Patient-Reported Outcomes in Randomized Controlled Trials. Sleep 2015; 38:1751-64. [PMID: 25902806 DOI: 10.5665/sleep.5158] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/14/2015] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is a debilitating comorbidity of chronic pain. This study evaluated the effect of nonpharmacological sleep treatments on patient-reported sleep quality, pain, and well-being in people with long-term cancer and non-cancer (e.g., back pain, arthritis, fibromyalgia) pain conditions. DESIGN We systematically searched Cochrane CENTRAL, MEDLINE, Embase, and PsychINFO for relevant studies. Search period was set to inception of these databases to March 2014. Studies were included if they were: original randomized controlled trials (RCTs); testing a nonpharmacological intervention; that targets sleep; in adults; with painful health conditions; that has a control group; includes a measure of sleep quality; and at least one other health and well-being outcome. MEASUREMENT AND FINDINGS Means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, physical and psychological functioning were extracted for the sleep treatment and control groups at baseline, posttreatment and final follow-up. Methodological details concerning the treatment, participants, and study design were abstracted to guide heterogeneity and subgroup analyses. Eleven RCTs involving 1,066 participants (mean age 45-61 years) met the criteria for the meta-analysis. There was no systematic evidence of publication bias. Nonpharmacological sleep treatments in chronic pain patients were associated with a large improvement in sleep quality (standardized mean difference = 0.78, 95% Confidence Interval [0.42, 1.13]; P < 0.001), small reduction in pain (0.18 [0, 0.36] P < 0.05), and moderate improvement in fatigue (0.38 [0.08, 0.69]; P < 0.01) at posttreatment. The effects on sleep quality and fatigue were maintained at follow-up (up to 1 year) when a moderate reduction in depression (0.31, [0.09, 0.53]; P < 0.01) was also observed. Both cancer and non-cancer pain patients benefited from nonpharmacological sleep treatments. Face-to-face treatments achieved better outcomes than those delivered over the phone/internet. CONCLUSIONS Although the body of evidence was small, nonpharmacological sleep interventions may represent a fruitful avenue for optimizing treatment outcomes in patients with chronic pain. REGISTRATION PROSPERO registration: CRD42013004131.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - S Tanya Lereya
- Department of Psychology, University of Warwick, Coventry, UK
| | - Hayley Boulton
- Department of Psychology, University of Warwick, Coventry, UK
| | | | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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Hertenstein E, Tang NKY, Bernstein CJ, Nissen C, Underwood MR, Sandhu HK. Sleep in patients with primary dystonia: A systematic review on the state of research and perspectives. Sleep Med Rev 2015; 26:95-107. [PMID: 26164369 DOI: 10.1016/j.smrv.2015.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 12/01/2022]
Abstract
Patients with primary dystonia, the third most prevalent movement disorder, suffer from a markedly reduced quality of life. This might, at least in part, be mediated by non-motor symptoms, including sleep disturbances. Characterising and treating sleep disturbances might provide new inroads to improve relevant patient-centred outcomes. This review evaluates the state of research on sleep in patients with dystonia and outlines an agenda for future research. A literature search was performed in July 2014 using PubMed, Medline via Ovid, PsycInfo, PsycArticles via Proquest and Embase via Ovid. Search results were screened for eligibility by two independent raters. Peer-reviewed publications reporting on sleep in patients with primary dystonia were included. Of 1445 studies identified through the search strategy, 18 met the inclusion criteria. In total, the included studies reported on 708 patients diagnosed with focal dystonia (cervical dystonia or blepharospasm), torsion dystonia, and dopa-responsive dystonia. The results indicate that at least half of the patients with focal cranial dystonia suffer from sleep disturbances, but excessive daytime sleepiness is uncommon. Sleep disturbance is associated with depressive symptoms. The frequency and duration of dystonic movements is markedly reduced during sleep. Reduced sleep quality appears to persist after treatment with botulinum toxin that successfully reduces motor symptoms. The findings are limited by a high clinical and methodological heterogeneity. Future research is needed to i) further characterize subjective and PSG sleep in patients with different types of dystonia, ii) determine the aetiology of sleep disturbances (e.g., abnormal brain function associated with dystonia, side effects of medication, psychological reasons), and iii) test whether targeted sleep interventions improve sleep and quality of life in patients with primary dystonia.
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Affiliation(s)
- Elisabeth Hertenstein
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany.
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Celia J Bernstein
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany
| | - Martin R Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Harbinder K Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Tang NKY, McBeth J, Jordan KP, Blagojevic-Bucknall M, Croft P, Wilkie R. Impact of musculoskeletal pain on insomnia onset: a prospective cohort study. Rheumatology (Oxford) 2014; 54:248-56. [PMID: 25125589 PMCID: PMC4301708 DOI: 10.1093/rheumatology/keu283] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective. Pain, the most common manifestation of rheumatological conditions, is highly prevalent among older adults, with worse health outcomes found in those with co-morbid insomnia. Proactive prevention of insomnia may reduce the overall disease burden of pain and rheumatological conditions. To inform such development, this study examined the role of pain, physical limitation and reduced social participation in predicting and mediating insomnia onset. Methods. A prospective cohort study was conducted involving 6676 individuals ≥50 years of age who completed questionnaires at baseline and a 3-year follow-up. Participants were classified into none, some and widespread pain according to the ACR criteria. Logistic regression was used to examine the relationship between baseline pain and insomnia onset at 3 years. Path analysis was used to test for the mediating role of physical limitation and social participation restriction. Results. Some [adjusted odds ratio (AOR) 1.57 (95% CI 1.15, 2.13)] and widespread [2.13 (1.66, 3.20)] pain increased the risk of insomnia onset at 3 years, after adjusting for age, gender, socio-economic class, education, anxiety, depression, sleep and co-morbidity at baseline. The combination of physical limitation and reduced social participation explained up to 68% of the effect of some pain on insomnia onset and 66% of the effect of widespread pain on insomnia onset. Conclusion. There was a dose–response association between the extent of pain at baseline and insomnia onset at 3 years that was substantially mediated by physical limitation and reduced social participation. Targeting physical limitation and social participation in older people with pain may buffer co-morbid insomnia, reducing the overall disease burden.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK. Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
| | - John McBeth
- Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
| | - Kelvin P Jordan
- Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
| | - Milisa Blagojevic-Bucknall
- Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
| | - Peter Croft
- Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
| | - Ross Wilkie
- Department of Psychology, University of Warwick, Coventry and Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK
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Abstract
Insomnia can be lethal, increasing the risk of suicide and accidental death by overdose. In this review we present a synthesis of the literature investigating the insomnia-suicide link and the psychological mechanisms underpinning the association. Specifically, we review the findings of prospective epidemiological studies demonstrating the insomnia-suicide link in adult and adolescent community populations. Robust associations between insomnia and suicide are observed in clinically depressed and anxious populations, and there are indications across a number of cross-sectional and longitudinal studies that these linkages are attributable to a disrupted sleep pattern, dysfunctional beliefs about sleep and nightmares, independent of depression and anxiety symptoms. Borderline personality disorder (BPD) and chronic pain (CP) are highlighted as high-risk subgroups given the elevated rates of insomnia and suicidality in both conditions. Aside from the influence of comorbid depression and anxiety symptoms, emerging evidence has identified impulsivity and emotional dysregulation as possible mechanisms driving the insomnia-suicide link in BPD, and catastrophizing and the sense of defeat/entrapment as potential cognitive pathways through which insomnia aggravates suicidality in CP. Screening for, and interventions that tackle, insomnia and these associated psychological mechanisms, offer a novel avenue for reducing suicidality across a range of clinical and non-clinical populations.
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Affiliation(s)
- Catherine Winsper
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick , Coventry , UK
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Tang NKY, Sanborn AN. Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship. PLoS One 2014; 9:e92158. [PMID: 24667276 PMCID: PMC3965418 DOI: 10.1371/journal.pone.0092158] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 02/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Promoting physical activity is key to the management of chronic pain, but little is understood about the factors facilitating an individual's engagement in physical activity on a day-to-day basis. This study examined the within-person effect of sleep on next day physical activity in patients with chronic pain and insomnia. METHODS 119 chronic pain patients monitored their sleep and physical activity for a week in their usual sleeping and living environment. Physical activity was measured using actigraphy to provide a mean activity score each hour. Sleep was estimated with actigraphy and an electronic diary, providing an objective and subjective index of sleep efficiency (A-SE, SE) and a sleep quality rating (SQ). The individual and relative roles of these sleep parameters, as well as morning ratings of pain and mood, in predicting subsequent physical activity were examined in multilevel models that took into account variations in relationships at the 'Day' and 'Participant' levels. RESULTS Of the 5 plausible predictors SQ was the only significant within-person predictor of subsequent physical activity, such that nights of higher sleep quality were followed by days of more physical activity, from noon to 11 pm. The temporal association was not explained by potential confounders such as morning pain, mood or effects of the circadian rhythm. CONCLUSIONS In the absence of interventions, chronic pain patients spontaneously engaged in more physical activity following a better night of sleep. Improving nighttime sleep may well be a novel avenue for promoting daytime physical activity in patients with chronic pain.
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Affiliation(s)
- Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Adam N. Sanborn
- Department of Psychology, University of Warwick, Coventry, United Kingdom
- * E-mail:
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Tang NKY, Goodchild CE, Salkovskis PM. Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: a pilot randomised controlled trial. Behav Res Ther 2012; 50:814-21. [PMID: 23123531 DOI: 10.1016/j.brat.2012.08.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 08/03/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Insomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference. METHODS Chronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose. RESULTS Compared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability. CONCLUSION The hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.
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Affiliation(s)
- Nicole K Y Tang
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK.
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Tang NKY, Goodchild CE, Hester J, Salkovskis PM. Pain-related insomnia versus primary insomnia: a comparison study of sleep pattern, psychological characteristics, and cognitive-behavioral processes. Clin J Pain 2012; 28:428-36. [PMID: 22179550 DOI: 10.1097/ajp.0b013e31823711bc] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent applications of cognitive-behavior therapy for primary insomnia in the management of pain-related insomnia are based on the implicit assumption that the 2 types of insomnia share the same presentation and maintaining mechanisms. The objectives of this study were to compare the characteristics of patients who have pain-related insomnia with those reporting primary insomnia and to identify psychological factors that predict pain-related insomnia. METHODS Chronic pain patients with concomitant insomnia (n=137; Pain-related Insomnia Group) completed a selection of questionnaires that measure sleep patterns, psychological attributes, and cognitive-behavioral processes associated with the persistence of insomnia. Their responses were compared with those of primary insomnia patients (n=33; Primary Insomnia Group), using 3 sets of multivariate analyses of covariance that took account of demographic differences. Hierarchical regression analyses were performed to identify predictors of insomnia severity among the chronic pain patients. RESULTS The Pain-related Insomnia Group did not differ from the Primary Insomnia Group in their pattern and severity of sleep disturbance. The 2 groups were largely comparable in terms of their psychological characteristics, except that the Primary Insomnia Group was distinguishable from the Pain-related Insomnia Group by their greater tendency to worry. Patients in the Pain-related Insomnia Group reported levels of sleep-related anxiety and presleep somatic arousal that matched with those reported by patients in the Primary Insomnia Group. However, relative to patients in the Pain-related Insomnia Group, those in the Primary Insomnia Group reported more dysfunctional sleep beliefs and presleep cognitive arousal. In addition to pain intensity, depression, and presleep cognitive arousal were significant predictors of insomnia severity within the Pain-related Insomnia Group. CONCLUSIONS There are more similarities than differences between the 2 types of insomnia. Besides pain, mood, and presleep, thought processes also seem to have a role in the manifestation of pain-related insomnia. It is suggested that hybrid treatments that seek to simultaneously address factors across these domains may represent more effective treatments than 1-dimensional interventions.
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Affiliation(s)
- Nicole K Y Tang
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
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Tang NKY, Goodchild CE, Sanborn AN, Howard J, Salkovskis PM. Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. Sleep 2012; 35:675-87A. [PMID: 22547894 PMCID: PMC3321427 DOI: 10.5665/sleep.1830] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. DESIGN A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. SETTING In the patients' natural living and sleeping environment. PATIENTS One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. MEASUREMENT An electronic diary was used to record patients' self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. RESULTS Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. CONCLUSIONS These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes.
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Affiliation(s)
- Nicole K Y Tang
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, United Kingdom.
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Abstract
Insomnia is prevalent, causing severe distress and impairment. This review focuses on illuminating the puzzling finding that many insomnia patients misperceive their sleep. They overestimate their sleep onset latency (SOL) and underestimate their total sleep time (TST), relative to objective measures. This tendency is ubiquitous (although not universal). Resolving this puzzle has clinical, theoretical, and public health importance. There are implications for assessment, definition, and treatment. Moreover, solving the puzzle creates an opportunity for real-world applications of theories from clinical, perceptual, and social psychology as well as neuroscience. Herein we evaluate 13 possible resolutions to the puzzle. Specifically, we consider the possible contribution, to misperception, of (1) features inherent to the context of sleep (e.g., darkness); (2) the definition of sleep onset, which may lack sensitivity for insomnia patients; (3) insomnia being an exaggerated sleep complaint; (4) psychological distress causing magnification; (5) a deficit in time estimation ability; (6) sleep being misperceived as wake; (7) worry and selective attention toward sleep-related threats; (8) a memory bias influenced by current symptoms and emotions, a confirmation bias/belief bias, or a recall bias linked to the intensity/recency of symptoms; (9) heightened physiological arousal; (10) elevated cortical arousal; (11) the presence of brief awakenings; (12) a fault in neuronal circuitry; and (13) there being 2 insomnia subtypes (one with and one without misperception). The best supported resolutions were misperception of sleep as wake, worry, and brief awakenings. A deficit in time estimation ability was not supported. We conclude by proposing several integrative solutions.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall, Berkeley, CA 94720-1650, USA.
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McCracken LM, Williams JL, Tang NKY. Psychological flexibility may reduce insomnia in persons with chronic pain: a preliminary retrospective study. Pain Med 2011; 12:904-12. [PMID: 21539701 DOI: 10.1111/j.1526-4637.2011.01115.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sleep disturbance is a common complaint in people with chronic pain, and is associated with a range of adverse outcomes including reports of greater pain and disability. Research into insomnia with chronic pain sufferers has not yet examined the role of psychological flexibility, a process from acceptance and commitment therapy. We examined this role. DESIGN Participants in this study were 159 adult patients attending an assessment at a specialist pain center. They were mostly women, 63%, and the mean age was 43.8 years. RESULTS In preliminary analyses 79% of participants met the criteria for significant insomnia based on their self-reported symptoms. As predicted, significant positive correlations were found between components of psychological flexibility, particularly acceptance of pain and values-based action, and all measures of sleep quality. In regression analyses, the components of psychological flexibility considered together accounted for between 11% and 19% of variance across a range of measures of sleep quality. CONCLUSION These results suggest the need to further develop treatment services for people with chronic pain and insomnia.
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Affiliation(s)
- Lance M McCracken
- Centre for Pain Services, Royal National Hospital for Rheumatic Diseases & Centre for Pain Research, University of Bath, Bath, UK.
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Tang NKY, Salkovskis PM, Hodges A, Soong E, Hanna MH, Hester J. Chronic pain syndrome associated with health anxiety: A qualitative thematic comparison between pain patients with high and low health anxiety. British Journal of Clinical Psychology 2010; 48:1-20. [DOI: 10.1348/014466508x336167] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Tang NKY, Goodchild CE, Hester J, Salkovskis PM. Mental defeat is linked to interference, distress and disability in chronic pain. Pain 2010; 149:547-554. [PMID: 20395047 DOI: 10.1016/j.pain.2010.03.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/11/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
Abstract
Mental defeat is a psychological construct that has recently been applied to characterize the experience of chronic pain. Elevated levels of mental defeat have been identified in patients with chronic pain, and while its presence distinguishes treatment seeking from non-treatment seeking individuals, the link between mental defeat and disability in chronic pain is yet to be established. The current study investigated the extent to which mental defeat is associated with pain-related interference, distress and disability. A total of 133 participants completed the Pain Self Perception Scale that assessed mental defeat in relation to pain. Moreover, the participants were asked to complete a set of questionnaires that measured pain interference, distress, disability and other demographic (age, body mass index), clinical (pain intensity) and psychological (catastrophizing, worry, rumination and health anxiety) predictors of disability. Mental defeat was found to be strongly correlated with pain interference, sleep disturbance, anxiety, depression, functional disability and psychosocial disability. These correlations remained significant even when pain intensity and demographic variables were partialled out. Relative to chronic pain patients with lower levels of mental defeat, those with higher levels of mental defeat reported greater degree of pain interference, distress and disability. In a series of regression analyses, mental defeat emerged as the strongest predictor of pain interference, depression and psychosocial disability, whereas catastrophizing was the best predictor of sleep interference, anxiety and functional disability. These findings suggest that mental defeat may be an important mediator of distress and disability in chronic pain. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, Institute of Psychiatry, King's College London, UK Pain Relief Research Unit, King's College Hospital, UK
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